Urinary tract infections

Generality

Urinary infections are infections affecting the anatomical structures that form the so-called urinary tract, ie: kidneys, ureters, bladder and urethra.

In defining the various urinary infections, doctors talk about urethritis when urinary infection is limited to the urethra, of cystitis when the infectious process affects the bladder, of ureteritis when the infection is located in one of the ureters and pyelonephritis when infection affects one of the kidneys.

The components of the urinary tract most affected are the urethra and bladder (the most frequent urinary infection is cystitis); however, although in a much rarer way, the other districts of the urinary tract (the aforementioned kidneys and ureters) may also be involved.

The main cause of urinary infections is a bacterium that normally lives within the gastrointestinal tract: the known Escherichia coli .

The typical symptoms of a urinary infection are: dysuria, urgent need to urinate, pain in the lower abdomen, need to urinate often, production of foul-smelling and cloudy urine, and inability to completely empty the bladder.

Therapy is generally based on antibiotics, the methods of administration of which vary according to the severity of the infection.

Brief anatomical reference of the urinary tract

The elements that make up the urinary tract are the kidneys and the urinary tract .

The kidneys are the main organs of the excretory system. In number of two, they reside in the abdominal cavity, on the sides of the last thoracic vertebrae and of the first lumbar vertebrae, they are symmetrical and possess a shape that resembles that of a bean.

The urinary tract, instead, form the so-called urinary tract and have the following structures:

The ureters . In number of two, it is the ducts that connect the kidneys to the bladder. For the avoidance of doubt, it is specified that each ureter is independent of the other.
The bladder . It is a small hollow muscular organ, which accumulates urine before urination.
The urethra . It is the tubular duct that connects the bladder to the urinary meatus and allows, through the latter, the expulsion of the urine .

NB: under the bladder, only in men, there is another very important organ, connected to the urinary tract but not belonging to the urinary tract: the prostate .

The prostate has the function of producing and emitting the seminal fluid.

What are urinary infections?

Urinary infections are infections affecting the components of the urinary tract, namely: kidneys, ureters, bladder and urethra.

Kidney infection is called pyelonephritis ; ureter infection is known as ureteritis ; bladder infection is the so-called cystitis ; finally, urethral infection is known as urethritis .

Lower and upper urinary tract infections

In medicine, pyelonephritis and ureteritis are the so-called upper urinary tract infections ; cystitis and urethritis, on the other hand, represent the so-called lower urinary tract infections .

Clinically, upper urinary tract infections are of greater concern than lower urinary tract infections. This is due to the possible kidney damage that can result from an infection of the kidneys or ureters.

Epidemiology

Urinary infections most frequently affect women (the reasons will be dealt with in a specific sub-chapter), in particular those between the ages of 16 and 35; in this regard, some medical-statistical studies have shown that the aforementioned infections are at least 4 times more frequent in women of the aforementioned age, compared to male peers.

In men, urinary infections are a fairly rare phenomenon until the middle-advanced age (under 50-60 years); after which they become decidedly more frequent, so as to almost reach the frequency relative to the female gender.

In the young population, the infections in question affect at least 10% of individuals; among children, the most affected are the uncircumcised male subjects under the age of 3 months, followed by female subjects less than one year old.

Among the various types of urinary infection, cystitis is undoubtedly the most widespread.

Two curiosities

In the countries of the Western world:

At least 10% of women develop a urinary infection each year;
As many as 40-60% of women and only 12% of men are subject to a urinary infection at least once in their lifetime.

In depth:

Urethritis Cystitis Prostatitis

Causes

Under normal conditions, the urine is sterile, as is the entire urinary tract, except for the terminal part of the male urethra in which there is a small (and harmless) bacterial microflora. The maintenance of sterility depends on the complete emptying and with a certain frequency of the bladder.

A urinary infection originates when a colony of pathogens - usually bacteria, more rarely fungi and viruses - invades the urethra massively and, from here, begins to rise towards the bladder and subsequent districts of the apparatus urinary.

What are the most common pathogens of urinary infections?

The urinary infections acquired in the community environment are due to: the bacterium Escherichia coli (or E. coli ), in 80-85% of cases; the bacterium Staphylococcus saprophyticus, in 5-10% of cases; finally, to a fungus or a virus, in the percentage that remains.

