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The incidence of UTIs varies based on age and gender. According to a study in the American journal of the urology, UTIs are estimated to affect 2.4% to 2.8% of children in the United States.
According to the American family physician journal, 8 % of girls and 2 % of boys who have acute urinary tract infections are subjected to having at least one episode by the age seven, and the recurrence rate in children is estimated between 30% and 40% for urinary tract infections according to a review in the Canadian Medical Association journal.
Women are more likely to experience UTI than men. According to a study in the American journal of medicine ,almost one of three women will have at least one episode of UTI by the age of 24 years.
Urinary tract infection (UTI) is a common infection that usually occurs when bacteria enter the opening of the urethra from the anus to multiply in the urinary system. UTIs are the most common of all bacterial infections and can occur at any time in the life of an individual. Women develop this condition much more often than men.
Urinary tract infections are classified according to their location into lower and Upper UTIs. The most common cause of urinary tract infection is Escherichia coli (E. coli).
Risk factors that are specific to certain groups of people play a major role in getting UTI. Risk factors specific to women could include female anatomy, sexual activity, and certain types of birth control. Prostate problems increase the possibility of getting urinary tract infections in men. There are risk factor specific to children as well, such as constipation, dysfunctional elimination syndrome, and vesicoureteral reflux (VUR).
Symptoms of UTI include a persistent urge to urinate, burning sensation when urinating, passing frequent and small amounts of urine, urine that appears cloudy and red color, foul-smelling urine, in addition to other possible symptoms.
Diagnosis of UTI depends on the person’s symptoms, on laboratory tests such as urine tests, and other tests that are used when the case fails to respond to medications and these include imaging tests such as ultrasound, X-Rays, cystoscopy.
Upon the confirmation of UTI, various types of antibiotics are used for treatment, based on the case, complicated , uncomplicated, primary, recurrent .Some antibiotics that are used for UTI such as trimethoprim/sulfamethoxazole, fosfomycin, nitrofurantoin, ciprofloxacin, levofloxacin, and cephalexin.
If UTI goes untreated, very serious consequences can be a result of that, like pyelonephritis to even become more serious by spreading into the bloodstream and cause sepsis.
The most recommended ways to prevent urinary tract infection are by drinking plenty of fluids especially water, cleaning the genital and urinary areas from front to back, emptying the bladder after intercourse, avoiding potentially irritating feminine products, and changing birth control methods.
Urinary tract infection (UTI) in adults is the presence of pathogenic microorganisms in any part of the urinary system such as kidneys, ureters, bladder and urethra , in addition to the tubes connected to them.
Urinary tract infections (UTIs) in children are fairly common with a high response to treatment by antibiotics.
These include:
Lower UTI either occurs either in the bladder as an infection known as cystitis or in the urethra as an infection known as urethritis. Lower UTIs are common and are not considered a major concern.
Upper UTI is an infection either in the kidney or the ureters; the tubes that connect the kidney to the bladder. When this condition goes untreated, upper UTIs, a damage to the kidneys or a spread to the bloodstream occurs.
Bacteria, fungus or viruses are usually not present in urine. The urinary system gets infected when microorganisms enter through the urethra or in rare cases from the bloodstream. A bacteria called Escherichia coli (E. coli) is considered the most common bacteria that reaches the urethra from the anus. Mycoplasma and chlamydia are other microorganisms that could cause urethritis, an inflammation of the urethra, in both men and women, and are sexually transmitted infections, that require treatment for both partners when an infection is detected.
Most UTI cases in children are caused by E. coli from the digestive system entering the urethra.
UTIs risk factors specific to women include:
The short distance between the urethra and the anal opening allows an easy passing for fecal bacteria from the anus pass to the urethra.
Sexual activity for women, in addition to having new sexual partners increase the risk of getting UTI.
Using diaphragms as a birth control and spermicidal agents raises the risk of having UTI.
