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Urinary Tract Infection , Cystitis

A urinary tract infection, also called a UTI, is an infection of the bladder. The bladder holds urine produced by the kidneys.

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Female Pelvic Organs

1. urinary Bladder
2. Uterus
3. Colon
4. Urethra

urinary Function

The bladder and the urine it holds are normally free from bacteria and other organisms. A urinary tract infection occurs when organisms are introduced into the bladder. Bacteria from the skin may enter through the urethra. The urethra is the tube that carries urine from the bladder to the outside of the body. Organisms can also enter the bladder on urinary catheters.

Bacteria in the bladder are usually flushed out when the person urinates. If bacteria multiply faster than they can be removed, a UTI results.

UTIs are more common in women than in men. Women have a shorter urethra which allows easier access for bacteria.

Causes and Risks

The most common cause of a UTI is a bacteria called E. coli. These bacteria are normally present in the bowel and feces. They can be introduced into the bladder by sexual activity.

Following are some of the risk factors for developing a UTI:

• advanced age
• bladder abnormalities
• blockage of the urethra by a tumor or enlarged prostate
• diabetes
• impaired bladder function
• inadequate fluid intake
• objects inserted into the bladder, such as a urinary catheter
• poor hygiene
• pregnancy

Cystitis is an inflammation of the urinary bladder or urethra. In most cases, cystitis is caused by a bacterial infection and is commonly referred to as a "urinary tract infection."

Cystitis is usually caused when bacteria enter the urethra and bladder and cause inflammation and infection. It is a very common condition. After infancy, urinary tract infections occur more often in females because their urethra is shorter and closer to the anus.

During childhood, about 1% of boys and up to 5% of girls will develop urinary tract infections. In boys the peak age is before the first birthday. urinary tract infections are much more common among uncircumcised boys. In girls, the peak age for first infections is 3 years, overlapping with the toilet training period.

Because cystitis in children can be promoted by abnormalities in the urinary tract, children with cystitis (especially those under age 5) deserve special follow-up to prevent later kidney damage.

The risk of cystitis is higher when the bladder or urethra becomes blocked, and the flow of urine stops. It can also occur when instruments are inserted into the urinary tract (such as during catheterization or cystoscopy. Other risks include pregnancy, diabetes, and a history of analgesic nephropathy or reflux nephropathy.

Over 90% of cases of cystitis are caused by E. coli, a bacterium normally found in the intestine. Normally, the urethra and bladder have no bacteria. Bacteria that manage to enter the bladder are usually removed during Urination. But if bacteria remain in the bladder, they grow easily and quickly and result in infection.

Sexual intercourse can increase the risk of urinary tract infections in women because bacteria can be introduced into the bladder through the urethra.

Older adults are at high risk for developing cystitis, with the incidence in the elderly being as high as 33 out of 100 people. They are at increased risk for developing urinary tract infections due primarily to incomplete emptying of the bladder associated with such conditions as benign prostatic hyperplasia (BPH), prostatitis, and urethral strictures.

Also, lack of adequate fluids, bowel incontinence, immobility or decreased mobility, indwelling urinary catheters and placement in a nursing home, all place the person at increased risk for developing cystitis.

Related disorders include:

• Cystitis - acute bacterial
• Cystitis - noninfectious (acute urethral syndrome)
• Cystitis - recurrent (repeated bladder infections)
• urinary tract infection - chronic or recurrent
• urinary tract infection - complicated (pyelonephritis)
• Vesicoureteral reflux

Prevention

Appropriate hygiene and cleanliness of the genital area may help reduce the chances of introducing bacteria through the urethra. The genitals should be cleaned and wiped from front to back to reduce the chance of dragging E. coli bacteria from the rectal area to the urethra.

For those who are prone to urinary tract infections, it may help to drink plenty of fluids, because frequent Urination flushes bacteria out the bladder. Urinating immediately after sexual intercourse may help flush out bacteria that may have been introduced with intercourse.

Signs and tests

Tests generally include taking a urine sample:

• A urinalysis commonly reveals white blood cells (WBC) or red blood cells (see also RBC - urine).

• A urine culture (clean catch) or catheterized urine specimen may be performed to determine the type of bacteria in the urine and the appropriate antibiotic for treatment.

Symptoms

• Pressure in the lower pelvis
• Foul or strong urine odor
• Urination, painful (dysuria)
• Frequent need to urinate (frequency)
• Need to urinate at night
• Abnormal urine color (cloudy urine)
• Blood in the urine (hematuria)
• Urgent need to urinate (urgency)
• Young children with urinary tract infections may only have a fever, or even no symptoms at all.

Additional symptoms that may be associated with this disease:

• Sexual intercourse, painful
• Fever
• Penis pain
• Flank pain
• Fatigue
• Vomiting
• Chills
• Mental changes or confusion (Note: in elderly people, mental changes or confusion often are the only signs of a possible urinary tract infection.)

TESTING IN CHILDREN

Because many children with cystitis have urinary tracts that predispose them to infections, because these infections are usually preventable, and because the long-term consequences of repeated urinary tract infections in children can be severe, many children with cystitis need special imaging studies to determine why they got their urinary tract infections.

These studies usually include both an ultrasound of the kidneys and an x-ray taken during Urination (called a voiding cystourethrogram or VCUG).

Most experts recommend this evaluation for:

• Girls over age 5 with 2 or more urinary tract infections
• All boys with their first urinary tract infection
• All children with a fever with their urinary tract infection
• All children under age 5 with their first urinary tract infection

For a girl's first urinary tract infection, recommendations vary on when a complete evaluation is necessary.

In young girls, recurrent urinary tract infections may be an indication of a urinary tract abnormality, such as vesicoureteral reflux, and should be evaluated by a medical care provider.

In boys, a single urinary tract infection indicates the necessity for evaluation, because urinary tract infections in boys are extremely uncommon in the absence of urinary tract abnormalities.