Urinary tract infections affect millions of people each year.

In fact, the only infection that occurs more frequent than urinary tract infections are infections of the respiratory system.  In 1997, urinary tract infections (UTIs) accounted for about 8.3 million doctor visits in the United States.  

Currently 11 million people are estimated to get a UTI every year in the United States.  Women are especially prone to UTIs for reasons that are poorly understood, but thought to be due to a smaller urethra.  1 in 5 women develop a UTI during her lifetime.  UTIs in men are not so common, but they can become quite serious when they occur.

The urinary system consists of the kidneys, ureters, bladder, and urethra.  The key elements in the system are the kidneys, a pair of purplish-brown organs located below the ribs toward the middle of the back.  

The kidneys remove excess liquid and wastes from the blood through urination.  And keep a stable balance of salts and other substances in the blood.  The kidneys also produce a hormone that aids the formation of red blood cells.  Narrow tubes called ureters carry urine from the kidneys to the bladder, a triangle-shaped chamber in the lower abdomen.  Urine is stored in the bladder, and when it becomes full is emptied through the urethra.

The average adult passes about a quart and a half of urine each day. The actual volume varies depending on the fluids and foods a person consumes.  The volume formed at night is about half of what is produced during the day.

What are the causes of UTI?

Normal urine is sterile. It contains fluids, salts, and waste products, but it is free of bacteria, viruses, and fungi. An infection occurs when microorganisms, usually bacteria from the digestive tract, cling to the opening of the urethra and begin to multiply. Most infections arise from one type of bacteria, Escherichia coli (E. coli), which normally lives in the colon.

Usually, bacteria first begin growing in the urethra. An infection limited to the urethra is called urethritis. From there bacteria often move up to the bladder, causing a bladder infection (cystitis).  If the infection is not treated promptly, bacteria may then go up the ureters resulting in a kidney infection (pyelonephritis).

Microorganisms called Chlamydia and Mycoplasma may also cause UTIs in both men and women, but these infections tend to remain limited to the urethra and reproductive system.  Unlike E. coli, Chlamydia and Mycoplasma may be sexually transmitted.

Thankfully, the urinary system is structured in a way that actually helps to prevent infections.  Usually the ureters and bladder stop urine from backing up toward the kidneys.  And the flow of urine from the bladder washes bacteria out of the body.   Also in men, the prostate gland produces secretions that slow bacterial growth.  In both sexes, immune defenses also prevent infection.  But despite these safeguards, infections still frequently occur.

Who is at risk?

Some people are more prone to getting a UTI than others. Any abnormality of the urinary tract that obstructs the flow of urine (a kidney stone, for example) sets the stage for an infection. An enlarged prostate gland also can slow the flow of urine, thus raising the risk of infection.

A common source of infection is catheters, or tubes, placed in the bladder. A person who cannot void or who is unconscious or critically ill often needs a catheter that stays in place for a long time. Some people, especially the elderly or those with nervous system disorders who lose bladder control, may need a catheter for life. Bacteria on the catheter can infect the bladder, so hospital staff take special care to keep the catheter sterile and remove it as soon as possible.

People with diabetes have a higher risk of a UTI because of changes in their immune system.  Any disorder that suppresses the immune system raises the risk of a urinary infection.

UTIs may occur in infants who are born with abnormalities of the urinary tract, which sometimes need to be corrected with surgery.  UTIs are rarely seen in boys and young men.  In women, though, the rate of UTIs gradually increase with age.  

Scientists are not sure why women have more urinary infections than men.  One factor may be that a woman's urethra is short, allowing bacteria quick access to the bladder. Also, a woman's urethral opening is near sources of bacteria from the anus and vagina. For many women, sexual intercourse seems to trigger an infection, although the reasons for this linkage are unclear.

Several studies indicate that women who use a diaphragm are more likely to develop a UTI than women who use other forms of birth control.  On top of that, recently, researchers found that women whose partners use a condom with spermicidal foam also tend to have growth of E. coli bacteria in the vagina.

Recurrent Infections

Almost 20% of women who have a UTI will have another, and 30% of those will have yet another. Of the last group, 80% will have recurrences.  Interestingly, in most cases, different bacteria are the causes of each infection.  Research funded by the National Institutes of Health (NIH) suggests that one reason for recurrent UTIs may be the ability of bacteria to attach to cells lining the urinary tract.  

Infections in Pregnancy

Pregnant women seem no more prone to UTIs than other women.  However, when a UTI does occur, it is more likely to travel to the kidneys during pregancy.  According to some reports, about 2 to 4 percent of pregnant women develop a urinary infection.  Scientists think that hormonal changes and shifts in the position of the urinary tract during pregnancy make it easier for bacteria to travel up the ureters to the kidneys. This is why many doctors recommend periodic testing of urine during pregnancy.

