Urinary Tract Infection (UTI)

A UTI or Urinary Tract Infection is an infection from microbes that affects any part of the urinary system. This includes the kidneys, bladder, ureters, and urethra.

Kidneys are bean-shaped organs located in the lower back, just below the ribcage, on each side of the spine. They are part of the urinary tract and primary filter out the blood, producing urine to transport excess water and urine out of the body. The urine is passed through the ureters and makes its way into the bladder. Kidneys ideally help control pH levels as well as blood pressure.

The bladder is a hollow, muscular sac that stores urine passed from the kidneys. It’s typically the size of a pear but can stretch larger as required. When it stretches to a certain point, it signals the body to relieve the increasing pressure. During urination, the muscular valve at the organ’s opening relaxes, the bladder contracts and urine is sent out of the body through the urethra.

Urinary Tract Infection is a blanket term, but the infection can be identified depending on the part of the urinary system that’s affected. Here are common examples of UTIs:

• Cystitis – Occurs when the bladder is infected.
• Pyelonephritis – The infection of one or both kidneys.
• Urethritis – The infection or inflammation of the urethra. This condition is often a symptom of an STD (sexually transmitted disease) like gonorrhea, chlamydia, or herpes. It is important to note that STD treatment is different from that of typical urinary tract infections.

UTIs usually develop when microbes make their way into the urethra. They stick to the urethra walls, multiply and move up the urinary tract. Most urinary tract infections don’t go beyond the lower tract, i.e., urethra and bladder. Here, they cause symptoms like a burning sensation when one urinates. UTIs are not complicated and are relatively easy to treat. However, if left unattended, they can move further to the upper tract and infect the ureters and kidneys.

The latter is considered more dangerous than bladder or urethra infection as it can result in permanent kidney damage. Some infections can make their way into the bloodstream, causing sepsis or septicemia, which can be life-threatening. However, such infections tend to be rare.

Even though viruses and fungi can cause UTIs, bacteria are the biggest culprits, most specifically Escherichia coli (bacteria that’s usually found in the digestive system and frequently present in stool and around the anus. Proteus, Enterococcus, Staphylococcus, and Klebsiella are other types of bacteria that can cause urinary tract infections.

UTIs are not an uncommon occurrence. According to the American Urological Association Foundation (AUAF), over 8 million people go to the hospital due to UTI concerns per year. UTIs can affect anyone, regardless of age, but women are more susceptible. According to stats, only 12% of men, compared to 40% of women contract at least one UTI in their lifetime.

The reason women are prone to these infections is thought to be partly anatomical as the female urethra is shorter than that of a male. As such, microbes don’t have to travel as far to get to the bladder. Ideally, the short distance between the female’s vagina and anus and the urethra increases the exposure to microbes.

Anything that blocks or slows urine passage or introduces bacteria into the urinary system increases the chances of the individual contracting a UTI.

Common conditions and activities that can result in the development of urinary tract infection include:

• Sexual intercourse
• A history of previous urinary tract infections
• The use of spermicides, particularly when combined with a condom
• Urine retention (This is a case where the bladder doesn’t empty entirely.)
• Vesicoureteral reflux (This is the unusual flow of urine, whereby it goes back to the ureters from the bladder.)
• Anatomical issues like narrowing of the ureters or urethra
• Long-term bladder catheterization
• Kidney stones
• Diabetes or changes to the immune system can damage the kidneys, resulting in the presence of glucose in the urine, which promotes bacteria growth
• Spinal cord injuries or nerve damage that involves the bladder
• Kidney disease/transplant

In women, menopause results in changes in the vagina lining, and estrogen loses its protective effects. In men, an enlarged prostate can interfere with urine flow. Basically, any condition that hampers the immune system can increase the risk of getting a UTI.

As mentioned earlier, UTIs are often acute and non-complex. When attended to, the symptoms go away in a few days. However, those that affect the kidney can lead to permanent kidney damage, particularly in young and elderly people.

