URINARY INFECTION: causes, symptoms and treatment of urinary tract infection

L' infection of the urinary tract (infection of the urinary tract or IVU, urinary tract infection or UTI) is an infection involving the kidneys, ureters, bladder or urethra. L'urinary infection, commonly called cystitis, it is a very common pathology and often asymptomatic. The causes the main ones are related to the morphology of the urinary system, to coexisting pathologies and to hygienic habits, i symptoms typical are burning urinary (dysuria), temperature is frequent urination (pollakiuria). There prevention it is carried out with proper hygiene and with acidification of the urine. There therapy it is carried out with antibiotic drugs.

Urinary tract

The urinary system consists of all the organs involved in the production and elimination of urine from the body. These are the structures that urine passes through before being eliminated from our body:

Kidneys

THE kidneys they are a pair of small organs found on the sides of the spine at the waist level. They have numerous important functions for the body, including the removal of waste substances and excess water from the blood, and their subsequent elimination in the form of urine. These functions make them particularly important in regulating blood pressure.

The kidneys are also very sensitive to changes in blood sugar levels, blood pressure and electrolyte balance. They are delicate organs, and diseases such as diabetes and hypertension can often cause serious and irreparable damage.

Ureters

Urine is drained from each kidney into the bladder through the two ureters, narrow tubes about 25 centimeters long.

Bladder

There bladder it is a small organ located above the pubic bone and in front of the sacrum that collects and stores urine. When the urine reaches a certain level in the bladder, we begin to feel the sensation of having to empty the bladder and urinate. The muscle that lines the bladder can then be voluntarily contracted to expel urine. There inflamed bladder secondarily to a bacterial infection it takes the medical name of cystitis and is the main urinary infection.

Urethra

L' urethra it is a small tube that connects the bladder with the outside of the body. To allow the body to excrete urine, a muscle called the urinary sphincter, located at the intersection of the bladder and urethra, will need to relax at the same time the bladder contracts. In presence of inflamed urethra we will talk about urethritis.

Any part of the urinary system can potentially be affected by an infection. As a rule, the higher the part of the urinary tract affected by the infectious event, the more severe the infection will be.

The upper urinary tract it is made up of the kidneys and ureters. Upper urinary tract infection usually affects the kidneys (pyelonephritis), which can cause manifestations such as fever, chills, nausea, vomiting and other severe symptoms.

The lower urinary tract it consists of the bladder and the urethra. Infection in the lower urinary tract can affect the urethra (urethritis) or the bladder (cystitis).

There are also types of generalized urinary infections with the entire urinary tract involved (cystopyelitis).
Every year in Italy about 2-3 million people are affected by urinary tract infections.

The urinary tract infections they are much more common in adults than in children: however, about 1%-2% in children have urinary tract infections, which tend to be more severe than those in adults (especially in younger children).
Urinary tract infection is the most common urinary tract problem in children, second only tonocturnal enuresis (bedwetting), and is the second most common type of infection after respiratory infections.

Such infections are much more common in girls and women than in boys and men under the age of 50. The reason is not fully known, but anatomical differences between the genders could be partially responsible (e.g. a ' female urethra shorter than in men).
It is estimated that about 40% of women and 12% of men could contract a urinary tract infection in their lifetime.

Causes and risk factors for urinary infections

What are the causes and risk factors of a urinary tract infection?
Urine is a normally sterile liquid. when the bacteria reach the urine and start to proliferate, an infection develops. Bacterial infection usually originates from the urinary meatus (ie the opening of the urethra, the point where urine exits the body) and moves upwards in the various parts of the urinary tract.

The germ responsible for at least 90% of uncomplicated urinary infections it is a gram negative bacterium called Escherichia coli, better known as E. coli. These bacteria normally live in the intestine, colonizing as bacterial flora especially the lower part of the intestine (colon, rectum, sigmoid and perineum, the area of skin around the anus). Other bacteria typically involved in cystitis are staffilococchi (S. auerus or S. saprophyticus), the enterococci (Enterococcus fecalis, Enterococcus fecium), gram negative germs such as Klebsiella, Acinetobacter or Pseudomonas, intracellular germs such as Chlamydiae (Chlamydia trachomatis) or Mycoplasbma (Mycoplasma hominis).