What are the symptoms of UTI?

Not everyone with a UTI has symptoms, but most people get at least some. These may include:

• frequent urge to urinate
• painful, burning feeling in t the bladder or urethra during urination
• feeling bad all over—tired, shaky, washed out
• feeling pain even when not urinating
• uncomfortable pressure above the pubic bone
• some men experience a fullness in the rectum
• despite the urge to urinate, only a small amount of urine is passed
• urine may look milky or cloudy, even reddish if blood is present
• A fever may mean that the infection has reached the kidneys
• Other symptoms of a kidney infection include:

• pain in the back or side below the ribs
• extreme fatigue
• nausea
• vomiting

In children, symptoms of a urinary infection may be overlooked or attributed to another disorder.  A UTI should be considered when a child or infant seems irritable, is not eating normally, has an unexplained fever that does not go away, has incontinence or loose bowels, or is not thriving.  The child should be seen by a doctor if there are any questions about these symptoms, especially a change in the child's urinary pattern.

How is UTI diagnosed?

To find out whether you have a UTI, your doctor will test a sample of urine for pus and bacteria. You will be asked to give a "clean catch" urine sample by washing the genital area and collecting a "midstream" sample of urine in a sterile container. (This method of collecting urine helps prevent bacteria around the genital area from getting into the sample and confusing the test results.) Usually, the sample is sent to a laboratory, although some doctors' offices are equipped to do the testing.

In the urinalysis test, the urine is examined for white and red blood cells and bacteria.  Then the bacteria are grown in a culture and tested against different antibiotics to see which drug best destroys the bacteria. This last step is called a sensitivity test.

Some microbes, like Chlamydia and Mycoplasma, can be detected only with special bacterial cultures. A doctor suspects one of these infections when a person has symptoms of a UTI and pus in the urine, but a standard culture fails to grow any bacteria.

When an infection does not clear up with treatment and is traced to the same strain of bacteria, the doctor will order a test that makes images of the urinary tract.  One of these tests is an intravenous pyelogram (IVP), which gives x-ray images of the bladder, kidneys, and ureters . An opaque dye visible on x-ray film is injected into a vein, and a series of x rays is taken.  The film shows an outline of the urinary tract, revealing even small changes in the structure of the tract.

If you have recurrent infections, your doctor also may recommend an ultrasound exam, which gives pictures from the echo patterns of soundwaves bounced back from internal organs.  Another useful test is cystoscopy.  A cystoscope is an instrument made of a hollow tube with several lenses and a light source, which allows the doctor to see inside the bladder from the urethra.

How is UTI treated?

UTIs are treated with antibacterial drugs. The choice of drug and length of treatment depend on the patient's history and the urine tests that identify the offending bacteria. The sensitivity test is especially useful in helping the doctor select the most effective drug. The drugs most often used to treat routine, uncomplicated UTIs are trimethoprim (Trimpex), trimethoprim/sulfamethoxazole (Bactrim, Septra, Cotrim), amoxicillin (Amoxil, Trimox, Wymox), nitrofurantoin (Macrodantin, Furadantin), and ampicillin. A class of drugs called quinolones includes four drugs approved in recent years for treating UTI. These drugs include ofloxacin (Floxin), norfloxacin (Noroxin), ciprofloxacin (Cipro), and trovafloxin (Trovan).

Often, a UTI can be cured with 1 or 2 days of treatment if the infection is not complicated by an obstruction or nervous system disorder.  Still, many doctors ask their patients to take antibiotics for a week or two to ensure that the infection has been cured.  Single-dose treatment is not recommended for some groups of patients.  Such as those who have delayed treatment or have signs of a kidney infection, patients with diabetes or structural abnormalities, or men who have prostate infections.  

Longer treatment is also needed by patients with infections caused by Mycoplasma or Chlamydia, which are usually treated with tetracycline, trimethoprim/sulfamethoxazole (TMP/SMZ), or doxycycline. A followup urinalysis helps to confirm that the urinary tract is infection-free. It is important to take the full course of treatment because symptoms may disappear before the infection is fully cleared.

Severely ill patients with kidney infections may be hospitalized until they can take fluids and needed drugs on their own. Kidney infections generally require several weeks of antibiotic treatment.  Researchers at the University of Washington found that 2-week therapy with TMP/SMZ was as effective as 6 weeks of treatment with the same drug in women with kidney infections that did not involve an obstruction or nervous system disorder.  In such cases, kidney infections rarely lead to kidney damage or kidney failure unless they go untreated.

