The Basics of Urinary Tract Infection

Urinary tract infections result in nearly 10 million office visits, 1.5 million hospitalizations and $1 billion in health care costs, according to the National Kidney Foundation. Two-thirds of office visits are by women of childbearing age.

One in every five women will have at least one urinary tract infection in her life, and some women will have more. Luckily, most infections are not serious and can be easily treated with antibiotic medications. But a urinary tract infection can be stubborn, and sometimes recurs a few weeks after treatment. Nearly 20 percent of women who have a urinary tract infection will have another, and 30 percent of those who have had two will have a third. About 80 percent of those who have had three will have a fourth. If left untreated, urinary tract infections can lead to other more complicated health problems, so they should not be ignored.

Your urinary tract includes two kidneys, two ureters, the bladder and the urethra. Your kidneys remove waste and water from your blood to produce urine. Urine travels through muscular tubes, called the ureters, to the bladder. The bladder is a balloon-like organ composed of muscle, connective tissue and nerves that swells as it fills with urine. Urine is stored in the bladder until it is released from the body through another tube, called the urethra. Two muscle groups, the pelvic floor muscles and the urinary sphincters, control the activity of the urethra and bladder neck. These muscles must work together to hold urine in the bladder most of the time and allow the bladder to empty when appropriate.

Most urinary tract infections are caused by a variety of bacteria, including Escherichia coli (E. coli), found in feces. In younger women staph saphrophyticus is the most common organism causing UTIs. Because the openings of the bowel, vagina and urethra are very close together, it's easy for the bacteria to spread to the urethra and travel up the urinary tract into the bladder, and sometimes up to the kidneys.

Infection occurs when the bacteria cling to the opening of the urethra and multiply, producing an infection of the urethra, called urethritis. The bacteria often spread up to the bladder, causing a bladder infection. If the problem is not treated, the infection can continue spreading up the urinary tract, causing infection in the kidneys, called pyelonephritis. A kidney infection that is not treated can result in the bacteria entering the bloodstream (this is known as urosepsis), which can be a life-threatening infection requiring hospitalization and intravenous antibiotics.

Copyright 2003 National Women's Health Resource Center Inc. (NWHRC)

The Basics of Urinary Tract Infection (<i>cont'd</i>)

The first sign of a bladder infection may be a strong urge to urinate or a painful burning sensation when you urinate. You may feel the urge to go frequently with little urine eliminated each time. The urge to urinate again returns quickly and urination may be hard to control. You may have urine leaks during sleep. You may also have soreness in your lower abdomen, in your back or in the sides of your body. Your urine may look cloudy or have a reddish tinge from blood. It may smell foul or strong. You also may feel tired, shaky and washed out. If the infection has spread to the kidneys, you may have fever, chills, nausea, vomiting and back pain, in addition to the frequent urge to urinate and painful urination.

Common Causes of UTIs

Some women are more prone to urinary tract infections than others because the cells in their vaginal areas and in their urethras are more easily invaded by bacteria. Women with mothers or sisters who have recurring urinary tract infections also tend to be more susceptible. Your risk of urinary tract infection also is greater if you're past menopause. Thinning of the vagina and urethra after menopause also may make these areas less resistant to bacteria and cause more frequent urinary tract infections.

Irritation or injury to the vagina or urethra caused by sexual intercourse, douching, tampons or feminine deodorants can give bacteria a chance to invade. Using a diaphragm can cause irritation and can interfere with the bladder's ability to empty, giving bacteria a place to grow. Constipation can lead to high levels of the E. coli bacteria in the bowel, increasing the risk that they could spread to the urinary tract.

Any abnormality of the urinary tract that blocks the flow of urine, such as a kidney stone or prolapse of the uterus or vagina, also can lead to an infection or recurrent infections. Illnesses that affect the immune system, such as diabetes, AIDS and chronic kidney diseases, increase the risk of urinary tract infections. Lengthy use of an indwelling catheter, a soft tube inserted through the urethra into the bladder to drain urine, is a common source of urinary tract infections. Intermittent catheterization (where a person empties the bladder several times a day but the catheter is removed immediately) actually is used to prevent recurrent infections in some patients.

Although pregnant women are no more prone to urinary tract infections than other women, when pregnant women do develop them, they are more likely to affect the kidneys. Hormonal changes and repositioning of the urinary tract during pregnancy may make it easier for bacteria to invade. Such infections in pregnant women can lead to urosepsis, kidney damage, high blood pressure and premature delivery of the baby. All pregnant women should have their urine tested periodically during pregnancy. Pregnant women with a history of frequent urinary tract infections should have their urine tested often. Most antibiotic medications are safe to take during pregnancy, but your health care professional will consider the drug's effectiveness, how far your pregnancy has progressed and the potential side effects on the fetus when determining which medication is right for you and how long you should take it.

Copyright 2003 National Women's Health Resource Center Inc. (NWHRC)