Urinary Tract Infections

What is a urinary tract infection (UTI)?

A urinary tract infection (UTI) is an infection in the urinary system. Urinary tract infections are common in women and affect millions of people each year. Women are especially prone to urinary tract infections.

What causes urinary tract infections?

Normal urine is sterile and contains fluids, salts, and waste products. It is free of bacteria, viruses, and fungi. An infection can occur when microorganisms, usually bacteria from the digestive tract, stick to the wall of the bladder and multiply. This can cause an inflammatory reaction in the bladder causing symptoms (see below).

Most infections arise from Escherichia coli (E. coli) bacteria, which normally live in the colon.

Not all bacteria in the bladder cause an infectious reaction that leads to symptoms. In fact, many women can be found to have asymptomatic bacteriuria where bacteria are found in the urine, but do not cause any reaction or symptoms. Asymptomatic bacteriuria usually does not require treatment.

What are the different types of urinary tract infections and their symptoms?

A urinary tract infection may involve different sections of the urinary tract including the following:

• An infection of the urethra: The hollow tube that drains urine from the bladder to the outside of the body. Urethritis typically presents as painful urination or a more constant urethral pain not necessarily occurring with urination.
• A bacterial infection in the bladder: The most common type of UTI. It is associated with symptoms of painful urination, urinary frequency, urinary urgency, pain or pressure in the bladder, blood in the urine, and rarely fever. The urine may appear cloudy or foul smelling.
• An infection of the kidneys: Usually a result of an infection that has spread up the urinary tract from the bladder. It can be associated with kidney stones or obstruction in the urinary tract. Patients usually experience pain in the flank (area where the kidneys are located) and it is often accompanied with fever and./or chills.

How are urinary tract infections diagnosed?

In addition to a complete medical history and physical examination, diagnostic tests and procedures may include the following:

• Laboratory examination of urine for various cells and chemicals, such as red blood cells, white blood cells, excessive protein. A urine analysis can be done immediately and while it does not definitively diagnose an infection or the bacteria causing it, it can give your doctor a good idea of whether an infection is or may be present.
• Urine culture. This test can specifically determine the type of bacteria causing the infection and the antibiotics that will appropriately treat the infection. This usually takes 1-3 days to get a result.
• tumors or stones.

What is the treatment for urinary tract infections?

Specific treatment for UTIs will be determined by your physician based on:

• Your age, overall health, and medical history
• Extent of the infection
• Your tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disease
• Your opinion or preference

Most commonly UTI's are treated with antibiotics. The type of antibiotic and length of treatment is determined by the specific bacteria and type of infection. Many women can be treated with a short course of antibiotics. Sometimes bladder analgesics such as phenazopyridine can be given to relieve the symptoms of the UTI. While these will not kill the bacteria they can significantly reduce symptoms. Drinking plenty of water to help cleanse the urinary tract of bacteria can be helpful. In cases of asymptomatic bacteriuria, often no treatment necessary or recommended.

How can urinary tract infections be prevented?

To reduce the likelihood of developing another UTI, a patient may consider the following:

• Drink plenty of water every day.
• Large amounts of vitamin C inhibit the growth of some bacteria by acidifying the urine. Vitamin C supplements have the same effect.
• Urinate when you feel the need and do not resist the urge to urinate.
• Wipe from front to back to prevent bacteria around the anus from entering the vagina or urethra.
• Take showers instead of tub baths.
• Cleanse the genital area before/after sexual intercourse.
• Avoid using feminine hygiene sprays and scented douches.
• Urinate after intercourse

Recurrent Urinary Tract Infections

Recurrent urinary tract infections, depending on their frequency and severity can be quite debilitating. A urinary tract infection is considered recurrent in women who have been adequately treated for an infection and then it returns after symptoms have resolved. Women who have more than 2 urinary tract infections in 6 months or more than 3 urinary tract infections in a year should consider medical evaluation.

What causes recurrent urinary tract infections?

The anatomy of the female urinary tract is in close proximity to the anal opening. Fecal bacteria can colonize the vagina and distal urethra (end of the urethra). The bacteria can then ascend into the urinary bladder causing an infection. Some women because of their anatomy of the type of bacteria that colonize (live normally) their skin are more susceptible than others to recurrent UTI's.

If you are experiencing recurrent infections, other medical causes need to be excluded.

A full evaluation for recurrent urinary tract infections will include a detailed medical history and focused genitourinary examination. Based on your consultation, other diagnostic tests may need to be performed. For instance, a kidney and/or bladder ultrasound to evaluate residual urine volume and check for stones, abnormal anatomy or other causes of UTI may be performed. In addition, your doctor may recommend a cystoscopy (evaluation of the bladder with a camera).

What to bring with you to your appointment:

You should bring any documented urine cultures to your office visit. In addition, it is helpful if you have a list of the antibiotics that have been used to treat your infections.

What treatments are available?

All symptomatic, culture proven urinary tract infections need to be treated with antibiotics. Your doctor may request a second follow-up culture to prove the infection has been eradicated.

There are a variety of treatments available for the prevention of recurrent urinary tract infections, including prophylactic antibiotics, bladder antiseptics, dietary supplements, and local estrogen replacement for post-menopausal women. Together with your UCLA physician, we will choose the regimen that is best for you.