Urinary Tract Infections is very common, especially in women. Approximately 50% of adult women report of having some episode of Urinary Tract Infection (UTI) during their lifetime.

UTIs include infections of the bladder (cystitis) and of the kidney (pyelonephritis); most infections in common cystitis are usually cured with a course of antibiotics. Moreover, the presence of bacteria (indicated by positive urine cultures) in the urine sample of a patient with no symptoms, called “asymptomatic bacteriuria” is common in young women. This finding does not necessarily lead to the prescription of an antibiotic, except in special conditions, such as in pregnancy.

What does Urinary Tract Infection (UTI) mean?

When bacteria enters the urinary tract and begins to multiply, it causes UTI. The vast majority of UTIs are bladder infections.

Causes of urinary tract infection in women

UTIs primarily affect women. It is believed that this is mainly due to the proximity of the urethral orifice and anus to the urethra, which is also shorter in comparison to men. Most UTIs are caused by the bacterium, Escherichia coli (E. coli), which is one of the most common microbes in feces. A fecal contamination can determine the path of a microorganism such as E. Coli to the urethra. These bacteria then pass into the bladder (and sometimes back up to the kidney) causing an infection. Certainly the E.COLI includes abilities that make it easy to cause UTI, such as the ability to adhere itself to the surface cells of the urethra and bladder.

What are the risk factors for the development of UTI?

The entry of bacteria into the urethra is affected by several factors, including factors related to the sex activity. The use of spermicides, particularly in combination with the diaphragm, seems to increase the risk of developing a UTI in women.

Some women are prone to recurrent UTIs. Factors that may predispose a young woman to repeated episodes of UTI are:

• The sexual activities

• The use of spermicides

• Genetic factors

• A new sexual partner

Some medical conditions can sometimes lead to UTIs that are more serious than a simple cystitis. These factors include:

• The indwelling bladder catheter
• A recent surgery/operation on the urological tract
• Anatomical abnormalities of the urinary tract
• Neurogenic bladder (bladder paralysis due to neurological disorders)
• Pregnancy
• Diabetes
• Age over 65 years, and the presence of urinary tract obstruction.

What are the symptoms of Urinary Tract Infection in women?

The typical symptoms of acute cystitis are:

• Frequent need to urinate
• Pain or burning during urination
• Blood in urine
• Discomfort in the middle of the lower abdomen (suprapubic pain)
• Lumbago (low back pain) in the bladder (generally below the navel),
• Urine that gives off a foul odor, which may seem cloudy

Patients also complaint frequently with vaginitis (inflammation of the vagina) or urethritis (inflammation of the urethra). The presence of blood in the urine is common in cystitis, but not in the other two conditions. The vaginal discharge, bad odor, itching or pain during sexual intercourse is typical symptoms of vaginitis.

Many of these symptoms occur with kidney infection, where it seems to the make patient sicker by developing a fever with shaking chills, flank pain or back pain, severe fatigue or vomiting.

Here are some tips to prevent cystitis:

• Try to urinate before having sex
• Drink plenty of water
• Do not hold pee for too long, leading to excessive concentration of bacteria.
• Do not wear jeans or pants too tight, which facilitate the implantation of bacteria.
• Do not abuse the cleansers, which can alter the pH and lower the body’s defenses.
• Try to avoid the use of tampons as much as possible
• Regular bowel movements, as free as possible, helps to prevent cystitis

Natural protective mechanisms

Most urinary tract infections are caused by the transfer of germs from the anus to the urethra. In the intestine, they occur naturally and there also have no pathological significance. If they get to the urethra, they multiply greatly, and continue to rise. This leads to inflammation of the tissue. Usually, a lot of fluid intake and frequent urination prevents the bacteria to settle in the urethra. In addition, the vaginal milieu represents a barrier that protects the entrance to the urethra.

Frequent pathogen

The most common causes are bacteria Enterococci and Escherichia coli, which can propagate to body due to poor hygiene, but can also be partially transmitted through sexual contact. Other bacteria include Staphylococcus, Proteus mirabilis, gonococcal (caused by gonorrhea), yeast (Candida), chlamydia , and certain viruses.

