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What causes urinary tract infections and how to avoid them?

Urinary tract infections (UTI’s) are very common in adults over the age of 20. Women tend to get UTI’s much more common due to a shorter urethra connecting the bladder to the outside. Men start getting UTI’s and prostate problems as they get older and the prostate gets bigger. There are many bacteria throughout the body and most are good for our health. If doctors find bacteria in the urine without signs of infection they usually don’t treat with antibiotics. One of the exceptions is for pregnant women, since the presence of bacteria without infection can cause complications.

Bladder emptying by urination and drinking plenty of water helps keep bacterial counts low. However, bacterial from the colon have a close access especially in females due to shorter distance from the anus to the urethra. These colonic bacteria like E. coli can travel up the urinary system, infecting the kidneys and entering the blood stream if not treated appropriately. Bacteria have small hair-like projections called pili, which help them attach to the bladder wall. Researchers are working on developing vaccines using bacterial pili. Drinking cranberry juice is thought to prevent the bacteria from attaching to the bladder wall and preventing UTI’s. A less common route of infection is if there’s an infection in different part of the body that can reach the urinary system via the blood. Urinary catheters used in the hospital can also lead to UTI’s.

Frequent UTI’s can occur due to:

  • Female sex
  • Holding the urine too long
  • Enlarged prostate
  • Personal history of UTI’s
  • Kidney stones
  • Sexual intercourse
  • Any anatomical problems of the urinary system
  • Spermicide or diaphragm use
  • Any catheter or instrumentation used

E. coli is responsible for >80% of UTI’s. The other bacteria, which cause UTI, are Klebsiella, Proteus, Enterobacter, and Pseudomonas. Urine cultures are done to find out which bacteria is the cause of UTI. For most UTI’s, a urine culture is not needed and the diagnosis can be made using the dipstick. Some women have molecules called glycolipids on their cell walls, which make it easier for E. coli to attach and colonize the vagina. Also the lack of estrogen after menopause leads to increased number of UTI causing bacteria to grow in the vagina. People with anatomical problems like uterine prolapse, neurogenic bladder, and prostate enlargement cannot empty the bladder effectively, which increases the risk for UTI’s.

Some signs and symptoms include:

  • Cloudy or smelly urine
  • Burning with urination
  • Increased urinary frequency and pressure
  • Increased urination at night
  • Bladder or flank pain
  • Fever or chills
  • Blood in the urine
  • General lack of well being

Older individuals with UTI may become confused, have urinary accidents and increased risk of falling.

What are some preventive strategies?

There are some ways you can prevent recurrent UTI’s depending on your risk factors.

Preventive strategies may involve:

  • Avoiding spermicides and diaphragms
  • Urinating after sexual intercourse
  • Increasing fluid intake
  • Using antibiotics daily or after sex
  • Using estrogen cream
  • Cranberry juice
  • Probiotics
  • D-mannose

Spermacides and vaginal diaphragms can disrupt the vaginal PH and promote bacterial growth. Avoid their use if you’re experiencing more UTI’s. Urinating after sex also decreases the number of bacteria in the urinary system. Even small amount of urination after sexual intercourse can be helpful. Drink plenty of water during the day to facilitate urination.

Women who get two or more UTI’s in 6 months may be candidates for some for of antibiotic prevention strategy. The Family physician or Urologist might start antibiotics for individuals who have recurrent UTI’s. Frequent antibiotic use increases bacterial resistance, which has to be considered before using antibiotics for prevention. Antibiotics might be used daily, just after sex or with the first signs of UTI in a well educated person. A urine culture is collected before starting antibiotics to check which bacteria is the cause of the UTI and which antibiotic is it susceptible to. Bactrim, Keflex, Macrobid, and Cipro are some of the antibiotics most commonly used. Antibiotic use causes more side effects including frequent yeast infections and gastrointestinal symptoms. Antibiotics are usually tried for six months since UTI’s seem to come in clusters. There are concerns with prolonged use of Nitrofurantoin (Macrobid) due to risk of pulmonary toxicity, chronic liver abnormality and nerve damage. Macrobid should be avoided in the elderly and those with poor kidney function. Cipro and other antibiotics in the same family should be avoided in pregnant women due to risk of fetal malformations. Another concern with prolonged antibiotic use is C. Diff infection. C. Diff is a bacteria that causes severe diarrhea and usually occurs after antibiotic use. Women on birth control should use condoms for back up since lot of antibiotics can make the oral contraceptives less effective.

For postmenopausal women, the lack of estrogen causes vaginal dryness and increased risk of UTI’s. Estrogen vaginal cream helps to restores the normal bacteria and decreases the incidence of UTI’s. Lactobacillus is one of the prominent bacteria in the normal vagina and estrogen helps to restore it.

As mentioned earlier, Cranberry juice can prevent UTI’s. Cranberries contain fructose and proanthocyanidins, which can stop bacteria like E. coli from sticking to the urinary tract.

Another way of preventing UTI’s is using probiotics. Probiotics are beneficial, healthy bacteria that prevent the growth of harmful bacteria. Some of the ways probiotics may help in preventing UTI’s are by blocking bacterial attachment, killing bacteria by producing hydrogen peroxide, producing anti-inflammatory responses inside our cells and keeping a low urinary PH. Probiotics with Lactobacillus have been used in clinical trials with one trial showing a significant reduction in UTI’s.

UTI’s can cause significant discomfort and complications if left untreated. You can prevent a lot of UTI’s by monitoring for symptoms and using some of the strategies mentioned above. Always contact your doctor for persistent symptoms.

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