Urinary Tract Infection (UTI)

The genitalia is a relatively sensitive area of the body, to begin with, and this characterization does not even begin to include all the potential conditions that could plague such a delicate location of the body. The genitalia is composed of several structures that work together to do two things: reproduce and excrete liquid waste. While it might seem like the topic itself is avoided by many due to the false connotation that talking about the genitalia is taboo, one could not deny that whatever happens, for as long as it involves the genitalia, anyone would become nervous in an instant – worried that something might happen and that it might affect their prospects, procreation being the primary contender in their long list of anxiety-inducing thoughts. When it comes to issues that mainly affect and manifest within this particular area, it is essential to be wary of the various facts that one needs to know to avoid any problems that you might encounter when a specific condition is left untreated for extended periods.

Urinary Tract Infection: A Quick Background

To begin with, perhaps it might be more efficient to introduce the condition that we will be dissecting in this comprehensive outline. It is, for sure, not unbeknownst to anybody due to how its name ripples throughout the public whenever someone experiences any discomfort within the genital area, mainly when one complains of difficulty or pain in urinating. Sure, it can indicate many other infections that are just as likely to occur and manifest as such, but none stands close to the infamous infection of infections – the common urinary tract infection.

Defining the Urinary Tract

A Urinary Tract Infection or UTI is essentially what its name suggests – it is an infection within the urinary tract or the intricate system of vessels and organs that all work together to excrete the urine in the body. Most people would often confuse the urinary tract with just the outer layer of the genitalia – the penis’ shaft in males and the outermost layer of the vagina in females. However, the urinary tract extends far more than that and involves several other organs that could all get infected to result in the condition known as a UTI.

Essentially, the urinary tract is the system that is responsible for making and storing urine. It is composed of four different parts that are all just as sensitive and prone to infections and precipitate the commonly encountered UTI presentations. It is composed of the kidneys, which serves as the filter of the body; the ureters, which are thin tubes that carry urine from the kidney to the bladder; the bladder which stores the urine before it is excreted; and the urethra, which is a tube that eliminates the urine out of the body. These four structures work hand in hand in ensuring that all liquid waste products in the body are safely excreted through the proper avenues.

Scope of its Prevalence

Urinary tract infections are prevalent because they can affect everyone, no matter the age and no matter the sex of the person. UTIs are very common with their ability to affect 1 out of every 5 people in their lifetime. UTIs are more common in women due to the structure of their genitalia that is relatively more exposed to external factors than the penis, which is covered by a protective skin layer with a single point of entry. Furthermore, records show that UTI cases reach up to 8 to 10 million in a year, further highlighting how prone everyone is to contract an infection when they become susceptible to any bacterial invasion within the four structures.

Risk Factors

To know whether you are at risk of contracting the condition at some point in your life, several risk factors might help ensure that you would be able to be wary of these factors and employ the necessary protective measures before you get infected. However, please note that while awareness does play a significant role in reducing prevalence, it would ultimately depend on your exposure to the potentially pathogenic bacteria and the environment to which you are currently exposing yourself. Preventive measures could only go so far in preventing actual infection cases themselves; one needs to be wary of the actual sources and site of infection as well.

Previous UTI Case

While there is not necessarily a direct causal link between the two situations, a previous UTI case means that you are already predisposed to the condition, are currently prone to a particular risk factor, or your environment is high-risk for such potential infections – indicating that while this might not be a specific cause for the condition, it does tell us that you are already at risk from the get-go. To address this, you could always consult your doctor about various preventive measures that you could employ to heighten further the safety of your environment and genitalia to such invasions.

Sexual Activity

Sexual activity, while pleasurable, sometimes comes off as unsanitary – and for a good reason, particularly in today’s modern practices. UTI is commonly caused by E. coli – a species commonly found in the excrements of humans. Partaking in anal sex is a potential risk of infection due to how the anal region is a high-risk environment for such bacteria, and penetration through this orifice could lead to an invasion within the urethral spaces of the genitalia. Penetrative vaginal sex is likewise a risk factor as anything inserted within these areas could potentially be a source of infection.

