Urinary Tract Infections

What is a UTI?

  • A UTI is an infection which can involve any part of the urogenital tract (kidney, ureter, bladder, urethra, prostate, testicles/epididymis)
  • Classically, a UTI is an infection within the bladder (cystitis)
  • In more severe cases, the infection may ascend to the kidney (pyelonephritis)
  • In males, infections with similar bacteria can also cause infections within the testicles/epididymis (epididymo-orchitis) or prostate (prostatitis)

What causes a UTI?

  • UTI’s are classically caused by bacteria that normally live around the genital areas
  • In most UTI’s, bacteria enter the urogenital tract via the urethra.  Females have much shorter urethras compared to males, this explains why UTI’s are much more common in females
  • The most common bacteria causing UTI’s is E.Coli.

What are the symptoms of a UTI?

  • Symptoms vary depending on the severity of infection and the location of the infection
  • Classical UTI symptoms of a bladder infection (cystitis) are:
    • Burning whilst passing urine (dysuria)
    • Frequent passage of urine (frequency)
    • Strong urge to pass urine (urgency)
    • Bladder/supra pubic pain
    • Fever
    • Blood in urine (haematuria)
    • Smelly urine
  • Infections of the kidney (pyelonephritis) may result in flank pain

What are the risk factors for recurrent UTI’s

  • Female sex
  • Increasing age (post menopausal)
  • Obesity/overweight
  • Diabetes
  • Immuno compromised conditions
  • Poor fluid intake
  • Kidney stones
  • Incomplete bladder emptying (BPH, poor functioning bladder)
  • Some anatomical abnormalities of the urinary tract

What tests will be required if I am experiencing recurrent UTI’s?

  • Urine culture – is mandatory to prove that a UTI exists. There are other conditions that can mimic a UTI (e.g. bladder stones, bladder cancer)
    • The urine culture will diagnose the infection and provide information on the causal bacteria and antibiotics that will be effective
  • Blood tests – full blood count and kidney function tests
  • X-rays – a kidney tract ultrasound is usually required to check for kidney stones, anatomical abnormalities and bladder emptying
  • Cystoscopy – (see Urological procedures explained)
    • A telescopic inspection of the urethra and bladder to exclude anatomical abnormalities, foreign bodies or stones

What are the treatment options for recurrent UTI’s?

  • The first step is to adequately eradicate and treat any current infection. A urine culture will be sent to ensure correct antibiotics are being used.  Usually a longer course of antibiotics (up to 2 weeks) will be used.
  • Increasing fluid (water) consumption is one of the best and easiest ways to reduce recurrent infections.  In essence, this is keeping the urinary tract “flushed” and diluting any bacteria present. In most cases, at least 2.5 litres a day is required, although in some elderly patients with certain medical conditions, a reduction may be necessary
  • If infections are recurrent despite adequate treatment and fluid consumption, 3 effective options exist. The best option for you may vary depending on the timing and frequency of infections. These include:
    • Prophylactic antibiotic course: This involves taking a low dose (usually one quarter or one half of the normal dose) daily for a prolonged period (3-6 months).  It is important to ensure that the antibiotic chosen is effective for the bacteria involved
    • Post coital (sex) antibiotic: especially for those woman prone to infections following sex, taking a single dose after sex may help reduce infections
    • Stop start treatment: involves starting a short course of antibiotics at the early signs of an infection. A urine culture will be often sent prior to the first dose
  • Other options that may help reduce the chances of recurrent infections include:
    • Cranberry tablets/juice
    • Hipprex – a urinary antiseptic
    • Passing urine immediately after sex if infections appear related to sex
    • Ensure good pelvic/genital hygiene
    • For females, wiping from front to back only