ANATOMICAL CAUSES

There are a number of reasons why the natural protective function of the body is lowered, so that a urinary tract infection can occur. The anatomy of the woman is the reason behind it. By a relatively short urethra, the bacterium gets a quicker way to the bladder. In addition, another reason is that urethra and anus are closer in women anatomically than in men, hence the chances of infection is much greater in women.

The congenital or acquired malformations of the urinary tract may also be responsible, for example, too narrow or a short urethra. These changes can lead to urinary obstruction or reflux of urine from the bladder into the kidneys. If the urine can not drain properly, it becomes easier for the bacteria to ascend into the urinary tract.

PHYSIOLOGICAL CAUSES

Often, even a weakened immune system, or hormonal change causes the emergence of a urine infection.

•        Changes in hormone levels

During the menstrual cycle, the amount of estrogen produced by the body varies than in normal days. A certain amount of estrogen is necessary for the lactobacilli, which colonize the vagina and grow and can proliferate there to provide the acidic environment. When the body is missing estrogen, such as for example in the case of menopause, the number of lactobacilli decreases which were providing a protective function. This affects the urethra, because it is not more in the protective effect benefiting from the vagina and exposed to the increased attacks by bacteria. That is why women tend to acquire increased urinary tract infections after menopause.

•        Susceptibility to infection

Some women get a urinary tract infection very easily, while others almost never it. It is now believed that the pathogenesis of urinary tract infections, the immunological-biological defects play a more important role. This means that infections of the urinary tract occur especially when a weakened immune system is present with increased susceptibility to infection. This can be caused by conditions such as stress, diabetes, and physical overwork as well as by certain medications.

OTHER CAUSES

•   Exaggerated Feminine Hygiene

Using too much soap or lotion can affect the natural protective function of the mucous membranes. In these cases, it is easier for the pathogen to establish itself in the mucous membranes.

•   Descending infection

In rarer cases, a urinary tract infection may be caused by inflammation of the kidneys with fistulas occurring (transitional compounds) between the bowel and urinary tract infection, and/or spread from any other body organ through the bloodstream or lymphatic system.

•   Underlying diseases

Also, underlying diseases of the urinary tract and kidneys, resulting in residual urine, such as kidney stones, prostate enlargement and congenital malformations are associated with increased susceptibility to urinary tract infections.

•   Low fluid intake

The risk for a urinary tract infection also increases with low fluid intake, since the urinary tract is not sufficiently flushed.

•   Catheter

Any form of catheterization (inserting a tube in the urethra for diagnostic or therapeutic purposes by the doctor) carries a risk of urinary tract infection. Particularly affected are patients, who require an indwelling catheter, such as paraplegic persons.

•   Frequent sexual intercourse

Very frequent intercourse can lead to mechanical irritation of the mucous membranes, which facilitates intestinal bacteria to ascend into the urinary tract.

Bladder Infections are caused by different inflammation causing microorganisms reaching the urinary tract, where they multiply and cause changes in normal kidney function and the urinary tract.

Statistics from different places in the world tells that bladder infections are the most common infections, even more common than respiratory infection, cough and sputum. Experts even say as one out of two women suffered from at least one episode of cystitis, a form of urinary infection in their life.

Urinary infections are found at:

Lower urinary tract:      Urethra (called urethritis infection), bladder (cystitis).

Upper urinary tract:      Ureters, kidneys (called nephritis infections, with variants pyelonephritis, glomerulonephritis).

Can be recurrent disease?

They return periodically throughout life, although it needs to be treated very accurately at correct time to get rid of infection.

Urinary infection, if there are discovered later, must be viewed very seriously every time and treated appropriately.

What causes Bladder Infections?

The most frequently involved bacterias are – Echerichia Coli (80%), Proteus, Pseudomonas, Klebsiella, Enterobacter, Staphylococcus (saprophyticus, Staphylococcus aureus). There are sexually transmitted infections character, caused by mycoplasmas (M. hominis, M. genitalium), Ureaplasma urealyticum, Chlamydia trachomatis, Trichomonasvaginalis, Neisseria gonorrhoeae frequently cause urethritis, prostatitis, cystitis rarely.