Changes in the Genitalia’s Bacterial Flora

Although a bacterium commonly causes a UTI, one must remember that not all bacteria are harmful. Some bacteria, especially those living within the vagina, are present to maintain the area's ideal conditions – each one balancing the other to ensure that no species will dominate and cause a pathogenic response. However, with aggressive washing and use of genital cleansers, there are cases wherein this balance is disrupted – resulting in the overgrowth of some bacteria and the subsequent colonization of the urinary tract as the bacteria travels towards these structures.

Pregnancy

When a woman is pregnant, the urine is essentially filled with sugar, protein, and several hormones due to the changes in a pregnant woman’s body. While these are normal and harmless for the most part, these molecules are likewise able to cause overgrowth and proliferation of the bacteria within the genital area – making your urine a very nutritious growth tool for the normal flora of the genitalia. As such, pregnant women would often complain of UTI cases, especially when there is a chronic instance of leftover urine when urinating.

Shorter Urethra

A shorter urethra is a common problem in women, but it is not necessarily a defect in the urinary tract structure. A shorter urethra occurs in women due to the design itself of the female reproductive system. In contrast to males with a penis shaft that serves as an extension of the urethra, the vagina is simply an open orifice that immediately leads towards the bladder. Due to this, when a certain pathogenic species come in contact with the outer vaginal wall, it is easy for the bacteria to enter the bladder and increase within – causing an infection that may even affect the upper urinary tract structures.

Structural Problems in the Genitalia

Similar to how a shorter urethra is a problem and considered a risk factor in females, any structural issues in the genitalia can be automatically considered a risk factor due to how it significantly increases the susceptibility of the structures within to infection from any pathogenic species. In cases where the genitalia present a particular opening other than the already susceptible openings of the urethra, it then introduces a new area of invasion that any bacteria can utilize to establish its pathogenesis and cause an infection within.

Poor Hygiene

Considering that the genitalia is sensitive enough, poor hygiene practices would essentially increase the risk of infection due to how this would introduce pathogenic species within the area that are not even supposed to be present or grow around this area. Due to this, when someone does not wash the area properly, or, in the case of women, when wiping their area following excretion and then they wipe towards the vagina, one would essentially introduce bacteria to the sensitive parts of the genitalia – causing an infection once the bacteria become successful in its proliferation.

Use of Spermicides

Spermicides or substances used to prevent any live sperm cells from surviving within the genitalia can alter the normal microbiome and flora to the point where the balance between good and bad bacteria becomes skewed. When this happens, some potentially pathogenic bacteria may proliferate and overgrow until it manifests specific presentations within the urinary tract.

Use of Condoms

Condoms are protective tools used by males to prevent any accidental insemination during sexual intercourse. This is commonly promoted during sexual education programs to decrease the rates of unintentional pregnancies, but what most people may not know is that unlubricated condoms are harmful to the structures of the genitalia. Due to the composition of condoms, unlubricated ones may cause unnecessary friction between the genitalia during penetrative intercourse – resulting in microtears that several bacteria may utilize as points of entry towards the urinary tract.

Use of Diaphragms

Diaphragms, similar to condoms, are protective measures used by the vagina with the same goal as a condom’s – to avoid accidental pregnancies. However, a diaphragm’s structure is composed in a way that it could put pressure into the urethra, causing a decrease in the patient’s bladder emptying. With the accumulation of urine within the bladder, it could serve as a potential source of bacterial growth, which could affect the surrounding regions and subsequently causes UTIs.

Estrogen Level Changes

Similar to how over washing the vagina can lead to changes in the normal genital microbiome, estrogen level changes, particularly following menopause, could lead to changes to the balance of the vaginal flora – resulting in the overgrowth of potentially pathogenic species, subsequently resulting in an infection within the urinary tract structures.

Available Treatment Options

Although UTIs are commonly caused by certain pathogenic bacterial species such as E. coli, one must remember that a viral or fungal infection may likewise cause UTIs. As such, any treatment strategy, particularly if you are thinking of a pharmaceutical remedy to the condition, must revolve around the provided diagnosis of your physician.