With regard to urinary infections acquired in the healthcare environment, the situation is quite different; in fact, these infections depend on: Escherichia coli, in 27% of cases; the bacterium Klebsiella, in 11% of cases; the bacterium Pseudomonas, in another 11% of cases; the fungus Candida albicans, in 9% of cases; the Enterococcus bacterium, in 7% of cases; finally, bacteria and fungi different from the previous ones, in the remaining percentage.

ESCHERICHIA COLI AND URINARY INFECTIONS

Escherichia coli is a bacterium that normally populates and without creating particular problems the gastrointestinal tract of human being.

Any problems related to him arise when the gastrointestinal tract moves elsewhere and invades places that are not suited to his presence. This is what happens, for example, during urinary infections: in fact, E. coli causes these last ones when, for example, from the anus it moves towards the nearby urethra and, from here, it goes up along the other districts of the apparatus urinary.

General risk factors: diseases and other circumstances

Urinary infections are commonly found in association with certain pathological conditions, such as:

Diabetes, because it causes immunodepression;
Tuberculosis ;
Congenital malformations of the urinary tract ;
Kidney stones and all those pathological conditions that similarly block or obstruct the transit of urine (eg, benign prostatic hypertrophy ).
Some tumors ;
AIDS, because, like diabetes, it causes immunodepression;
Some neurological conditions, such as spinal cord injuries or multiple sclerosis ;
Vesicoureteral reflux ;
The polycystic kidney ;
Urethral stenosis . It is the abnormal narrowing of the urethra.

Furthermore, urinary infections are also a risk of some circumstances that are not strictly pathological or at all pathological, such as:

Membership in the female sex;
Chemotherapy, because it causes immunodepression;
Use of the catheter for urination ( bladder catheterization );
Intake of corticosteroids;
Menopause and the consequent reduction in the level of estrogen;
Urinary tract surgery;
The very young age;
Particularly intense sexual activity.

Female predisposition to urinary infections: what is it due to?

To make urinary infections a problem with which many women are often forced to live together are mainly: the short urethra, the particular proximity of the urethra to the anal region (this closeness translates into a greater possibility of colonization of the urethral duct by the germs with intestinal site), the absence of bactericidal prostatic secretions, the traumas resulting from sexual intercourse, the use of intrauterine contraceptive devices (spiral or diaphragm) and, finally, pregnancy (for urinary stasis and anatomical and endocrine changes to which it is associated).

What increases the risk of urinary infection in humans and children?

In humans, the risk of urinary infections increases over 50 years, due to urinary retention due to prostatic hypertrophy, a typical condition of older males.

In children of both sexes, on the other hand, the problem of urinary infections is closely related to the immune defenses that are still incomplete.

Symptoms and complications

In general, all urinary tract infections - ie both those affecting the bladder and the urethra, and those affecting the kidneys and ureters - are responsible for:

Impellent urge to urinate, but poor elimination of urine;
Need to urinate more frequently than usual, sometimes associated with nocturia;
Pain or burning sensation during urination (dysuria);
Difficulty of complete emptying of the bladder;
Lower abdomen pain;
Production of cloudy, smelly urine and / or with traces of blood;
Sense of general malaise and fatigue.

However, unlike what happens in the presence of lower urinary tract infections, infections in the upper urinary tract almost always add to these symptoms further manifestations, including;

High fever;
Tremors and chills;
Pain in the hips or back;
Nausea and vomit;
Strange sense of agitation or restlessness.

Urinary infections cause different symptoms depending on the anatomical area of interest. Below is a brief summary of the typical symptomatological patterns of different urinary infections.

Part of infected urinary tract	Signs and symptoms
Kidneys and ureters	Pain in the hips or back High fever Tremors and chills Nausea He retched
Bladder	Sense of pressure at the pelvic level Lower abdomen pain Dysuria, need to urinate often and suddenly Blood in the urine Difficulty of complete emptying of the bladder
Urethra	Sense of burning during urination Production of turbid and foul-smelling urine

How can the symptoms vary in the very young and the elderly

In very young subjects and in the elderly, urinary tract infections can occur in ways other than what is customary.

Indeed:

in newborns they can cause: fever, hypothermia (low temperature), malnutrition and jaundice;
in infants may be due to: vomiting, diarrhea, fever and malnutrition;
in children they can induce: irritability, malnutrition, persistent fever, loss of bowel control, diarrhea and change in urinary habits;
in the elderly they may be responsible for: fever, hypothermia, loss of appetite, lethargy and confusion.