Other causative agents can be involved: Candida albicans, Gardnerella vaginalis, Herpes simplex, adenoviruses, citomegalavirusurile, and anaerobic germs, such as Corinebacterium genitalis.

The role of family physician is to recognize these problems and ensure necessary consultation of specialists in the field (Dermatology, urologist).

Pathogens (e.g. bacteria, fungi) can enter the urinary tract through:

• the urethra into the bladder: with the existence of reflux in bladder-ureter, e.g. during intercourse.

• the kidneys by blood: pathogens can cause an outbreak of infection in the body by reaching the kidneys through blood. (every minute, approximately 1.2 liters of blood passes through the kidneys at a normal cardiac output of 5 liters per minute. It follows that about 24% of cardiac output reaches the kidneys, which provides organs with abundant supply of blood).

• a direct way: e.g. bladder catheter.

Predisposing Factor

It is prevalent more in females due to:

• Short length of urethra, in comparison to males
• Urethral orifice opening into the vagina, where bacteria may exist, and which may enter the urethra during intercourse or poor hygiene.
• Use of contraceptives (diaphragms – spermicidal, spermicide)
• Genetic predisposition
• Instrumental usage in pregnancy, urological maneuvers
• Inadequate fluid intake, which disrupts the rhythm of urination and bladder emptying
• Diabetes mellitus
• Urinary obstruction
• Neurogenic bladder dysfunction
• Colitis
• Constipation
• Chronic biliary disease
• Renal stones
• Genital infections, bladder spasms and vesiculobullous

What are the symptoms Bladder Infections?

Symptoms of UTIs include:

• Dysuria (discomfort in urination)
• Polyuria (increased number of daily urination)
• Nocturia (urination at night)
• Incontinence (involuntary loss of urine)
• Nocturnal enuresis (bed wetting at night)
• Urethral pain
• Pain in lower back
• Hematuria (blood in urine)
• Fever
• Shivering

Analysis to detect Bladder Infections

Urinalysis and urine culture are essential to detect UTI in their wake, so it can be correctly stated and treatment of infection can be initiated.

Abdominal ultrasound is useful in the detection of renal malformations, there are other blood tests that your GP will prescribe to identify renal function (urea, creatinine) or signs of inflammation (ESR, fibrinogen) or anemia (blood count).

How to treat Bladder Infections?

Most urinary tract infections are treated successfully with antibiotics. Antibiotic therapy targets to lower urinary tract infections, relieve symptoms, eliminate infection and prevent its recurrence, and prevention of severe complications such as kidney disease and septicemia (generalized infection caused by the release status of a pathogen).

In pregnant women, protection of the fetus is also essential while undergoing the treatment of bladder infection.

Initial Treatment of Bladder Infections

In women with uncomplicated bladder infections, antibiotic treatment duration is three days. However, in pregnant women, treatment course and duration may differ.

At home, it is recommend to consume lots of water and other liquids (tea, juice), thus favoring diuresis (urination), increasing the frequency of emptying the bladder.

It is important to tell your doctor, if you have other symptoms such as back pain (back) and fever (especially a fever over 38°C, which could mean that the infection has spread to the kidneys).

It is also very important to correctly follow the exact instructions from the doctor, for example, not taking pills at the right time could make treatment ineffective and may allow development of a kidney infection (pyelonephritis).

Antibiotics administered orally (by mouth) are effective in kidney infection (pyelonephritis). But in some cases when the condition is more serious or the patient has nausea, where she not able to take oral medication, it requires a short hospitalization for intravenous antibiotics (antibiotics injected into the vein).

Kidney infections (pyelonephritis) are usually more serious than bladder infections. Once the patient feels better after treatment, she can take oral antibiotics again for two weeks. After treatment, a new urine test is done to guarantee the status of healing infection.

