Using good hygiene, drinking cranberry juice help cub common problem
Urinary tract infections (UTIs) are not uncommon. There are different risk factors, depending on the age of the patient. For young women, the most important risk factor is sexual activity.
“Research has shown that in nine cases out of 10, urinary tract infections in young women are triggered at the point of intercourse,” said Dr. James Borders, family practice physician. Diagnosing a UTI is usually straightforward. “In young women, the symptoms are so reliable and frequent that we don’t always rely on a urine analysis or culture,” Borders said. These symptoms include urinary frequency, voiding small amounts, urinary urgency and dysuria.
The most basic habit doctors can encourage is for women to empty the bladder before and after intercourse. “Good hygiene can reduce bladder infection risk,” said Borders.
In older women, the problem frequently has to do with inadequate bladder support, particularly after a hysterectomy. “The bladder falls outward and downward as part of the age-related relaxation that occurs,” said Borders. Cystocoeles and urethrocoeles are associated with age, child-bearing, obesity and chronic pulmonary disease such as those discussed in the article on COPD in this issue of Kentucky Doc. Women who have a cystocoele frequently don’t empty their bladder completely. This retained urine can lead to cystitis. When women void, they should be sure to empty completely. If a woman leans forward after she feels she has finished urinating, that may help get the residual urine out.
All women can strive to be proactive against UTIs. “They can increase their fluid intake, and we also talk about cranberry juice because cranberries have a way of reducing adhesion of bacteria to the lining of the bladder,” said Borders.
Primary care providers must realize that not all UTIs are symptomatic. Women especially don’t always have dysuria when they are infected and may present with some urgency or frequency. Doctors should wait for the classic UTI symptoms to appear before pulling the trigger and giving an antibiotic.
“Nine times out of 10, urinary tract infections are confined to the bladder and involve burning, frequency and urgency,” said Borders. Only 10 percent of infections ascend to the kidneys as a pyelonephritis. A kidney infection is associated with pain, fever and other systemic symptoms such as fatigue and sometimes nausea. The vast majority of time women are correct when they think they have a bladder infection.
Men can suffer from UTIs, too. In men, the most common infection is prostatitis. Symptoms are often not similar to those experienced by women and include deep pelvic pain, urethral discharge and difficulty voiding completely, so the same risk factor for developing cystitis comes into play for men as it does for women. “In men, it is a prostate infection until proven otherwise,” said Borders.
For men, the most common risk factor for a UTI is an enlarged prostate, which is akin to the situation in women whose bladders do not empty completely due to anatomic changes. “If the prostate is enlarged, the bladder has to contract against resistance. Over time it does not empty completely, so men are left with the same risk factor as women,” said Borders.
Far and away the most common predisposing factor for urinary tract infections, including pyelonephritis, among hospitalized patients is the use of Foley catheters. Foleys should be avoided if at all possible. If they are used, they should be removed as quickly as is reasonably possible. Obtaining a catheterized specimen just prior to removal may be helpful in determining if an infection has occurred.
One of the more common trends now in treating a simple bladder infection is to medicate for a shorter course. “We still like to use macrodantin (furadantoin) for young women, but it is not a good choice for older women since it can impair kidney function,” said Borders. Macrodantin is the drug of first choice because it goes into the urine without going into the bloodstream. Patients therefore do not get much systemic exposure to the antibiotic, though it is a seven-day course.
Other antibiotics frequently used include bactrim DS in twice-a-day dosing and ciprofloxacin, dosed at 500mg twice a day. Both regimens can last for three days. “Sometimes we use something different than that and sulfa, Cipro and such, in which case only three days of treatment is typical,” said Borders.
There is a lot of debate among physicians about how long to treat UTIs in women, but most agree a three-day course of antibiotics is sufficient. On the other hand, men need to be treated for a longer time period. Prostate infections are treated for 14 to 28 days.
If a patient continually presents with a UTI, further investigation is necessary. “If a person has recurring infections despite the risk factors, a urinary tract infection should not be assumed,” Border said. “A full urologic evaluation should be carried out to rule out other kinds of obstruction because anything that obstructs the flow of urine can increase the risk of infection, such as obstructing renal stones or ureteral polyps.”
By Jamie Lober, Staff Writer