The feedback from escherichia coli in the urine or in any case others bacteria in the urine is not always indicative of acute infection: in the absence of specific symptoms and / or white blood cells in the urine (bacteriuria), a picture of asymptomatic bacteriuria, which should not be treated except in specific cases such as in pregnant women.

In a non-negligible fraction of cases, urinary infection is secondary to fungi or mushrooms, whose most frequent organism is the Candida.

These bacteria can move from the perineum to the opening of the urethra: in fact, the two most common causes of urinary infections are non-optimal intimate hygiene and sexual intercourse. Usually, the act of emptying the bladder, urinating after sexual intercourse eliminates a good part of the bacteria present in the urethra.

Obviously, if present in high quantities, it is not enough to urinate frequently to prevent their spread.
Bacteria can travel from the urethra to the bladder, where they are able to multiply and cause a very common infection, cystitis.

L' infection it can spread further as bacteria proliferate and rise from the bladder to the kidneys through the ureters.
If they reach the kidney, they can cause a kidney infection (pyelonephritis), representing a pathology potentially very serious if not treated promptly.

Urinary infection

Urinary system with the main sites of urinary infection

What are the people most a risk for it development of urinary infection? The following people are at increased risk of urinary tract infection:

  • People with conditions that block the urinary tract by hindering the normal outflow of urine, such as malformations, prostate hypertrophy, or kidney stones
  • People with medical conditions that cause incomplete bladder emptying (e.g. patients with spinal cord injury)
  • Postmenopausal women: The decrease in circulating estrogen makes the urinary tract more vulnerable to bacterial growth.
  • People with a malfunctioning immune system: HIV infection with AIDS, people on cortisone therapy, immunosuppressive drugs or chemotherapy, diabetes.
  • Sexually active women: Sexual intercourse can help introduce more bacteria into the bladder. Urinating after intercourse appears to decrease the likelihood of developing a urinary infection.
  • Women using a diaphragm for birth control
  • Males with enlarged prostate: the presence of prostatic hypertrophy or prostatitis (inflammation of the prostate often bacterial origin) can lead to incomplete bladder emptying, thus increasing the risk of infection. These disorders are more common in older men.

The following special groups of people appear to be at increased risk of getting a urinary infection:

  • Babies: bacteria enter the urinary tract through the bloodstream from other parts of the body, making urinary infections frequent.
  • Children: the use of diapers leads to greater contact of urine with the urinary tract and surrounding skin, increasing the risk of bacterial overgrowth. Also, young children have a hard time washing their hands after draining. Poor hygiene is linked to a higher frequency of urinary tract infections.
  • Children of all ages: urinary tract infection in children can be (but not always) a sign of abnormality in the urinary tract, such as the presence of usually a partial obstruction of the urinary outflow. An example is the presence of bladder reflux, a condition in which urine flows back from the bladder upward into the ureters.
  • Patients porters of urinary catheter: Hospitalized or nursing home or nursing home residents can be catheterized for long periods and are therefore vulnerable to urinary tract infection. Catheterization is simply the placement of a thin latex or silicone tube through the urethra to drain urine from the bladder in people with urination difficulties.

Breastfeeding has instead been shown to reduce the risk of urinary tract infections in babies.

Is urinary infection contagious?

Urinary infection is not contagious. Certainly, however, having sex with a person with a urinary tract infection increases the risk of contracting a urinary tract infection in turn.

Urinary Infection Symptoms

What are the symptoms and signs of urinary tract infection?

Lower urinary tract infection: bladder infections or cystitis, infection or urethra or urethritis.

  • Burning in urinating
  • Dysuria: pain when urinating
  • Pollakiuria: increased frequency of urination. The presence of more frequent urination or the presence of nocturnal awakenings to urinate - nocturia - often emitting only a small amount of urine, are among a very common symptom of cystitis
  • Urgency voiding: the feeling of having to urinate urgently is often present in urinary infections
  • Cloudy, foul-smelling urine or with traces of blood
  • Abdominal pain lower quadrants: pain in the lower abdomen or pelvic pain
  • Temperature, often with chills
  • Malaise

Upper urinary tract infection: pyelonephritis or kidney infection.
Symptoms develop rapidly and may or may not include symptoms of a lower urinary tract infection, plus:

  • Temperature high
  • Thrill shaking
  • Nausea
  • He retched
  • Ache: pain in the back or hips, usually on the side of the affected kidney, the pain is localized at the waist

In infants, children, and older people, the classic symptoms of a urinary tract infection may not be present.