Duration of antibiotic treatment for urinary tract infections may be longer. In the following situations, more analysis is needed, both before and after treatment:

• pregnant women
• people with diabetes
• immunocompromised individuals (people with overactive immune systems, whose immune systems are suppressed with azathioprine drugs).
• people over 65

In men, urinary tract infections usually require one or two weeks of treatment. Also, some additional analysis and targeted therapies for prostate problems (prostatitis) and STDs (Chlamydia trachomatis infection or gonorrhea) are needed.

Hospitalization is required in cases of kidney infection (pyelonephritis), or when severe bladder or kidney infections are complicated by other factors. The patient can be quickly treated for a urinary tract infection, if he or she acts quickly at the initial signs of disease, such as pain and burning when urinating.

Besides taking antibiotics and NSAIDs and antispasmodics, the recommended treatment at home involves consuming large amounts of liquids, especially in the first 24 hours of symptoms. It will result in the formation of less concentrated urine; with frequent urination, the tract where bacteria can cause infection is “washed”, each time the bladder is emptied completely.

How to prevent Bladder Infections?

• Ensure personal hygiene, including the perineal region
• Sanitation for gynecological infectious outbreaks or other chronic infectious outbreaks
• Treatment of intestinal disorders
• Avoid constipation
• Stopping contraceptives in recurrent urinary tract infections
• Increased consumption of fluids every day: it determines the frequency of urination, thus clearing the urinary tract of bacteria
• Avoiding straining to urinate.

Most often, symptoms of bladder infection in women appear as frequent pain during urination. And since such pain is tolerable to certain extent, many patients with the disease to attempt to self-medicate, which they feel would be effective. But, this is not the right way – symptoms of bladder infection (cystitis) are only temporarily, and the infection is likely to come back again, leading to a complication.

It is known that this is a widespread disease, which occurs mostly in women. According to various sources, 30% to 50% of women consult a doctor about this disease. The incidence of cystitis in men of reproductive age is extremely low and does not exceed 6.8 per 1,000 people per year. This difference of such an incidence is due to anatomical features of women (short and wide urethra, which servers as a better place for the bacteria).
The most effective way to treat bladder infection depends on the stage of the disease. If the treatment of the disease is delayed, it results in the so-called chronic cystitis, will be more complicated, and takes much more time and money for cure.
Symptoms of bladder infection in women
Cystitis has fairly typical symptoms, so diagnosis in often not initiated, even after the basis of complaints. The most common symptoms include:

• Frequent urination in small amounts
• Pain, cramps, burning sensation in the abdomen and the perineum during and after urination
• A feeling of incomplete emptying of the bladder
• Feeling of incontinence and strong urge to urinate subject to episodes, because of inflammation of external anal sphincter of the bladder, a common symptom cervical cystitis.
• Urine becomes turbid, it may be darkening, the appearance of impurity levels (in the form of hemorrhagic cystitis)
• In some cases, body temperature may increase.

Symptoms of chronic bladder infection in women are the same as in the acute form, but they are often less pronounced.

IMPORTANT: If the above symptoms, the temperature exceed 38 degrees, and there is a fever, the person should immediately contact a urologist. Such a body temperature may indicate incipient inflammation of the kidneys – pyelonephritis.

Cystitis in women should be treated at the earliest, to get rid of it forever.

Diagnosis of bladder infection in women

Diagnosis of acute disease is not difficult, if sufficiently tests are made of acute cystitis urinalysis and blood only to confirm inflammation.

In cases where the patient has a chronic indolent inflammation of the bladder, adequate treatment is not possible without a precise identification of micro-organisms causing inflammation, as well as their sensitivity to antibiotics. Therefore, performing urine culture is mandatory method for diagnosing this disease.

Prevention of bladder infection (cystitis) in women

1.   Eliminate negative factors as much as possible, such as stress, exhaustion, hypothermia.

2.   In your diet, include various vegetables and fruit.

3.   Reduce the consumption of fried, greasy, spicy foods, and stop smoking.

4.   Also recommended to drink one glass of cranberry juice, or cranberry fruit drink each day.

5.   Daily fluid intake should be at least 2 liters.

6.   If possible, urinate at first urge, and don’t suppress urine.