The Urinary Tract
The excretory system of the body is responsible for ridding the body of waste materials, such as urea, ammonia, excess water, etc. If these toxins accumulate in the body, they lead to serious health conditions. The urinary tract is the conduit through which urine is removed from the body. The phrases urinary tract and the excretory system are commonly used synonymously. The tract comprises of the kidneys, ureters, urinary bladder and urethra. It also includes two muscle sphincters that work as valves, to keep the urine from leaking out of the bladder and to hold the urine at times of urgency.
The infection may affect any part of the urinary tract, called the urinary tract infection or UTI. Most commonly it affects the urinary bladder, which is termed cystitis. If the infection is limited to the urethra, it’s called urethritis. And if it goes upstream reaching the kidney, it is called pyelonephritis.
The infection usually starts in the lower urinary tract or bladder and extends upwards if not treated properly. The higher up the infection, the more serious the consequences.
The urine in the urinary tract flows in one direction; from kidneys to the bladder, and then exiting the body through the urethra. This one–way flow keeps the bacteria out of the tract and flushes them away if they get access to the urethra. But because of the closeness to the rectum and inadequate hygiene upkeep, sometimes the bacteria find a way up through the urethra, resulting in infection. Most of these bacteria come from the gut, for example, Escherichia coli/E. coli. Women are also susceptible to getting fungal infections for nearness to the vaginal opening.
Women are more prone to develop UTI than men, because of the shorter urethra and approximation of the rectal bacteria to the bladder. On the other hand, men who have restrictions in the urine flow, such as in prostate issues are at risk of developing infections due to stasis and backflow of urine. Some more risk factors for UTI include:
- Sexual activity and poor post-coital hygiene
- Older women who are menopaused
- Women who use material birth control methods like spermicides and diaphragm
- Incomplete or difficulty emptying of the bladder, as in nerve damage, spinal injury, enlarged prostate, kidney stones, etc.
- Structural abnormalities of the urinary tract, such as vesicoureteral reflux
- Previous UTIs
- Bedbound, immobile patients, with indwelling urinary catheters
- Diabetes, immune deficiency
Acute, Recurrent or Complicated
UTI is said to be acute when it presents with a short history and complains of fever, flank pain and bacteria in the urine. An infection in a patient who has preceding risk factors is a complicated infection. And then there is recurrent UTI, which is defined as 2 or more episodes of UTI in 6 months, or 3 or more episodes in 12 months. Complicated and recurrent infections are seen in patients who have high-risk factors and are difficult to treat.
At least 50% of the world’s women develop UTI once in their lifetime, mostly bladder infections, while 1 in 4 develops recurrent infections.
Symptoms of bladder and kidney
Symptoms are variable in presentation and severity from person to person. The usual complaints in cystitis include:
- burning or pain in urination
- frequent and sudden urge to pass urine
- reduced urine output
- pelvic and rectal pains
- cloudy or urine pus-like urine
In the case of pyelonephritis, the symptoms are more severe and the infection can be life-threatening.
- flank pain and upper backaches
- nausea, vomiting
- dark or pus-like urine.
In addition to the proper history, the doctor may recommend urine analysis and culture, to find the reason for the infection. In cases of recurrent or complicated infections, the doctors may also ask for a scan, like an ultrasound or CT scan, of the Kidney-Urinary-Bladder system, and the prostate in males. Sometimes a tiny camera on a tube is used to look inside the urethra and bladder, a procedure called cystoscopy; while to look for sphincter issues, they might order a cystogram.
In initial stages and milder cases, conservative management is useful. It includes drinking lots of liquids to flush out the bladder.
Antibiotics are needed in most cases to eliminate the bacteria, according to the type of bacteria involved and the site of infection.
In cases of recurrent UTI, the doctor may advise antibiotics on lower doses for longer periods, single-dose after sexual intercourse, or for 2-3 days whenever symptoms appear.
However, the high prevalence of UTI and frequent use of antibiotics has led to the development of many antibiotic-resistant bacteria and difficulties in treatment. This calls for better precautions and preventive interventions.
- Proper cleaning technique- wipe from front to back
- Pee before and after sexual activity
- Good hydration
- Complete emptying of bladder
- Use of Cranberry juice and extracts for UTI prevention
- Don’t use irritant feminine products, talcum powder down there
- Don’t hold in pee for long times
- Don’t wear tight, nylon undergarments
- Avoid baths, bubble baths,
- Don’t use material birth control methods, like condoms, diaphragms or spermicides,
- If early and lower UTIs are left untreated, it ascends to infect the kidneys resulting in permanent kidney damage and chronic kidney disease.
- Pregnant women with UTI are at risk of giving early births and babies with low birth weight.
- Urethral narrowing from recurrent infection makes the peeing painful and worsens the stasis/infection chance.
- Urosepsis is a full-blown infection starting with a UTI in high-risk cases, such as elderly, bedbound, and low immunity patients.
Urinary tract infections are a preventable and treatable cause of global burden. Women are more likely to develop UTIs than men because of structural traits, while men are more likely to develop complicated infections. Good hygiene maintenance and adequate cleaning can save the world from the rising antibiotic-resistant bacteria.