After menopause begins, estrogen loss causes changes in the urinary tract which highly increases the possibility of having UTI.
Women who have skin allergies to ingredients in soaps, vaginal creams, bubble baths, or other chemicals that are used in the genital area encounter an increased risk of UTI.
Antibiotics can cause an overgrowth of E. coli in the vagina due to the fact that antibiotics often eliminate lactobacilli; the protective bacteria along with harmful bacteria.
Pregnant women should be screened and treated for asymptomatic bacteriuria since they face frequent urination ,caused by pressure on the bladder, at early stages of pregnancy which is also a common symptom of UTI. Pregnancy does not increase the possibility of asymptomatic bacteriuria but it does increase asymptomatic bacteriuria progressing into a full-blown kidney infection, which can cause early labor and other serious pregnancy complications.
UTIs risk factors specific to men include:
The possibility of having UTI is increased with prostate problems. Such problems include benign prostatic hyperplasia (BPH); enlargement of the prostate gland that can produce obstruction in the urinary tract, and subsequently increase the risk for infection and prostatitis; an infection of the prostate gland that is associated with recurrent urinary tract infections.
UTIs risk factors specific to children include:
Swelling of a part of the large intestine may form pressure on the bladder, that prevents emptying normally.
It is a common condition in children where the child has the urge to urinate but instead holds the urine inside.
In this case, urine flows backward from the bladder into the ureters and kidneys due to a problem in the valves of the ureters. Vesicoureteral reflux may produce kidney infection (pyelonephritis) that could lead to kidney damage.
Other risk factor of UTIs:
Urine can be blocked from leaving the bladder due to an enlarged prostate and kidney stones.
Certain diseases such as diabetes can impair the immune system which increases the risk of UTIs.
This includes people who are unable to urinate on their own like people who are hospitalized, people with neurological problems and people who are paralyzed. These categories use a tube (catheter) to urinate and and have an increased risk of UTI.
Urinary surgery or medical instruments that are used to examine the urinary tract can increase risk of developing UTIs.
Asymptomatic bacteriuria in women is highly increased with diabetes. . Diabetes increase the risk for UTI complications, and fungal-related UTI.
Brain and nerve disorders such as multiple sclerosis, stroke, spinal cord injury, and diabetic neuropathy can affect the nerves of the bladder, leading to problems with the ability to empty the bladder and control urine leakage.
Patients with this disease are at a higher risk of getting UTI since their disease makes them more prone to kidney damage.
Such abnormalities cause urine to stall or flow backward into the upper urinary tract. When urination is incomplete , urine accumulates to create a breeding environment for bacteria which is known as a prolapsed bladder (cystocele). The urethral wall may develop diverticula; tiny pockets , that can collect urine and debris to further increase the risk for infection.
While being admitted to the hospital, an increased risk of developing urinary tract infections is possible. Nosocomial infections; any systemic or localized conditions that result from the reaction by an infectious agent or toxin., vary from those that commonly cause UTI. Furthermore, some medical conditions puts hospitalized patients at the highest risk such as those with urinary catheters, patients undergoing urinary procedures, long-stay elderly men, and patients with severe medical conditions.
When older adults are immobilized, catheterized, or dehydrated, the possibility for UTI is increased. The risk is considered very high in nursing home residents, especially those who are incontinent.
Once the bacteria enters the urinary tract through the urethra and begin to multiply in the bladder , UTI occurs. When the urinary system fails in to maintain its function in keeping out such microscopic invaders, the bacteria grow into a full-blown infection in the urinary tract.
There are a number of symptoms associated with UTI including:
The parts affected by UTI are accompanied by some symptoms that are specific to that part as follows:
1-Upper back and side (flank) pain.
2-High fever.
3-Shaking and chills.
4-Nausea.
5-Vomiting.
1-Pelvic pressure.
2-Lower abdomen discomfort.
3-Frequent, painful urination.
4-Blood in urine.
1-Burning while urination.
