URINARY TRACT INFECTION

Recurrent Urinary Tract Infection in women

Urinary tract infection ( UTI ) is 8 times more common in women than men; As per statistics, 50% of women will have at least one episode of UTI during their lifetime.

Recurrent UTI is defined as at least 3 episodes of infection with a positive  culture report during the last 12 months or 2 episodes of infection during the preceding 06 months

Types of UTI

There are 05 categories of UTI

UNCOMPLICATED  UTI – urinary tract infection taking place in a structurally and physiologically normal urinary tract and there is no other  comorbid disease that can impair the host defence mechanism

COMPLICATED UTI – Infection taking place in an abnormal urinary tract like PUJ, ureteric or bladder outlet obstruction like prostate or stricture urethra or vesicoureteric reflux in children etc.

ISOLATED INFECTION – Infections occurring 06 months apart.

UNRESOLVED INFECTION – Infection doesn’t get cleared at all; this happens either bacteria is resistant or two different types of bacteria infect at the same time.

REINFECTION – UTI gets fully treated and culture becomes sterile but the same bacteria grow after 2 weeks of therapy or infection with different bacteria during any period of time. 95% of UTIs in women fall into this category.

Risk Factors for UTI

1. Anatomically, urethral opening in females is closer to the vagina and anal orifice. So the naturally occurring bacteria around vagina and anus can easily enter the urethra. Also, the female urethra is shorter hence, pathogens have to travel a small distance to enter the bladder.
2. The chances of getting a Urinary Tract infection increases with age.  In post menopausal women, UTI is more common  because of reduced oestrogen, loss of lactobacillus (normal in vaginal flora) and increased chances of prolapse. We also see increased incidences of periurethral E. Coli colonisation and increased probability of co-existing medical illnesses such as Diabetes Mellitus in these ladies.
3. Among sexually active pre-menopausal women, the risk of recurrent UTI include
   1. The use of spermicides as a means of contraception.
   2. Frequently changing sexual partners.
   3. The age when first UTI occurred
   4. Maternal history of UTI
   5. Voiding dysfunction
   6. Onset of symptoms soon after sexual activity.
4. Recurrent UTI is also seen more commonly in women who use practises such as using tight undergarments, vaginal douching, wrong wiping technique, deferred voiding habit and voiding patterns pre or post coitus.
5. Women with pre existing medical conditions, immunosuppressive diseases patients or pregnant women are at increased risk of getting recurrent UTI because in such conditions, natural protective mechanisms of our body fail to defeat the overriding pathogens.
6. Other risk factors include – use of catheter for a long time, blockade in the urinary tract (due to stones) and urethral stenosis.

Symptoms of UTI

1. Lower abdominal symptoms which are more common include
   1. Dysuria
   2. Frequent urination
   3. Urgency
   4. Pain right above the pubic region or pelvic area
   5. In some patients, hematuria can occur.
2. Cloudy appearing urine.
3. Foul-smelling urine.
4. Systemic symptoms like fever, chills, fatigue, flank pain or vomiting are seen in certain cases.

These symptoms can appear individually, or some can co-exist together.

UTI Tests & Diagnosis

When you visit a urologist, initial assessment is done by history taking and a clinical examination when required. Most commonly, urine analysis and urine culture for sensitivity are performed to detect the infection. These tests help the doctor chart out an exact plan for individualised treatment.

These help the doctor figure out the causative organism and the type of anti-microbial therapy that is suited to you.

If you get recurrent UTI, a urologist can perform an Ultrasound scan, Uroflowmetry, Intravenous Pyrography (IVP) or a CT Scan to see the complete urinary tract including the kidneys. These radiological tests are also necessary to detect congenital, structural or urogenital problems. In some cases, a procedure known as cystoscopy may be performed which uses a long and flexible tube to assess the bladder and urethra. 

The treatment plan for UTI

No two UTI infections are the same. The treatment depends on whether the infection is bacterial (most common), viral or fungal. The test results would mention the nature of the infection. The treatment also relies on symptoms and co-existing medical conditions which need to be assessed clinically. It is very important to discuss the best possible plan for your treatment with your urologist. The following are the common modalities of treatment in use by doctors:

1. Antimicrobial therapy – This is the most common and most widely used treatment modality. It is very important to determine which part of the tract is affected by the infection. Lower UTI are usually treated with an oral antibiotic course after checking the sensitivity of the organism. Upper UTI may need an intravenous treatment plan.
   
   These antibiotics are always dose-adjusted for patients with co-existing conditions such as renal insufficiency, age, pregnancy, lactation status, diabetes, liver and other organ diseases, immune-compromised state, recurrent infections, hospitalised patients and hydration levels.
2. Adjuvant measures like Oestrogen therapy, Acupuncture and Probiotics have a more preventive role rather than the curative role.
3. Cranberry Juice & Tablets – These contain tannins aka proanthocyanidin which reduce the colonisation of E. coli in  vagina. Hence these may be helpful in prevention.
4. General Measures
   1. Drinking 2-3 litres of water on a daily basis
   2. Urinate frequently to flush out the pathogens
   3. Not trying to hold urine for a long time
   4. Sexual hygiene
   5. Avoiding multiple sex partners also helps prevent sexually transmitted diseases.
   6. Avoiding spermicidal contraceptives, diaphragms, vaginal douching, unlubricated condoms or condoms with spermicide.
   7. Avoiding potentially irritating feminine products such as bubble bath liquids/soaps, various fragranced bath oils, vaginal creams or lotions, deodorant sprays and harsh soaps.
   8. Learn the correct wiping technique – front to back.
   9. Talk to your urologist about any difficulty in fully emptying your bladder.
   10. Avoid self-treatment

Complications of UTI

1. Repeated infections. Women are more likely to have repeated urinary tract infections when not treated properly.
2. Kidney infection and kidney damage due to untreated or incorrectly treated UTI. Collection of pus near kidneys.
3. Scar tissue developing in the urinary tract.
4. The infection spreads to other parts of the body or Urosepsis.
5. In pregnant women, untreated UTI can lead to delivering Low birth weight infants.
6. Infection becoming chronic.