Mediclinic Al Sufouh

Knowledge Village - Dubai

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UTI (Urinary Tract Infections)

Cystitis (UTI)

Table of Contents

UTI stands for Urinary Tract Infection. Any organ of the urinary tract may be infected.

UTI occurs almost exclusively in women, affects their bladder (cystitis), usually requires only empiric antibiotic treatment, without any test.

In men, UTI means generally prostatitis.

Symptoms are lower abdominal pain and frequent and painful urination. A less frequent sign is blood in the urine.

Additional symptoms (fever, lumbar pain) are signs of complication, and it needs prompt diagnosis and aggressive treatment. Quick urine culture tests and focused antibiotic treatment are mandatory in these cases.

Causes of UTI

E. coli is a bacterium that causes most of these UTI. After bowel movements, the bacterial count increases in the genital area. If the bowel movements are irregular with constipation or diarrhoea, this count will be even higher. Moreover, if hygiene is lacking, the bacteria will replicate, further infecting the vagina. After that, they enter the bladder easily through the urethra.

Specific risk factors for cystitis in women are:

  • Sexual activity: sexually active women have more UTIs than women who aren’t sexually active. The risk increases with a new sexual partner.
  • Mother with a history of UTI;
  • history of UTI during childhood;
  • spermicidal agents and diaphragms used for birth control;
  • Menopause: after menopause, a decline in circulating oestrogen causes changes in the urinary tract that make you more vulnerable to infection.

Symptoms

The typical symptoms of UTI are sudden onset of pain while urinating and frequent urination (dysuria and frequency) with lower abdominal pain. Additional signs like bloody urine and vaginal discharge mean we need to differentiate uncomplicated cystitis from other diagnoses, commonly vaginitis or stone disease. Fever and lumbar pain are signs of complicated UTI.

Diagnosis
Symptoms are enough to diagnose non-complicated cystitis. Urine dipstick or urine analysis is optional. Additional symptoms like bloody urine or vaginal discharge should prompt differential diagnosis with vaginitis and stone disease. However, we highly recommend the urine culture in patients with atypical symptoms, pregnancy, suspect of kidney infection, or failure to respond to appropriate antimicrobial therapy.

Treatment

The treatment with Fosfomycin, single-dose, pivmecillinam 400 mg three times a day for three to five days, and nitrofurantoin, should be considered for first-line treatment.

UTI in pregnancy

Urine analysis and culture are strong recommendations. Not all antimicrobials are suitable during pregnancy.

UTI in men

UTI in men is a complicated infection because of the almost constant involvement of the prostate (prostatitis). Therefore, we need treatment with antimicrobials penetrating the prostate tissue. A treatment duration of at least fourteen days is recommended, preferably with trimethoprim-sulfamethoxazole or fluoroquinolone.

Prevention of UTI

To prevent cystitis, you must avoid bacterial growth in the vagina and the bladder:

Reduce the bacterial count in the area around the anus after bowel movements:

  • Use a bidet for washing the perianal area, use mild soap and clean the area around the anus gently, wiping from front to back. Any wiping motion that starts nearer to the rectum and then approaches the bladder-opening area moves potentially pathogenic bacteria closer to the bladder; finally, dry the space between the urethral meatus and anus with a clean towel same movements front to back.

  • If you can’t use a bidet, you can use an antiseptic wet wipe used with the same wiping motions.

Avoid creating a suitable environment for bacterial growth in the genital area:

  • Use tampons for periods. Tampons are advised during the menstrual period rather than sanitary napkins or pads because they keep the bladder opening area drier than a clean pad, limiting bacterial overgrowth.

  • Do not wear tight-fitting undergarments made of non-breathing materials. With such fabrics, accumulating moisture builds up. It leads to maceration of the skin and bacterial overgrowth adjacent to the opening of the bladder. We suggest cotton underwear for general.

  • Avoid the use of spermicidal jelly. It kills sperm and normal vaginal florae, which are extremely important in suppressing colonisation with pathogenic bacteria.

  • Avoid vaginal douches.

Avoid that bacteria entering the bladder:

  • Take special precautions after sexual activity; such activity may also increase risk by introducing bacteria into the bladder. We recommend cleaning the genital area just before sexual intercourse. Moreover, you must empty the bladder just after intercourse; drink two extra glasses of water after having sex.

  • When engaging in physical activity and exercise, make sure to empty the bladder frequently and drink plenty of water and other fluids.

  • Take showers and avoid long baths. Bathwater may quickly become contaminated by the bather’s skin florae. Sitting in a tub allows bacteria to reach the bladder opening area.

Avoid that the bacteria grow into your bladder:

  • Extremely useful is avoiding long intervals between urinating. Try to empty the bladder at least every 4 hours during the day while awake, even if the need or urge to void is absent; when feeling the need to empty the bladder, do not try to “hold it”.

  • Drink more water. If the urine appears darker than a very pale yellow, this means not enough liquid is being ingested; increase the fluid intake.

Final recommendations

We can treat the typical symptoms of cystitis in females empirically without diagnostics.

In selected cases of recurrent cystitis, women can use the self-treatment by taking Fosfomycin 3000 mg one shot at the early symptoms’ onset.

Pregnancy and additional symptoms can lead to complications and are always good reasons to see a doctor.

Prevention is the central part of the strategy in recurrent cases.