Here are other symptoms that may indicate a urinary tract infection:

  • Babies: fever or hypothermia (low body temperature), poor appetite, jaundice
  • Children: vomiting, diarrhea, fever, poor nutrition, failure to thrive
  • Children: irritability, poor nutrition, unexplained fever that does not resolve spontaneously, loss of bowel control with incontinence, change in the frequency and extent of urination.
  • Senior citizens: fever or hypothermia, poor appetite, confusional state with change in mental status
  • The pregnant women are at greater risk of urinary infection. Typically, pregnant women have no particular or different symptoms than common ones. If a woman is pregnant, it is advisable to analyze the urine during antenatal visits because an unrecognized infection can cause health complications of the fetus during pregnancy.

Although most people have symptoms with a urinary tract infection, some do have them: it is estimated that up to 16% of people with bacteria in their urine show no symptoms (asymptomatic bacteriuria).

Symptoms of urinary tract infection can resemble those of sexually transmitted diseases.

What to do and when to contact your doctor if you have a urinary infection

Any adult or child who develops any of the symptoms of a urinary infection should be evaluated by a physician within 24 hours of the onset of symptoms. Most doctors' surgeries are able to test urine using a rapid urine test (urinary stick) which, using a map with various gradations, allows you to measure in a rough but useful way the presence of various substances in the urine, including the number of white blood cells and bacteria.

Anyone with symptoms of a lower urinary tract infection should call a healthcare professional to arrange a medical examination, preferably on the same day that symptoms began.
Anyone who has symptoms of an upper urinary tract infection thus involving the kidneys should immediately contact a healthcare professional. Depending on the clinical situation, the doctor or nurse will decide whether an outpatient visit can be scheduled or whether urgent hospitalization is required.

Here is a series of signs is symptoms who must warn us about the presence of an upper urinary tract infection:

  • Vomiting and inability to retain swallowed fluids or medications
  • No improvement after taking antibiotics for two consecutive days
  • Pregnancy
  • Presence of diabetes or disorders affecting the immune system
  • Habitual intake of drugs that reduce immune defenses, such as cancer chemotherapy, cortisone, or other immunosuppressants
  • Infants, children, and older people with any of the signs and symptoms of urinary infection should see a healthcare professional or go to an emergency room for evaluation as soon as possible.

Symptoms such as fever, lethargy (a tendency to sleep all the time) and poor appetite may indicate a urinary tract infection in these at-risk groups.

Urinary Infection Diagnosis

Diagnosis of a urinary tract infection is based on the presence of symptoms, medical history, medications, habits and lifestyle. The evaluation is complemented by a physical examination and laboratory tests.

The doctor can simply perform a rapid urine test (stick test) in the clinic. It only takes a few minutes to get the results.

The main test for the diagnosis of urinary infection is urinalysis, which will document the presence of white blood cells and bacteria in the urine sediment. The doctor may also send a urine sample to the laboratory for crop analysis, the results of which will be available in a few days. This last analysis, called uroculture or urine culture, tells the doctor the type of bacteria responsible for the infection, and to which antibiotics these bacteria are resistant or sensitive.

Urine culture it is usually performed for particular types of people, such as the elderly, women with recurrent cystitis despite adequate antibiotic therapy or men, for whom urinary infection is less frequent than women. There is no need to do a culture at all as most cystitis are caused by the same type of bacteria.

The urine in the laboratory will be cultured: this means that a small amount of urine is placed in contact with a sterile nutrient in a plastic disc. The plate is left to sit for a few days and then examined to see what kind of bacteria, if any, have grown.

