Overview
Urinary tract infections are bacterial infections of the urinary tract, namely the kidney, ureter, bladder, and urethra. When bacteria are found in your pee, it’s called bacteriuria, and it’s usually a sign of a urinary tract infection (Lee & Neild, 2007). UTIs are one of the most widespread bacterial illnesses, afflicting 150 million individuals annually worldwide (Flores-Mireles et al., 2015). Approximately half of all women are expected to have at least one occurrence of urinary tract infection (UTI) at some point in their lifetime. Among these women, around 25% are likely to have recurrent UTIs (Flores-Mireles et al., 2019). UTIs can lead to various health problems and complications in people of all ages and genders, but infants, older men, and women are particularly at risk for experiencing significant health issues related to UTIs (Flores-Mireles et al., 2015).
What causes UTIs?
E. coli, a type of bacteria, is the most frequent culprit behind UTIs (Flores-Mireles et al., 2015). UTIs usually start when harmful bacteria get into the area around the urethra, the tube-like structure that connects the urinary bladder to the external opening of the body. From there, they travel up to the bladder and sometimes even up to the kidneys (Bono et al., 2023). These bacteria cause damage to the cells in the urinary tract. In uncomplicated UTIs, the bacteria can multiply and form a biofilm which is a protective layer formed by bacteria. This biofilm can make it difficult for antibiotics to reach and fight the bacteria underneath and, thereby, harder for the immune system to clear the infection. If left untreated, the bacteria can enter the bloodstream and spread throughout the body. This can lead to a severe and life-threatening condition called sepsis which can eventually lead to death. In complicated UTIs, the bladder is damaged by things like urinary catheters, which are thin, flexible tubes inserted into the bladder through the urethra to help urine drain out of the body when a person is unable to pass urine normally. The catheters in the urinary tract induce changes in the bladder, creating a good environment for bacteria to attach and grow. These bacteria can also spread to the kidneys and bloodstream if left untreated (Flores-Mireles et al., 2019).
What makes someone prone to UTIs?
- Women tend to get UTIs more often than men because their urethra is shorter, which makes it easier for bacteria to get into their bladder and cause infection (Bono et al., 2023).
- Pregnant women are also at a higher risk for UTIs, which can be dangerous for both the mother and the baby (Gupta et al., 2017). The growing womb during pregnancy can put pressure on the urinary tract and potentially obstruct the flow of urine. Also, hormonal changes during pregnancy can make it easier for UTIs to happen and harder to treat them (Neal, 2008).
- People with certain health conditions, such as diabetes, problems with their bladder nerves, spinal cord injuries, prostate enlargement, or having had a medical procedure involving their urinary tract, are also more likely to get UTIs (Gupta et al., 2017). Diabetic patients are more likely to develop widespread bloodstream infections due to poor glucose control (Gupta et al., 2017). Increased glucose levels in urine encourage the proliferation of harmful bacteria. When the nerves controlling the bladder and urinary system are damaged in people with diabetes, it can cause problems with emptying the bladder properly and holding urine. As a result, germs may remain in the urinary system for prolonged periods, which may facilitate their growth and ability to cause illnesses (Saliba et al., 2015).
- Conditions such as spinal cord injury or neurogenic bladder can make it difficult for the bladder to empty urine, allowing bacteria to grow and cause infections (Neal, 2008). When an intervention is done on the urinary tract, it can make a person more likely to get UTIs because it can damage the lining of the urinary tract. Also, the stitches used in the surgery can lead to infections and blockages (Neal, 2008).
Clinical Types
Depending on the part of the urinary tract involved, UTIs can be classified as:
- Urethritis (infection of the urethra),
- Vaginitis (infection of the vagina),
- Cystitis (infection of the urinary bladder),
- Prostatitis (infection of the prostate gland, in males),
- Pyelonephritis (infection of the kidneys).
Asymptomatic UTI is the presence of bacteria in urine without any clinical symptoms (Lee & Neild, 2007).
