Definition

A urinary tract infection (UTI) is an infection that affects the urinary system, including the kidneys, ureters, bladder, and urethra. UTIs commonly occur in the lower urinary tract, affecting the bladder (cystitis) and the urethra (urethritis). UTIs are more prevalent in females, with about 50% of women experiencing this infection at least once in their lifetime. However, it's important to note that men can also develop UTIs, and about 1 in 10 men will have a UTI during their lifetime.

Causes

Urinary tract infections (UTIs) occur when bacteria enter the urinary system and cause infection. These bacteria typically enter through the urethra, the tube that carries urine from the bladder out of the body and can proliferate anywhere along the urinary tract. The most common bacteria responsible for UTIs is Escherichia coli (E. coli), commonly found in the digestive tract. These bacteria can migrate to the urethra and overcome the body's natural defenses, leading to infection. Various factors can contribute to the transfer of these bacteria, including inadequate genital area hygiene, sexual intercourse, and other factors.

Risk factor

UTIs are more common in females than males due to various factors that increase the risk among women:

• Female urinary tract anatomy: The female urethra is shorter and located near the vagina and anus, making it easier for bacteria to migrate to the urinary tract.
• High sexual activity: Increased sexual activity can introduce bacteria into the urinary tract, increasing the risk of infection.
• Hormonal factors: Circulation of estrogen hormones can make the urinary tract more susceptible to infection.
• Contraceptive methods: Certain contraceptive methods, such as diaphragms and unlubricated condoms, can increase the risk of UTIs.
• Pregnancy: Hormonal and physiological changes during pregnancy can predispose women to UTIs.
• Poor genital hygiene: Leaving the genital area moist and unclean can create a conducive environment for bacterial growth.

Other non-specific risk factors for UTIs include:

• Abnormal urinary tract anatomy.
• Urinary tract blockages (e.g., kidney stones, prostate enlargement).
• Decreased immune system function (e.g., diabetes, chemotherapy).
• Long-term use of urinary catheters.
• Previous surgical procedures on the urinary system.
• Presence of sexually transmitted infections.
• Inadequate water intake.

Symptoms

Symptoms of a UTI arise due to irritation in the infected urinary tract. Common symptoms include:

• Strong urge to urinate.
• Pain or burning sensation during urination.
• Pain in the lower abdomen or lower back.
• Increased frequency of urination but only passing small amounts of urine.
• Changes in urine color, such as cloudy appearance or red, pink, or brown coloration.
• Strong-smelling urine.
• Fever or chills, which may indicate that the infection has spread to the kidneys.

Diagnosis

Diagnosis can be established through symptoms and examinations conducted by the doctor. The examination or diagnostic tests may include:

• Urine Test or Urinalysis

This laboratory test involves analyzing the urine for the presence of red blood cells, white blood cells, or bacteria. Before collecting the sample, it's important to clean the genital area with an antiseptic cloth. The urine sample should then be collected midstream.

• Urine Culture

This test aims to observe bacterial growth from the urine sample and identify the specific bacteria present. This helps determine the most appropriate antibiotic treatment.

• Imaging Tests

Imaging tests such as ultrasound (USG), CT scan, or MRI may be performed, especially for recurrent urinary tract infections, to assess whether the infection has reached the kidneys. These tests also help visualize the anatomical structure of the urinary tract. Additionally, cystoscopy may be conducted in some cases. This procedure involves inserting a long, thin tube with a camera attached through the urethra to visualize the urethra and bladder. Cystoscopy can be uncomfortable and is reserved for specific cases of recurrent urinary tract infections.

Management

The treatment of UTIs often requires antibiotics, which are prescribed by a doctor to kill the infecting bacteria. Following the doctor's advice or recommendations for the antibiotics to be effective is crucial. Antibiotics should be taken until finished, even if symptoms have reduced.

If there is pain or a burning sensation when urinating, the doctor may prescribe medication to reduce pain. Painkillers like paracetamol can be effective. Additionally, placing a warm cloth or towel on the abdominal area can alleviate discomfort and reduce pressure on the bladder. Increasing water intake can also help dilute urine.

If UTIs reappear after treatment, the doctor may prescribe a low dosage of antibiotics longer. In cases where UTIs occur three or more times in a year, the doctor may refer the patient to a urologist for further evaluation and management.

Complications

Complications are rare in lower urinary tract infections, but recurrent conditions and inadequate treatment can lead to serious issues. These may include:

• Chronic urinary tract infections typically occurring in women who experience two or more UTIs within one year.
• Permanent kidney damage.
• Increased risk of premature birth in pregnant women and low birth weight in infants.
• Urethral stricture or narrowing in men.
• Sepsis or severe infection, especially if the infection reaches the kidneys.

Prevention

Prevention can begin early with some effective measures, including:

• Stay hydrated by drinking an adequate amount of water.
• Reduce consumption of coffee, alcohol, and soda beverages containing citrus juice, as they can irritate the bladder and worsen inflammation.
• Clean the genital area from front to back to prevent bacteria from the anus or vagina from spreading to the urethra.
• Urinate after sexual intercourse and clean the genital area.
• Avoid holding in urine.
• Avoid using products for intimate areas that may irritate the genital area, such as scented products.
• Choose contraceptive methods other than a diaphragm or unlubricated condom.
• Wear cotton underwear to prevent moisture and change underwear when wet. Avoid wearing tight underwear, as moist conditions accelerate bacterial growth.

When to see a doctor?

If you experience symptoms of a urinary tract infection, promptly seek medical attention at the nearest healthcare facility. This condition should be treated appropriately to reduce the risk of recurrent infections and other complications. Be aware of the following warning signs:

• Fever with a very high temperature, accompanied by chills.
• Body temperature dropping below 36°C.
• Decreased consciousness.
• Inability to urinate throughout the day.
• Severe pain in the lower abdomen or lower back.
• Blood is visible in the urine.

If you notice any of the above warning signs, seek medical attention promptly for timely treatment.

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