In a second step, these bacteria are treated with different antibiotics to see which one is most effective. This allows you to get the antibiogram, a list of antibiotics more or less effective on the bacterium responsible for the infection, which is of fundamental importance to guide the doctor in identifying the best treatment.

Blood tests are usually not needed unless a complicated infection, such as pyelonephritis or the development of kidney failure, is suspected.
To obtain a urine sample for culture, the patient will be asked to urinate into a small container without pouring the liquid or touching it with his hands. In this way, contamination of the urine with skin bacteria is avoided. .

It is also recommended to urinate a little in the toilet before collecting a sample. The idea is to avoid collecting the urine that comes out in the first few seconds of urination, as it is often contaminated.

In-depth exams

In the presence of recurrent urinary infections, it is advisable to carry out one urological visit. The urologist will be able to identify and correct, if present, factors favoring urinary infections.

Depending on the symptoms, sexually active women may need to have a gynecological examination, given that because genital or pelvic infections can have symptoms similar to those of a urinary tract infection.

Males may need examination andrological, depending on the symptoms, a urological examination aimed at analyzing the prostate. A' infection of the prostate (prostatitis) requires longer antibiotic treatment than a urinary tract infection.

The woman has no prostate, although it is often spoken of female prostate referring to skene's gland, an exocrine paraurethral gland located to the side of the female urinary meatus.

Rarely, imaging tests may be indicated to detect any problems in the urinary tract that may be promoting the development of urinary infections. This is usually only necessary in cases of repeated infections or special circumstances (infections caused by unusual bacteria, suspected anatomical abnormalities).

A'ultrasound of the lower abdomen or pelvic ultrasound can evaluate kidney and bladder morphological disorders, while a cystoscopy, which involves the insertion of a thin and flexible tube with a tiny camera through the urethra, into the bladder, it allows to detect anomalies inside the bladder that can contribute to the onset of infections.
There CT scan of the lower abdomen provides a very detailed three-dimensional picture of the urinary tract.

Treatment of urinary infections

How to cure a urinary infection?

Most urinary tract infections can be easily cured your doctor or your child's pediatrician. They are usually a good option for treatment as they are familiar with your medical history, medications you are taking, and other factors that could affect your treatment.

If frequent cases of cystitis or other types of urinary infections occur, or if complications are present, it may be useful to involve a urologist specialist, a doctor who specializes in the diagnosis and treatment of disorders related to the urinary system.

What are the simplest and most affordable remedies for relieving the symptoms of a urinary infection already at home?
There are some measures and other treatments available for urinary tract infections that can be safely started at home, such as:

  • Use a hot water bottle for pain relief.
  • Drink a lot of water.
  • Avoid coffee, alcohol, and spicy foods that irritate the bladder and urethra
  • Take cranberry juice which, having the power to acidify the urine, can help fight a urinary tract infection and prevent its recurrence.

In any case, since the symptoms of a urinary tract infection could be similar to those of other conditions, even serious ones, it is always recommended to consult a doctor if a urinary tract infection is suspected, while self-medication is not recommended or healthy. .

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What is the treatment for a urinary tract infection?

Treatment for urinary tract infections is in most cases an antibiotic. The type of antibiotic and the duration of treatment depend on each case. Examples of common antibiotics used in the treatment include amoxicillin (Zimox), amoxicillin / clavulanic acid (Augmentin), sulfamethoxazole / trimethoprim (Bactrim), ciprofloxacin (Ciproxine), nitrofurantoin (Neofuradantin), fosfomycin (Monuril) and many others. Your doctor will choose the appropriate drug for your condition by considering the extent of the symptoms, the resistance of the bacteria based on the geographical area in which you are located and also evaluating previous infections that you have suffered in the past.

Lower urinary tract infection: therapy of cystitis or urethritis

What is the duration of the treatment for a urinary infection? In a healthy person, a three-day course of antibiotic therapy is usually sufficient to eradicate the bacteria, although many doctors recommend a seven-day course for safety. For some types of drugs, such as fosfomycin, a single dose of antibiotic is enough for effective therapy.

In the adult males, if the prostate is also affected by infection (prostatitis), four weeks or more of antibiotic treatment may be required. In other cases, the use ofantibiotic in urinary tract infection in humans it has no differences in dosage or duration from that in women.

