Urinary Tract Infections

Urinary tract infections (UTI), or acute cystitis, is an inflammation of the mucous membrane of the bladder, typically caused by bacteria that enter the urethra and make their way into the bladder. Once inside the bladder, the bacteria stick to the bladder wall, multiply and cause inflammation and irritation to the bladder lining. The irritation leads to urinary urgency, frequency and dysuria (or burning with urination) – the classic signs of a UTI.

Some people appear to be more likely than are others to develop UTIs. Risk factors for developing acute cystitis include:

• Being female. Urinary tract infections are more common in women than in men because women have a shorter urethra, which cuts down on the distance bacteria must travel to reach the bladder.
• Sexual activity. Women who are sexually active tend to have more UTIs than women who are not sexually active. Intercourse may have a mechanical pushing of bacteria into the urethra.
• Vaginal atrophy. The normal vagina is filled with certain types of bacteria, i.e. “good bacteria.” After menopause, a lack of estrogen causes the tissue inside the vagina to become thin and dry. The pH of the vagina shifts leading to an excess of “bad” bacteria.  Increases in bad bacteria make women more vulnerable to infection.
• Urinary tract abnormalities. Urinary tract abnormalities, normally due to congenital birth defects, may prevent urine from passing from the bladder normally. Urine that does not freely pass from the body has a higher likelihood of creating infections.
• Urinary tract obstructions. Urinary stones in the bladder can trap urine, just like urinary tract abnormalities mentioned above.
• A suppressed immune system. The immune system is the body’s primary defense against germs and infection. Individuals with diseases that compromise their immune systems, such as Lupus and Diabetes, are at an increased risk of infections.
• Using a catheter to urinate. People who experience difficulty urinating may be required to utilize a tube (catheter) in order to drain their bladder. These individuals have an increased risk of urinary tract infections. Patients who are hospitalized, those with neurological problems, and those who are paralyzed are common victims of these types of infections.

The hallmark of treating a UTI lies in treating the cause of the UTI.  While UTIs are caused by bacteria and, most times, are easily treated with antibiotics, care must be taken to address any cause that may have contributed to the development of the UTI.  For instance, if the cause is thought to be sexual activity (“honeymoon cystitis”), a prophylactic dose of antibiotic following intercourse can reduce the chance of infection.  Those with vaginal atrophy should have their atrophy corrected using estrogen creams, suppositories or tablets.  Continued vaginal atrophy can lead to recurrent urinary tract infections (having 2 infections in 6 months, or 3 in 1 year).

Recurrent urinary tract infections without identifiable risk factors may require additional workup, to include renal and/or abdominal ultrasounds, x-rays, and possibly even CT scans.  Additionally, recurrent urinary tract infections may require the need for prolonged, low-dose antibiotic therapy.