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What is UTI?

Posted on08 Jul 2019
Urinary Tract Infections - How to prevent? ​About 25 percent of women with acute cystitis develop recurrent UTIs. Most recurrent infections are from bacteria present in the faecal or periurethral reservoirs.

Some strategies can be undertaken to reduce the risk of recurrent infections.

1. Lifestyle changes -Sexually active women should attempt to void immediately after intercourse to reduce the risk of coitus-related introduction of bacteria into the bladder. Wiping from front to back after going to the toilet to avoid faecal contamination of the urinary tract (especially during an episode of diarrhoea).

Daily consumption of cranberry juice or cranberry tablets. Avoid use of diaphgrams and spermicide by considering other forms of contraception.
Avoid use of deodorants and bubble baths. Drinking plenty of water.

2. Prophylactic antibiotics A once-daily dose of an appropriate antibiotic may be indicated in patients with a history of multiple episodes of UTI to minimise the risk of recurrence of infection.

3. Treatment of any existing structural abnormalities If recurrent UTI occurs against a background of structural abnormalities in the urinary tract (e.g. stones, kidney cysts), consideration should be given to the treatment of these conditions to eradicate the source.

4. Treatment of any vaginal/lower genital tract infection These infections may spread to the urinary tract. As such, they should be treated promptly, if present.

What are the predisposing factors? The largest group of patients with UTIs is that of adult women. Women are more prone to UTIs than men because in females, the urethra is much shorter and closer to the anus.

Other predisposing factors include:
1. Menopause Rates of UTIs are higher in postmenopausal women for a few reasons. For one, the presence of bladder or uterine prolapse can cause incomplete bladder emptying and stasis (reduced or stoppage flow) of urine which in turn promotes the growth of pathogens. Also, the loss of oestrogen after menopause leads to changes in the vaginal flora, especially the loss of lactobacilli, and increases your susceptibility to infection.

2. Sexual activity UTIs are very common in women aged 18-30 years as it is associated with coitus (the so-called ‘honeymoon cystitis’). In this age group, sexual intercourse is the cause of 75 to 90 percent of bladder infections, with the risk of infection being related to the frequency of sex. The use of spermicides and diaphgrams for contraceptive purposes further increases the risk of UTIs as it causes a change in the vaginal flora and eradication of the vaginal lactobacilli.

3. Recent instrumentation of the urinary tract (e.g. catheterisation, cystoscopy, urodynamic studies) The insertion of foreign instruments into the urinary tract promotes the translocation of bacteria colonised around the peri-urethral area into the bladder and other parts of the urinary tract. This increases the risk of developing bacteruria (presence of bacteria in the urine) in significant numbers eventually leading to a UTI.

4. Foreign bodies (e.g. catheters, urinary stones) Urinary catheters are the most important risk factors for bacteriuria. Catheters introduce organisms into the bladder and promote colonisation by providing a foreign surface for bacteria to adhere to and by causing irritation of the bladder mucosa. 80 percent of UTIs that occur while in hospitals or healthcare institutions are related to urethral catheterisation, and 5-10 percent are related to manipulation of the genito-urinary tract. Urinary stones similarly irritate the bladder as well as provide a nidus for bacteria to adhere to, thereby increasing the risk of developing a UTI.

5. Neurological disorders, drugs or pelvic organ prolapse These conditions may cause incomplete emptying of the bladder, thereby promoting stasis of urine which increases the risk of UTI development.

6. Medical conditions (e.g. diabetes) Diabetes leading to glycosuria (sugar in the urine) makes for fertile breeding ground for bacteria. A study showed that 9.4 percent of patients with Type 2 diabetes had a UTI compared to only 5.7 percent of people without diabetes. Urinary Tract Infections - Treatments Empirical antibiotics are usually prescribed for UTIs.

The patient may be prescribed alternative antibiotics after the urine culture results are available. The duration of treatment of the UTI depends on the antibiotic in use. Some common first-choice agents for the treatment of uncomplicated cystitis in women include nitrofuratoin, bactrim or beta-lactams such as cephalexins.

Cran-Max (In LactoCran + Probiotics) Cranberry has a long history of use as a remedy for UTIs, and Cran-Max is a proprietary cranberry concentrate that has been found particularly effective. Anecdotal evidence shows that it may also help prevent UTIs when taken at the first sign of symptoms. UTIs occur when E. coli bacteria attach themselves to cell walls in the bladder. "Cran-Max stops bacteria from adhering," says Sherry Torkos, BSc, Phm, author of The Canadian Encyclopedia of Natural Medicine.

E. coli are shaped like rods, with a lot of surface area that adheres to the interior walls of the bladder. Proanthocyanidins, substances naturally present in cranberries, change the shape of the E. coli into spheres, so there's less surface area for attachment. Cranberry doesn't actually kill the bacteria, but if E. coli can't stick to the bladder, they simply get eliminated without causing any harm. "It takes time to get enough in your system," says Torkos. It's realistic to expect preventive benefits to kick in within the first week.

Study Highlights Studies that followed a total of more than 600 women found that when taken daily, Cran-Max reduces UTIs almost as effectively as a low-dose antibiotic, without the side effects. And because cranberry doesn't kill them, bacteria can't become resistant to it. Another side effect of antibiotics is that they destroy probiotics, beneficial bacteria that are essential for healthy digestion.

A lack of probiotics predisposes women to yeast infections. Recurrent UTI Recurrent UTI is defined as having UTI three or more times in a year. This can be due to the same or different bacteria. In these cases, further investigations may need to be done, e.g. renal ultrasound, intravenous pyelogram, cystoscopy, urine for tuberculosis and cytology, to look for any underlying causes and complications of recurrent UTIs.