Various drugs are available to relieve the pain of a UTI.  A heating pad may also help. Most doctors suggest that drinking plenty of water helps cleanse the urinary tract of bacteria.  During treatment, it is best to avoid coffee, alcohol, and spicy foods.  And one of the best things a smoker can do for his or her bladder is to quit smoking.  Smoking is the major known cause of bladder cancer.

Doctors suggest some additional steps that a woman can take on her own to avoid an infection:

1. Drink plenty of water every day.
2. Urinate when you feel the need; don't resist the urge to urinate.
3. Wipe from front to back to prevent bacteria around the anus from entering the vagina or urethra.
4. Take showers instead of tub baths.
5. Cleanse the genital area before sexual intercourse.
6. Avoid using feminine hygiene sprays and scented douches, which may irritate the urethra.
7. Some doctors suggest drinking cranberry juice.

Can Acupuncture Help?

Due to the growing threat of antibiotic resistance in bacteria, researchers began to investigate other, nonpharmaceutical means of reducing the frequency and duration of urinary tract infections.  Terje Alraek, a researcher of the University of Bergen in Norway, conducted a study using acupuncture to treat the condition in women. The results, published in the October 2002 issue of the American Journal of Public Health,found that the therapy was highly successful, and reduced the infection rate by more than 50% in the six months following treatment.

"Our results showed that acupuncture reduced the recurrence rate among cystitis-prone women to half the rate among untreated women," the researchers noted in their conclusion. "Also, women in the acupuncture group exhibited reductions in residual urine · In summary, our results, as well as previous findings, indicate that acupuncture treatment may be effective in preventing recurrent lower UTIs in healthy adult women."

Infections in Pregnancy

A pregnant woman who develops a UTI should be treated promptly to avoid premature delivery of her baby and other risks such as high blood pressure. Some antibiotics are not safe to take during pregnancy. In selecting the best treatments, doctors consider various factors such as the drug's effectiveness, the stage of pregnancy, the mother's health, and potential effects on the fetus.

Complicated Infections

Curing infections that stem from a urinary obstruction or nervous system disorder depends on finding and correcting the underlying problem, sometimes with surgery. If the root cause goes untreated, this group of patients is at risk of kidney damage. Also, such infections tend to arise from a wider range of bacteria, and sometimes from more than one type of bacteria at a time.

Infections in Men

UTIs in men usually stem from an obstruction—for example, a urinary stone or enlarged prostate—or from a medical procedure involving a catheter. The first step is to identify the infecting organism and the drugs to which it is sensitive. Usually, doctors recommend lengthier therapy in men than in women, in part to prevent infections of the prostate gland.

Prostate infections (chronic bacterial prostatitis) are harder to cure because antibiotics are unable to penetrate infected prostate tissue effectively. For this reason, men with prostatitis often need long-term treatment with a carefully selected antibiotic. UTIs in older men are frequently associated with acute bacterial prostatitis, which can be fatal if not treated immediately.

Is there a vaccine to prevent recurrent UTIs?

In the future, scientists may develop a vaccine that can prevent UTIs from coming back. Researchers in different studies have found that children and women who tend to get UTIs repeatedly are likely to lack proteins called immunoglobulins, which fight infection. Children and women who do not get UTIs are more likely to have normal levels of immunoglobulins in their genital and urinary tracts.

Early tests indicate that a vaccine helps patients build up their own natural infection-fighting powers. The dead bacteria in the vaccine do not spread like an infection; instead, they prompt the body to produce antibodies that can later fight against live organisms. Researchers are testing injected and oral vaccines to see which works best. Another method being considered for women is to apply the vaccine directly as a suppository in the vagina.

Nutritional and Herbal Therapy for Urinary Tract Infections

1. Drink plenty of water and caffeine-free herbal teas. Avoid sweetened drinks.
2. Drink unsweetened cranberry juice. Cranberries acidify the urine which inhibits bacteria from adhering to the urinary tract.
3. Vitamin C (250 to 500 mg twice a day) also acidifies urine and it boosts immunity.
4. Zinc (30 to 50 mg a day) increases immunity.
5. Acidophilus is important to take if you are taking antibiotics. Not only does antibiotics kill bad bacteria but it also kills the good and vital bacterial flora in your digestive tract. Taking acidophilus helps replenish your body's flora. Plain yogurt is a good source.
6. The Tao of Nutrition recommends drinking plenty of cornsilk tea (which is readily available at your local health food store).

 

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