Urinary Tract Infections: Causes, Symptoms, and Prevention, Monografías, Ensayos de Semiología

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Urinary tract infection

A urinary tract infection (UTI) is an infection in any part of the urinary system (kidneys, ureters, bladder and urethra). Most infections involve the lower urinary tract (bladder and the urethra). Women are at

Urinary tract infections are common in women, and many women experience more than one infection during their lifetimes.

Risk factors specific to women for UTIs include:

• Female anatomy. A woman has a shorter urethra than a man does, which shortens the distance that bacteria must travel to reach the bladder.
• Sexual activity. Sexually active women tend to have more UTIs than do women who aren't sexually active. Having a new sexual partner also increases your risk.
• Certain types of birth control. Women who use diaphragms for birth control may be at higher risk, as well as women who use spermicidal agents.
• Menopause. After menopause, a decline in circulating estrogen causes changes in the urinary tract that make you more vulnerable to infection.

Other risk factors for UTIs include:

• Urinary tract abnormalities. Babies born with urinary tract abnormalities that don't allow urine to leave the body normally or cause urine to back up in the urethra have an increased risk of UTIs.
• Blockages in the urinary tract. Kidney stones or an enlarged prostate can trap urine in the bladder and increase the risk of UTIs.
• A suppressed immune system. Diabetes and other diseases that impair the immune system — the body's defense against germs — can increase the risk of UTIs.
• Catheter use. People who can't urinate on their own and use a tube (catheter) to urinate have an increased risk of UTIs. This may include people who are hospitalized, people with neurological problems that make it difficult to control their ability to urinate and people who are paralyzed.
• A recent urinary procedure. Urinary surgery or an exam of your urinary tract that involves medical instruments can both increase your risk of developing a urinary tract infection.

Complications

When treated promptly and properly, lower urinary tract infections rarely lead to complications. But left untreated, a urinary tract infection can have serious consequences.

• Recurrent infections, especially in women who experience two or more UTIs in a six-month period or four or more within a year.
• Permanent kidney damage from an acute or chronic kidney infection (pyelonephritis) due to an untreated UTI.
• Increased risk in pregnant women of delivering low birth weight or premature infants.
• Urethral narrowing (stricture) in men from recurrent urethritis, previously seen with gonococcal urethritis.
• Sepsis, a potentially life-threatening complication of an infection, especially if the infection works its way up your urinary tract to your kidneys.

Symptoms

Urinary tract infections don't always cause signs and symptoms, but when they do they may include:

• A strong, persistent urge to urinate
• A burning sensation when urinating
• Passing frequent, small amounts of urine
• Urine that appears cloudy
• Urine that appears red, bright pink or cola-colored — a sign of blood in the urine
• Strong-smelling urine
• Pelvic pain, in women — especially in the center of the pelvis and around the area of the pubic bone

Types of urinary tract infection

Each type of UTI may result in more-specific signs and symptoms, depending on which part of your urinary tract is infected.

Part of urinary tract affected Signs and symptoms Kidney (acute pyelonephritis) Upper back and side (flank) pain

High fever

Shaking and chills

Nausea

Vomiting Bladder (cystitis) Pelvic pressure

Lower abdomen discomfort

Blood in urine Urethra(urethritis) Burning with urination

Discharge

Prevention

You can take these steps to reduce your risk of urinary tract infections:

• Drink plenty of liquids, especially water. Drinking water helps dilute your urine and ensures that you'll urinate more frequently — allowing bacteria to be flushed from your urinary tract before an infection can begin.
• Drink cranberry juice. Although studies are not conclusive that cranberry juice prevents UTIs, it is likely not harmful.
• Wipe from front to back. Doing so after urinating and after a bowel movement helps prevent bacteria in the anal region from spreading to the vagina and urethra.
• Empty your bladder soon after intercourse. Also, drink a full glass of water to help flush bacteria.

Often, symptoms clear up within a few days of treatment. But you may need to continue

antibiotics for a week or more. Take the entire course of antibiotics as prescribed.

For an uncomplicated UTI that occurs when you're otherwise healthy, your doctor may

recommend a shorter course of treatment, such as taking an antibiotic for one to three

days. But whether this short course of treatment is enough to treat your infection

depends on your particular symptoms and medical history.

Your doctor may also prescribe a pain medication (analgesic) that numbs your bladder

and urethra to relieve burning while urinating, but pain usually is relieved soon after

starting an antibiotic.

Conclusions

Although UTIs are often considered to be easily managed infections, they remain a huge burden for millions of individuals and our healthcare system. The increasing prevalence of antibiotic resistance among uropathogens presents a major challenge to the clinical management of UTIs. Recurrent infections, including those caused by antibiotic-sensitive pathogens, are exceptionally common and are likely attributable in part to the establishment of recalcitrant intracellular bacterial reservoirs within the bladder mucosa. Eradication of these clinically relevant reservoirs will require a better understanding of the underlying molecular mechanisms that allow for their persistence. The ongoing development of new antimicrobial approaches, such as the use of pilicides and mannosides in conjunction with antibiotics, will provide new treatment options, while the identification of new vaccine candidates and optimized vaccination protocols promises relief to individuals who suffer from recurrent or chronic UTI.