Diseases or conditions that lead to chronic or recurrent urinary tract infections can ideally cause kidney damage and, in some cases, septicemia and renal failure. These call for prompt treatment, which usually calls for hospitalization. In men, these infections can lead to prostate infection and inflammation. In women, they can cause premature labor and high blood pressure.

Chronic or recurrent urinary tract infections are an issue for 1 in 5 women after the initial infection. Often, recurrent infections are caused by the same bacteria responsible for the first infection. With each infection, the risk of having more increases.

Some of the recurrent UTIs recurrent factors in women are:

• Use of spermicide
• Contracting UTI at an early age
• Frequent sexual intercourse
• Maternal history of urinary tract infections

It’s rare for men to have a first UTI, but once it happens, the chances of getting another increase as the microbes may hide deep within the prostate tissue.

UTI Signs and Symptoms

Even though urinary tract infection symptoms tend to vary, the following tend to be common:

• Burning sensation or burning during urination
• A frequent urge to urinate
• Pelvic pain
• Strong-smelling, cloudy urine

Individuals with UTIs can ideally experience pressure in the lower abdomen and notice small blood amounts in the urine. If the infection is more severe, it can cause nausea, vomiting, shaking, fever, chills, and flank pain. Fevers are ideally experienced when the individual has septicemia.

Laboratory Tests

Common UTI lab tests include:

Urinalysis

Most, if not all, urinary tract infections are detected by conducting urinalysis, a procedure that searches for infection evidence like bacteria and white blood cells in a urine sample.

Urine Culture

For patients with recurring UTIs or those who are hospitalized, urine culture is done to confirm urinalysis.

One or more lab tests can be conducted as follow up cases. These include:

• When the doctor suspects the infection may have made its way into the bloodstream. In this case, a blood culture is performed.
• When the doctor suspects the patient’s symptoms are due to an STD like gonorrhea or chlamydia. In this case, testing for more than one STD is conducted.
• When the patient has chronic or recurring UTIs. Tests like glucose or hemoglobin a1c or BUN and creatinine can ideally be done.
• When the individual has had kidney stones in addition to a urinary tract infection. In such a case, a kidney stone analysis is conducted.

Non-Lab UTI Tests

X-rays and imaging scans can be used to assess anatomical issues or the signs of an underlying condition or disease that could be causing recurrent urinary tract infections. These tests are usually performed on children with UTIs, adults with recurrent or frequent UTIs, and those with blood in the urine.

There are different types of imaging tests, each providing different, but crucial information:

Voiding Cystourethrogram

This is an imaging technique that allows practitioners to see the bladder and urethra in real-time.

Kidney & Bladder Ultrasound

In this test, sound waves are utilized to produce images of these organs, allowing the practitioners to assess any abnormalities.

Cystoscopy

In this technique, a flexible tube is inserted into the urethra, up into the bladder. It allows the doctors to assess the inner lining of urethra and bladder. It helps identify blockages and structural abnormalities. If there is a stone, the same technique can be used to break or remove the stone. Tissue and urine samples can ideally be obtained using this technique.

Nuclear Scans

There’s an array of scans that can be used to check the shape and function of the kidneys and bladder. For each type of scan, a radioactive dye is introduced to the bloodstream, which is transported to the kidneys and bladder. This allows the visualization of anatomical abnormalities.

Intravenous Pyelogram or IVP

This is another imaging technique that is used to look at the entire urinary system. An opaque dye is injected into the bloodstream, which then makes its way to the bladder and kidneys. A series of x-rays are then taken, which reveal anatomical abnormalities or reveal obstructions.

These are the main tests conducted to confirm urinary tract infection. Thanks to technological advancements in the medical field, these tests can be easily done in most hospitals. With this guide, you should be able to tell whether you are looking at a UTI, especially when you experience a burning sensation when urinating. UTIs, as mentioned earlier, are easily identifiable and treatable, and symptoms often disappear in two days. If you suspect you have a UTI, however, it’s important to consult your doctor as soon as possible to avoid life-threatening conditions like sepsis.