Urinary tract infection or UTI refers to the infection of the urinary system.
The urinary system includes the kidneys, the ureter which connects the kidneys to the urinary bladder and the urethra which extends from the bladder to the outside of the body.
Urinary Infection occurs when bacteria enter the urinary tract through the urethra from outside of the body.
Urinary tract infection is an increasingly worldwide problem in females; studies have shown that one in five women experience urinary tract infection.
This is due to the anatomy of the female urinary tract where the shorter length of the female urethra allows for bacteria easier access to the bladder.
The urinary tract is normally sterile and the direction of flow of urine helps to minimise urinary tract infection.
Interference to this flow of urine increases the person’s susceptibility to developing UTI.
Some factors that increase a person’s chances to developing urinary infection are:
lack of intake of fluids leading to dehydration;
structural obstructions e.g. Urinary strictures / prostate enlargement / urine stones;
use of indwelling catheter or a urinary tube;
diabetes type 2 then onto kidney failure; and
immunocompromised e.g. Cancer / HIV / old age / those undergoing chemotherapy.
When a patient presents to the hospital with urinary tract infection a presumptive diagnosis of uncomplicated urinary infection can be made.
This is based on the findings on history, physical examination of the patient along with investigations of urine sample.
Some classic symptoms of urinary tract infection are pain on urination (dysuria), feeling the urge to pass urine (urgency) and frequently passing urine (frequency).
Often patients may come complaining of a feeling of fullness in the lower abdomen, pain or discomfort maybe felt in the lower abdomen especially when your doctor applies pressure on it when examining the abdomen.
Sometimes, pain may also radiate or be felt on the back, this suggests upper urinary tract infection.
Other symptoms such as blood in urine, fever, chills, nausea and vomiting may or may not be accompanied with urinary tract infection.
After taking history and a physical examination your doctor will then request to take a sample of your urine for a urine analysis which includes a dipstick, microscopy, culture and sensitivity of the urinary sample.
The results for this test might be ready after five days but it will confirm presence of bacteria in urine, the name of the bacteria and the different antibiotics that can be prescribed to eradicate the bacteria and also the names of antibiotics that the bacteria is resistant to.
Now in most instances if your doctor is convinced that you have urinary tract infection based on the findings in your history and physical examination, she will then prescribe you a broad-spectrum antibiotic to take while awaiting your urine results.
This can then be discussed on your next visit for review.
Although simple urinary tract infection may resolve spontaneously, effective treatment lessens the duration of symptoms and stops the progression of the infection to the upper urinary tract.
Majority of urinary tract infections are treated as an outpatient basis, admission of patient to the hospital is considered if the patient has factors that would cause the patient to have a poor prognosis e.g. immunocompromised, chronic kidney disease, structural abnormalities in the urinary tract.
Despite the effective treatment of UTI with antibiotics, the average duration of severe symptoms in women usually lasts longer than three days.
Even with treatment, 25 per cent of women with urinary tract infection will experience a recurrence.
Management of urinary tract infection will also include patient education on preventative measures e.g. emphasise compliance to antibiotics prescribed, good oral fluid intake, frequent urination (including urinating after intercourse) and drinking cranberry juice/tablets.
- Dr Taraivini Waseiyaroi is a general practitioner at Oceania Hospitals Pte Ltd. The views expressed are hers and not necessarily of this newspaper.