Asymptomatic urinary infections: do they exist?

Sometimes, urinary infections can occur without any significant clinical symptoms, ie they are asymptomatic.

Among the various urinary infections, those that most frequently lack an associated symptom picture are urethritis.

How to notice a urinary infection and when to consult a doctor?

In general, noticing an ongoing urinary infection is quite simple.

An alarm bell should sound whenever symptoms arise such as urgent and frequent urination, difficulty urinating and pain when urinating.

Further concerns, furthermore, should come from the presence, associated with the aforementioned symptoms, of high fever, chills, pain in the lumbar region, general fatigue and fatigue (in these situations it is probable that the upper urinary tract is involved).

In the face of all these manifestations, even when they are blurred or modest, medical consultation is very important.

Complications

If not treated properly or in time, urinary infections can be the cause of several complications, including:

Tendency to easily develop other urinary tract infections;
Permanent kidney damage . It is a possible complication of upper urinary tract infections;
Urethral stricture, especially in men;
In pregnant women, increased risk of giving birth prematurely;
Sepsis.

Diagnosis

For a correct and accurate diagnosis of urinary infections are often sufficient: physical examination, medical history, microscopic examination of urine (see urine test ) and urine culture.

If from these diagnostic procedures the need to further investigate the situation emerges, an imaging test (eg: uro-CT, magnetic resonance of the urinary tract and / or kidney ultrasound) and cystoscopy are useful (if not indispensable).

Microscopic examination: what does it highlight?

The microscopic examination of the urine can show the presence of traces of blood (sometimes visible even with the naked eye) or leukocytes .

Urine culture: how many bacteria indicate a urinary infection?

Values exceeding 100, 000 bacterial colonies per ml of urine are an indication of a current urinary tract infection.

Therapy

The treatment of urinary infections differs according to their cause of origin. If the symptoms are related to an infection not associated with any pathology, the therapy is based, exclusively, on the administration of antibiotics (remember that urinary infections are almost always bacterial). On the contrary, when the infection is determined, for example, by kidney stones or benign prostatic hypertrophy (so there is an associated pathology), the therapy must include not only an antibiotic treatment, but also a specific treatment towards the associated pathological condition ( causal therapy ).

To know more

Drugs for the treatment of cystitis Drugs for the treatment of urethritis Drugs for the treatment of pyelonephritis Lithotripsy

Simple, recurrent and serious infections: how does antibiotic treatment vary?

For simpler urinary infections, a few days (usually a week or so) are sufficient for oral antibiotic therapy .

For recurrent infections, antibiotic treatment involves several months (usually 6, but even more possible) of low-dose oral administrations.

Finally, for serious and acute infections, an intravenous antibiotic treatment implemented in the hospital regime is essential.

For the painful sensation during urination, doctors could prescribe, in addition to antibiotics, also an analgesic (eg: paracetamol).

Some important dietary tips

Urine stagnation inside the bladder is an important predisposing factor for urinary infections; for this reason, it is very important that infected individuals drink a lot of water throughout the day (2 to 3 liters are recommended) and use some diuretic of vegetable origin, such as dandelion, asparagus and fennel.

Among the most common dietary recommendations, temporary renunciation (until the end of treatment) of caffeine-based drinks and fruit juices is included, to avoid any irritation of the bladder.

Personal care

In women affected by recurrent urinary infections, it is very important to respect the rules of intimate hygiene and to adopt the behaviors listed in the article "vaginal flora".

Prognosis

If the therapy is adequate, timely, and implemented in the right way, urinary infections generally have a positive prognosis. Conversely, they could lead to complications, sometimes even very serious.

Prevention

Some of the main medical tips, to prevent urinary infections, are:

empty the bladder completely, especially after sexual intercourse,
drink a lot of water,
adopt a diet rich in fiber and low in fats and animal proteins,
try contraceptive methods other than the spiral or the diaphragm,
provide for intimate hygiene,
avoid potentially irritating intimate products and prefer cotton underwear.

Video

Urinary infections - Causes - Risk factors - Symptoms - Prevention

Directly from the MypersonaltrainerTv studies, this video comprehensively deals with the topic of urinary infections, focusing on the causes, risk factors, symptoms and rules for healthy prevention, also with the help of natural remedies.