UTIs are also classified as uncomplicated or complicated. Uncomplicated UTIs generally occur in healthy individuals with the normal structural and functional integrity of the urinary tract. Complicated UTIs, however, are associated with specific patient factors such as using a urinary catheter, urinary blockages brought on by stones or retention, weakened immune systems, renal failure, kidney transplantation, and pregnancy (Flores-Mireles et al., 2019).
Symptoms of UTIs include:
- Pain or burning during urination
- Increased frequency of urination
- The urgency of urination (Gupta et al., 2017)
- Discharge from urethra
- Blood in urine
- Cloudy urine and strong-smelling urine
- Fever, chills, nausea, and back discomfort in some cases where kidneys get affected (Lee & Neild, 2007)
How does your doctor know if you have UTIs?
To check if someone has UTI, the doctor will ask them to give a sample of their urine in a clean cup. The urine will be checked for things like acidity level, certain chemicals, and the presence of blood or white blood cells. If any of these tests show a problem, the doctor will look at the pee under a microscope to see if there are bacteria or other signs of an infection (Bono et al., 2023). In some cases, a urine culture test may be done to figure out what type of bacteria is causing the infection (Bono et al., 2023). Additional tests are required to rule out the presence of stones or obstruction in recurrent UTIs (Lee & Neild, 2007).
Treatment of UTIs
UTIs are typically treated with broad-spectrum antibiotics, which are medications that cover a wide range of disease-causing organisms on an empirical basis. Ampicillin, ciprofloxacin, and trimethoprim-sulfamethoxazole are a few of the most often suggested antibiotics for UTIs (Flores-Mireles et al., 2015).
Uncomplicated UTIs are typically treated with short-term therapy, which may involve Nitrofurantoin for 5-7 days, Trimethoprim/Sulfamethoxazole for three days, or a single-dose therapy with fosfomycin (Bono et al., 2023).
About 20% of women will experience spontaneous resolution of their UTIs even without treatment, especially if increased hydration is employed (Bono et al., 2023).
Sachets of Sodium Citrate, a chemical compound that makes urine alkaline, have been proven to provide relief from symptoms (Spooner, 1984).
Additional Measures to Prevent UTIs:
- Regular consumption of cranberry juice
- Increased water intake
- Urinating before and after sexual intercourse
- Refraining from using antibiotics and spermicidal creams (Lee & Neild, 2007)
References
Bono, M. J., Leslie, S. W., & Reygaert, W. C. (2023). Uncomplicated Urinary Tract Infections. In StatPearls. StatPearls Publishing.
Flores-Mireles, A. L., Walker, J. N., Caparon, M., & Hultgren, S. J. (2015). Urinary tract infections: Epidemiology, mechanisms of infection and treatment options. Nature News. https://www.nature.com/articles/nrmicro3432
Flores-Mireles, A., Hreha, T. N., & Hunstad, D. A. (2019). Pathophysiology, treatment, and prevention of catheter-associated urinary tract infection. Topics in Spinal Cord Injury Rehabilitation, 25(3), 228–240. https://doi.org/10.1310/sci2503-228
Gupta, K., Grigoryan, L., & Trautner, B. (2017). Urinary tract infection. Annals of Internal Medicine, 167(7). https://doi.org/10.7326/aitc201710030
Lee, J. B. L., & Neild, G. H. (2007). Urinary tract infection. Medicine, 35(8), 423–428. https://doi.org/10.1016/j.mpmed.2007.05.009
Neal, D. E. (2008). Complicated urinary tract infections. Urologic Clinics of North America, 35(1), 13–22. https://doi.org/10.1016/j.ucl.2007.09.010
Saliba, W., Nitzan, O., Chazan, B., & Elias, M. (2015). Urinary tract infections in patients with type 2 diabetes mellitus: Review of prevalence, diagnosis, and management. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 129. https://doi.org/10.2147/dmso.s51792
Spooner, J. B. (1984). Alkalinisation in the management of cystitis. Journal of International Medical Research, 12(1), 30–34. https://doi.org/10.1177/030006058401200105
Provided and edited by the members of MARI Research, Error in Medicine Foundation and MISMEDICINE Research Institute, including Shiwani Kashyap, Helia Falahatkar and Dr. Pooya Beigi MD. MSc.