The women with potential or kidney involvement (nephritis or pyelonephritis), with urinary tract abnormalities or with diabetes mellitus usually need at least 5-7 days of antibiotics.
THE children with simple cystitis they are treated with 10 days of antibiotics.

To relieve burning during urination, in addition to antibiotics, it may be useful to associate pain relievers such as phenazopyridine (eg. Uricalm) or the association Flavoxate - Propiphenazone (e. Cistalgan).

Upper urinary tract infection: therapy of pyelonephritis

Young, healthy patients with symptoms of pyelonephritis can be treated as outpatients, possibly receiving an initial dose of intravenous or intramuscular antibiotics, in the emergency room, followed by 10-14 days of oral antibiotics. The course should still be monitored with your healthcare provider over a day or two to check for actual improvement.

In case there is a person very affected by the infection, dehydrated or unable to hydrate and eat due to nausea and / or vomiting, hospitalization with intravenous fluids and antibiotics is indicated until the picture does not allow to pass to an oral antibiotic.

A complicated acute infection may require several weeks of treatment.
A person may be hospitalized if they have symptoms of pyelonephritis and any of the following:

  • Important weakness
  • State of pregnancy
  • No improvement with outpatient antibiotic treatment
  • Presence of underlying conditions that compromise the immune system (diabetes, chronic bronchitis, heart disease) or taking immunosuppressive drugs
  • Inability to take anything by mouth due to nausea or vomiting
  • Previous kidney disease, especially pyelonephritis, within the past 30 days
  • Presence of a bladder catheter
  • Presence of kidney stones

How long does the treatment of a urinary infection last?

Symptoms of lower urinary tract infections usually resolve within 24 hours of starting treatment. Prescribed antibiotics must be taken for the entire duration even if the symptoms have completely disappeared.

Symptoms of an upper urinary tract infection (pyelonephritis) usually take longer to respond to treatment.

I twicked of complete recovery from urinary infection therefore they vary according to the type of infection, ranging from a few days in the case of a trivial cystitis, to over 30 days in the case of complicated pyelonephritis or prostatitis.

Prophylaxis of urinary infections

In some people, especially women, the presence of repeated urinary infections (recurrent or relapsing) represents the indication to take an antibiotic prophylaxis, which is carried out through the administration of antibiotic in small periodic doses. An example of prophylaxis is represented by fosfomycin taken as a single sachet dose every 7-10 days, or Bactrim every 3 days.

This allows you to "disinfect" the urinary tract and prevent the bacterial overgrowth from reaching an entity such as to lead to a real infection. The risk in these cases is to create multi-resistant bacteria, who have gradually selected and "trained" to resist antibiotics.

Can you have sex with a urinary tract infection?

Can you make love if you have cystitis or another acute urinary infection? There are generally no absolute contraindications tohaving sex with a current urinary tract infection. It is good to know, however, that in some cases the germ can be transmitted to one's partner, with greater frequency from man to woman and especially in the case of infection with atypical germs such as Chlamydia trachomatis and Mycoplasma hominis or in the case of the so-called "thrush" i.e. during a Candida infection (candidiasis urinary or genital).

Furthermore, the sexual act could cause congestion and irritation of the external urinary meatus, causing pain and burning.

Prevention of urinary infections

How can urinary infections be prevented? Here are some helpful tips for preventing urinary tract infections:

  • Maintain adequate perineal and genital hygiene, preferably using water and neutral soap
  • Hydrate adequately, at least 1.5-2 liters of fluids per day in the absence of contraindications (heart failure, kidney failure, etc.)
  • Urinating frequently
  • Regularize the intestine
  • Periodically acidify the urine through the use of cranberry derivatives or other acidifiers
  • Do not do more than 1-2 douches per week (women)
  • Urinating before and after intercourse
  • Avoid synthetic fiber underwear or wearing pants that are too tight (they could cause perspiration problems)
  • Avoid using mechanical contraceptives, such as diaphragm or spermicidal creams
  • Avoid if possible the use of oral contraceptives with a high hormonal dose, due to the pelvic congestion effect of the latter
  • Avoid using tampons if possible
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