2-Discharge.
UTI symptoms in children are:
UTIs symptoms in older patients include:
Symptoms and laboratory tests determine the diagnosis of UTIs. Laboratory tests include:
Urinalysis is an easy test that observe color, turbidity, mucous, and chemical component such as nitrates, red blood cells, white blood cells, and epithelia of urine sample. This test provides the doctor or nurse with enough information to begin treatment.
When needed, a urine culture involves incubating and growing the bacteria contained in the urine to determine the specific type of bacteria responsible for the infection and the consequent antibiotic recommended. Other cases require ordering urine culture, such as when urinalysis shows no infection but still the symptoms indicate a UTI infection, or when complications caused by the infection are expected.
Other tests
When an infection fails to respond to medication, imaging tests can help in identifying cases of pyelonephritis that are recurrent and serious, structural abnormalities, obstruction or abscess, and possible obstruction or vesicoureteral reflux in children ages 2 - 24 months. These imaging tests include:
Ultrasound is used to detect the obstruction in urine flow ; hydronephrosis, kidney stones that could be a possible cause of infection, and kidney abscesses. Ultrasound can detect enlargement or abscesses of the prostate in men. In men over 50 years, incomplete urination; a common cause of UTI is detected by ultrasound. Vesicoureteral reflux; a problem in the valve-like mechanism between the ureter and bladder in children, can be detected by ultrasound.
Special x-rays can be used to screen for structural abnormalities, urethral narrowing, and incomplete emptying of the bladder.
A dye named contrast material is injected into a catheter that passes from the urethra until the bladder .Voiding cystourethrogram is an x-ray of the bladder and urethra.
It is specified to the kidneys where the contrast material is injected into a vein and eliminated by the kidneys. This helps in showing any obstruction or abnormality since it extends throughout the urinary tract. In both cases, the dye passes through the urinary tract and reveals any obstructions or abnormalities on x-ray images.
When X-rays or IVP are unable to detect structural abnormalities, interstitial cystitis, and masses , cystoscopy is used. Cystoscopy procedure that uses tube with a lens to see inside urethra and bladder.
It is able to detect kidney stones or other obstructions.
This technique provides a detailed pictures of the body’s internal organs using radio waves and magnets.
Itis an imaging technique that uses the injection of radioactive chemicals for detecting small amounts of radiation .
These tests are concerned with the ability of the bladder to hold urine , to empty steadily and completely.
It is essential when symptoms are severe, for determining whether the infection is in the bloodstream and is threatening other parts of the body.
Antibiotics are used to treat UTI. The type of infection; complicated or uncomplicated or primary or recurrent , determines the antibiotics treatment chosen.. The type of patient; man or woman, pregnant or non -pregnant woman, child, hospitalized or nonhospitalized patient, person with diabetes, also plays a role in determining the type of antibiotic used for treatment, which makes a doctor’s consultation essential before taking any type of antibiotic.
Treatment for simple infection UTIs
This type of UTI uses a short course of antibiotic, which depends on the symptoms and medical history of the patient. Analgesics that are prescribed to numb the bladder and urethra in order to relieve burning while urinating, is possible but could leave a side effect of discolored urine; orange or red. Antibiotics recommended in this case:
Treatment for recurrent infections
Treatment for women who have recurrent UTIs, include:
In recurrent infections in women, a doctor should be consulted when:
Self-treatment can’t be used in women with impaired immune systems, previous kidney infections, structural abnormalities of the urinary tract, or a history of infection with antibiotic-resistant bacteria . (15)
Postcoital Antibiotics
When there is clear evidence correlating recurrent infections to sexual activity and they do recur more than two times within 6 months a single preventive dose of the following, trimethoprim/sulfamethoxazole(TMP- SMX), nitrofurantoin, cephalexin, or fluoroquinolone ciprofloxacin except for pregnant women, should be taken immediately after intercourse.
