What is a UTI?
- A UTI is an infection which can involve any part of the urogenital tract (kidney, ureter, bladder, urethra, prostate, testicles/epididymis)
- Usually when people refer to a UTI, they mean infection of the bladder (cystitis)
- The infection may ascend to the kidney (pyelonephritis), which is more severe
- The infection may also spread to the prostate (prostatitis) or testicles/epididymis (epididymo-orchitis) in men
What causes a UTI?
- If bacteria which normally live in the genital area are introduced into the urinary tract via the urethra (water pipe), they can multiply and cause an infection
- Female urethras are much shorter, which explains why UTIs are more common in women
- The most common bacteria causing UTIs is E.Coli
- In many young women sexual intercourse may cause UTIs on occasion
- Some conditions may increase the risk of UTIs including:
- Obesity
- Diabetes
- Immunosuppression (from medications such as prednisolone, methotrexate, etc)
- Increase age and post-menopausal state
- Anatomical abnormalities in the urinary tract
- Incomplete bladder emptying (high post-void residuals)
- Kidney/bladder stones
What are the symptoms of a UTI?
- Burning/stinging when passing urine (dysuria)
- Frequent passage of urine (frequency)
- Strong urge to pass urine (urgency)
- Bladder/lower abdominal pain
- Fever
- Blood in urine (haematuria)
- Smelly or cloudy urine
- Flank pain – if the infections spreads to the kidney(s) (pyelonephritis)
How are recurrent UTIs evaluated?
- Urine culture – to prove infection exists or is cleared after antibiotics
- Blood tests – including kidney function
- Imaging with kidney tract ultrasound or CT scan to look for:
- Post void residual volume – remaining urine volume in bladder after voiding
- Rule out bladder, kidney stones and other anatomical abnormalities (eg. cancer)
- Flow rate/bladder scan – performed in the office at GM Urology
- Cystoscopy – to look for anatomical abnormalities in the urethra and bladder
How can recurrent UTIs be prevented/treated?
- 1. Antibiotics – best if based on a specific culture result to ensure the bacteria are sensitive to this antibiotic
- A longer course is usually required for recurrent cases (up to 2 weeks)
- 2. Conservative measures
- Increasing fluid (water) intake (>2.5L per day) – to keep flushing the urinary tract and any bacteria present (please check if you have any medical conditions, for which fluid restriction is required)
- Good genital hygiene (eg. wiping front to back, not using soap)
- Voiding after intercourse
- Ensure the bladder does not get too full (timed voiding)
- 3. Medications/supplements
- Cranberry tablets/juice
- Hipprex – a urinary antiseptic
- Antibiotics
- Self-start antibiotic course at first sign of UTI
- Important to send a culture before the first dose
- Post-coital prophylaxis (if UTIs appear to be related to sex)
- Prophylactic course (3-6 months) of low daily dose of antibiotic
- Vaginal pessaries – for post-menopausal women with atrophic vaginitis