Little steps to keep urinary infection at bay

By Smriti Daniel

Within their lifetime, a vast majority of women will have at least one episode of urinary infection. Though urinary infections are less common in men, they can be very serious when they do occur. Urinary infections are known to afflict people of all ages, from infancy into old age, says Dr. Anura Wijewardane, Consultant Urologist. This week he speaks to Mediscene about how the infection spreads, and what you can do to help your body defeat it.

A matter of anatomy

Together, the kidneys, ureters, bladder, and urethra make up the urinary system. Within this, the kidneys (located toward the lower back) play a particularly critical role. They filter waste and excess water out of the blood, draining it in the form of urine. They also produce essential hormones that help regulate the production of red blood cells, among other things.

The urine produced in the kidney is collected and carried out through the narrow tubes known as ureters and into the bladder. (Like a balloon, the bladder can stretch to accommodate a surprisingly large quantity of urine.) Urine from the bladder is then emptied through the urethra.

There is a reason that urinary tract infections are described as “ascending” says Dr. Wijewardane, explaining that an infection typically occurs when bacteria from the digestive tract begin to proliferate around the urethra.

If the infection remains confined to the urethra it is known as urethritis, but if it begins to climb until the bladder is also affected then it is known as cystitis. In the most serious case of all, the bacteria can travel through the ureter and colonize the kidneys, in which case patients must be diagnosed with pyelonephritis.

In most cases the bacteria known as Escherichia coli (E. coli) is the culprit. Living in the colon, it is also found in the area between the genitals and the anus (perineum) – and due to the proximity of the two, E.coli can easily come into contact with the urethra.

Raising the body’s defences

Fortunately, E.coli will not find it easy to take hold. In place are a few simple measures that will, more often than not, defeat the infection. The design of the ureters and bladder prevents urine from flowing back up. Instead every time you use the toilet, the body ‘flushes’ out any offending bacteria, with each successive urination diluting the density of the gathered bacteria. We have our own washroom inside, says Dr. Wijewardane. In both sexes, secretions are released from the lining of the urinary tract that actively discourage bacterial infections, he adds. So why do infections still occur?

A hint may be found in the fact that among the most vulnerable are women who have recently become sexually active and women who are in menopause. While it is not fully understood why women are more vulnerable to urinary tract infections, some speculate the answer is in the very structure of her urinary system. First, there is the close proximity between her perineum and her urethral opening. Then, with her shorter urethra, an infection can climb more quickly up to a woman’s bladder, says Dr. Wijewardane. As she hits menopause, a drop in her estrogen levels can further contribute to urethral stenosis, the narrowing of her urethra, leading to the improper drainage of urine. In the meantime, other defensive secretions will decline to counteract the migrating bacteria, he explains. If the bladder is not draining fully, the risk of contracting infection is so much more.

In men, an enlarged prostrate can block the flow of urine and trigger an infection too. Further up, in either sex, something like a kidney stone blocking the ureter will have the same effect. However, for those born with congenital abnormalities of the urethra or ureters, blockages can induce painful infections in childhood. In some cases surgery will be required to correct the problem.

Dr. Wijewardane points out that patients with weakened immune systems, such as those with diabetes, cancer or on chemotherapy, are more vulnerable. When hospitalised, some of these patients are forced to rely on catheters to drain the bladder and this is a common source of infection which is why they must be cleaned frequently.

Symptoms of infection

While a lucky few will not have symptoms, a majority of those with urinary tract infections present with at least one symptom. Most common among these are an increase in the urgency felt and an increase in frequency of urination, says Dr. Wijewardane, adding that patients will typically complain of a burning sensation while passing urine. Though the urge to use the facilities might be frequent, only a very small amount of urine might actually be passed with some pain and sometimes stained with blood. It is not unusual to also feel tired and weak. Pain over the bladder region (supr pubic) too can occur with cystititis
If the infection has travelled to the kidneys symptoms are likely to be considerably more serious.

Patients have reported fever, chills and rigors, nausea and lingering pain and in such cases you are advised to seek a doctor’s opinion as soon as possible. When an infection occurs in the kidney following a blockage of the Ureter with stone it can lead to very serious infection and one could become very ill. It is worth making a note of the colour of your urine – some patients describe it as cloudy and for others it might be tinged with blood.

Diagnosis, treatment and the risk of recurrent infections

In most cases, your doctor will ask you to take a urine test which is meant to identify any pus and bacteria. (Though urine contains the body’s waste, it is sterile, i.e it is free from the likes of bacteria and fungi.) Typically, you will be asked to collect the sample ‘midstream’ so that bacteria found around the genital area do not confuse the results. Dr. Wijewardane emphasises that this must be done using a sterile container at a reputable laboratory to ensure good results. This test is called Urine Full report [MSSU], Culture and ABST.

Once the diagnosis is confirmed, your doctor will usually put you on a course of antibacterial antibiotics. In some patients, urinary infections will recur many times. While a first urinary infection might not warrant extensive testing, a doctor might decide to do this should your infection reappear within a few months of the first.

Tests such as Ulltra Sound Scan,x-rays, some times CT scans and endoscopy examination of the Bladder[Cystoscopy] will reveal if there is an abnormality in the urinary tract and interventional treatment may be required if one is discovered. If not, doctors will sometimes opt to put patients with recurring urinary infections on a course of preventive antibiotics. It is essential that these are not taken haphazardly, cautions Dr. Wijewardane, explaining that their efficacy will be greatly reduced.

Dr. Wijewardane also makes these simple suggestions:

Drink plenty of water – at least 2 ½ litres everyday. Some doctors recommend the consumption of Vitamin C rich liquids like lime juice.

Maintain good personal hygiene. After using the facilities, women should wipe front to back to control the spread of bacteria.

Use the facilities frequently. Avoid keeping your bladder full for long periods of time.

After sexual activity, make it a point to urinate within 15 minutes.

Avoid constipation as this can interfere with your bladder

Avoiding misdiagnosis

While the symptoms of urinary infection are well known, what is less known is how these can be brought on by more serious conditions such as cancer or kidney disease. The symptoms could also occasionally be induced by microorganisms like chlamydia and mycoplasma which may be sexually transmitted. If you have had a worrying sexual encounter recently, it is best to be open with your doctor so he can treat you appropriately, says Dr. Wijewardane.

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