Continuous Preventive Antibiotics (Prophylaxis)
When other measure fail in women , continuous preventive (prophylactic) antibiotics are considered a choice and include taking low-dose antibiotics ,continuously for 6 months or longer.
Treatment for kidney infections (pyelonephritis)
Oral antibiotics treatment at home is available for uncomplicated kidney infections (pyelonephritis). However, hospitalization could be required in moderate- to –severe acute kidney infections, severe symptoms and cases with complications. . Patients with chronic pyelonephritis may require long term antibiotic treatment.
Treating Children with UTIs
These antibiotics are usually taken orally in either liquid or pill form but could be given in the form of an IV or shot and include:
Two treatment options are available for children with vesicoureteral reflux (VUR); which forms a concern for children with UTIs, which are a preventive method using long-term antibiotics, and a corrective method using surgery.
Children with acute kidney infections are treated by oral cefixime or with short course; 2 - 4 days , intravenous (IV) antibiotic, usually gentamicin, and followed by an oral antibiotic.
Treating Pregnant women
Pregnant women are at high risk of getting UTIs and their consequent complications . Antibiotics that areusually given to pregnant women include amoxicillin, ampicillin, nitrofurantoin, cephalosporin, and fosfomycin which could be less effective than the previous ones, and. Fluoroquinolones are excluded from treatment during pregnancy. Asymptomatic bacteriuria in pregnant women requires screening and treatment for such a case since they are at higher risk of acute pyelonephritis in their second or third trimester.
Very serious consequences or life-threatening conditions could be the outcome of UTI without treatment like pyelonephritis that could lead to permanent damage or scarring to the kidneys, and sepsis that occurs when the infection has reached the bloodstream and other places in the body. Complications of a UTI may include:
Healthy habits that can protect from UTIinclude:
This aids in diluting urine and in frequent urination that allow bacteria to be flushed from the urinary tract.
Once an individual is done with urinating and a bowel movement, wiping from front to back makes sure that bacteria will not reach the vagina and urethra from the anal region.. (18)
Before and after intercourse, urinating is necessary to empty the bladder and cleanse the urethra from bacteria, in addition to keeping the genital and anal areas clean. (19) Contraceptive alternatives to the spermicides used with condoms and diaphragms should be discussed with a specialist. Preventing sexually transmitted diseases and other complications that are a result of having multiple partners.
Sexually transmitted diseases, and urethra and vagina irritation are caused by douching. Furthermore, bath oils, feminine hygiene sprays, and powders should be avoided in the genital area since they could irritate the urethra.
Birth control methods may promote bacterial growth like diaphragms, or unlubricated or spermicide-treated condoms.
To reduce the risk of UTI, avoid tight pants and wear cotton underwear.
Tannins or proanthocyanadins are present in lingonberry, cranberries, and blueberries. Tannins are helpful in preventing the adherence of E. coli bacteria to cells in the urinary tract, which inhibits infection. Furthermore, cranberry juice has proven to decrease the number of symptomatic UTI particularly recurrent urinary tract infections that occur in women. .
Infections in the genital and urinary tracts are minimized by probiotics; beneficial microorganisms . Lactobacilli probiotics that has been proven to prevent the spread of recurrent UTI.
Antibiotic treatment usually clears the infection of the lower urinary tract infection. Serious problems may occur when the infection spreads to the upper urinary tract, such as:
The incidence of UTIs varies based on age and gender. According to a study in the American journal of the urology, UTIs are estimated to affect 2.4% to 2.8% of children in the United States.
According to the American family physician journal, 8 % of girls and 2 % of boys who have acute urinary tract infections are subjected to having at least one episode by the age seven, and the recurrence rate in children is estimated between 30% and 40% for urinary tract infections according to a review in the Canadian Medical Association journal.
Women are more likely to experience UTI than men. According to a study in the American journal of medicine ,almost one of three women will have at least one episode of UTI by the age of 24 years.
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