Family doctor

Overview:

• Urinary tract infections are also known as uncomplicated cystitis
• They are common in women but unusual in men
• Infections are caused by bacteria which are present on the skin in the area, and also in the bowel (e.coli is the most common organism)
• Sexual intercourse may precipitate an infection, but urine infection is not a sexually transmitted condition
• Symptoms include a frequent urge to urinate and a burning sensation while urinating
• A short course of antibiotics usually cures the infection
• Some hygiene measures may help prevent infection
• About 10 percent of women have recurrent infections

What is it?

Urinary tract infections are also known as uncomplicated cystitis and the problem mainly affects women.

About one in five women will experience a urinary tract infection.

Infections can be caused by bacteria which get into the bladder via the urethra (small tube leading from the bladder). Sexual intercourse may be a trigger to this happening. This is more likely if sex has been vigorous or if lubrication is not good.

In older, post menopausal women, factors favouring urine infection relate more to changes involving the effects of less oestrogen on the tissues around the bladder and vagina.

It is believed women's genitals are more sensitive to infections because the urethra, vagina and anus are placed close together, making it easier for bacteria to infect the urethra. The urethra is also much shorter in women than in men.

Sometimes underlying problems such as kidney stones or kidney abnormalities may lead to urine infections. Sometimes further tests are done to check for this, particularly if infections are recurring often.

Pregnant women, people with diabetes and weak immune systems are also more at risk of infection.

What are the symptoms?

Pain while urinating and a frequent urge to urinate are the main symptoms of a urinary tract infection.

There may be a burning or scalding sensation when going to the toilet, passing only a small amount of urine, or not be able to go at all. You may feel the need to go again after having just been to the toilet. The urine may look cloudy.

There may also be blood in the urine and an ache above the pelvic bone.

The main complication of a bladder infection is that it can spread to the kidneys. A fever, rigors (shaking and shivering), and pain on the loin area (back of the abdomen), may mean the infection has reached the kidneys.

Children with an infection may have a change in their toileting, experience incontinence, loose bowel movements, and have a fever. Children need a different approach to investigating urinary infection, as underlying abnormalities need to be excluded.

Men with an infection often have a kidney stone, or an enlarged prostate gland.

Men are usually investigated after a urinary infection to make sure there is no underlying problem.

Laboratory tests of urine can confirm an infection. Inflammatory cells (white cells) are present in the urine and a culture of the urine usually shows which bacteria are present and which antibiotic they are sensitive to. A follow up test may be required in some cases.

What can be done to help?

Drinking lots of fluid to flush out the infection, and using the toilet when you feel the urge to go.

Do not have sexual intercourse or use tampons until after you have recovered.

The condition can be treated with a course of antibiotics. The choice of antibiotic is usually determined by local knowledge of the sensitivity of common bacteria. Commonly used antibiotics include bactrim (co-trimoxazole) trimethoprim (triprim) or norfloxacilin (noroxin). Your doctor may recommend a different antibiotic if you are pregnant.

Recurrent infections occur in about 10 percent of women and they may need to take low-dose antibiotics for a longer period. An ultrasound examination or a cystoscopy may be recommended to establish the source of infection.

Men with an infection may be treated with antibiotics for a longer period to stop the prostate gland being infected.

How can it be prevented?

The condition can be prevented in some cases by following this advice:

• Dab instead of wiping the genitals after urinating
• Drink lots of water or cranberry juice
• Wipe from front to back after going to the toilet
• Use the toilet and drink water after having sex
• Wash the genitals before sex
• Have showers instead of baths
• Use the toilet when you feel the urge
• Do not use feminine hygiene products
• Avoid tight fitting garments like pantyhose
• Wear cotton underwear
• Wash your genitals with just water or mild soap

Some other points:

Research suggests that women who use diaphragms are more at risk of developing a urinary tract infection than others, and those with certain blood types could be more at risk.

Another study has found women whose partners use condoms with spermicides may have bacteria in the vagina that can cause an infection.

Some women with recurrent infections may have bacteria that burrow in the bladder wall and lie dormant between attacks.

Getting help

It is best to have a urinary infection properly diagnosed and treated by your doctor.