When addressing UTIs, a bacterial UTI is commonly treated using antibiotics, fungal UTIs are treated with antifungals, and viral UTIs are treated with antiviral drugs. In addition to that, your doctor may likewise prescribe several non-pharmacologic remedies that could fasten your recovery time and ensure that any potential causative factors present are addressed and managed immediately.

Are Urinary Tract Infections Sexually Transmitted?

In the simplest sense, UTIs are not sexually transmitted to answer that question. Sexually transmitted infections or STIs are diseases transmitted through sexual contact, particularly when someone comes into contact with infected tissue or an infected bodily fluid. UTIs, on the one hand, although sexual activity is considered a risk factor for potential infection, could not be transmitted through sex. However, it should be noted that you should still be careful during sexual intercourse as this could still cause, rather than transmit, a urinary tract infection in some cases.

Preventive Measures Against UTIs

To know more about the various measures that could be done to prevent any cases of UTI, the following steps can be followed and employed during your everyday routine. Do note that while these preventive measures are known to decrease one’s risk of an infection, it does not guarantee complete immunity, and any extenuating circumstances could similarly put you at risk for an infection with your urinary tract’s structures.

Drinking Sufficient Water

While this might seem like such a cliché, drinking sufficient water ensures that you are constantly hydrated and that your urine output will be adequate to flush the bladder during every excretion. Again, incomplete bladder emptying may result in the accumulation of urine, leading to an overgrowth of bacteria. Furthermore, sufficient hydration is necessary in ensuring that your structures will not be damaged to the point where it is possible to excrete several growth-inducing substances in the urine – another risk factor for a potential UTI case.

Avoiding Holding Your Urine for Long Periods

Similar to the rationale of the previous recommendation, incomplete bladder emptying is a risk factor for the overgrowth of bacteria within the urinary tract structures. When holding the urine for long periods, this act essentially simulates a similar scenario to an incomplete bladder emptying – one that results in the development of bacterial growth within this area, along with its colonization of several surrounding structures that could just as well result in the development of the same manifestations.

Communicating any Signs of Incontinence

While this is not necessarily a preventive measure due to how it might already be a given to anyone who is particularly attentive to their performance, any signs of incontinence should be reported to your physician at the soonest possible time for them to be able to perform the necessary tests immediately before any complications arise. Again, incontinence or the inability to form a urine stream may be a sign of incomplete bladder emptying – a symptom that could result in the overgrowth of bacteria within the bladder and the invasion of its surrounding structures to cause the same UTI-like manifestations and presentations.

Urinary Tract Infection: Pathogenesis

Typically, your urinary tract is sterile and does not contain any pathogenic microorganisms. The urinary tract comprises four primary structures: the kidney, the ureter, the bladder, and the urethra. All four structures work hand in hand in allowing the body to dispose of its liquid waste through filtration and reabsorption – reabsorbing the essential nutrients and molecules while likewise eliminating those that serve as the waste byproducts of the body’s processes. This would then pass through the urinary tract and is ultimately excreted through the genitalia.

However, there are certain instances when this peaceful process becomes disrupted due to an invasion of pathogenic microorganisms within the urinary tract. This is commonly caused by a bacterial species known as E. coli – a bacteria present in the feces, explaining why an improper washing technique following defecation is a common cause of UTI among females. For reference, one should wipe the vagina towards the anus instead of the other way around.

Going back to the topic at hand, when pathogenic microorganisms such as E. coli – which may also be fungal or viral in some cases – enter the urethra due to a specific risk factor or high-risk activity, the bacteria may then proliferate within the structures of the urinary tract. This can be aided with the help of the urine, which may contain minerals necessary for bacterial growth – signifying the importance of urine quality and absence of urine accumulation in the bladder to ensure that there will be no exacerbating factors present that could result in the development of the subsequent symptoms.

When the bacterium successfully proliferates, this could cause an infection within the urinary tract – starting with the lower urinary tract, which is the most accessible area, moving towards the upper urinary tract when the condition is left untreated. In some cases, if the infection is allowed to persist without proper treatment, upper UTIs may cause complications, particularly among pregnant women where the disease is more common.

Urinary Tract Infection: Manifestations and Presentations

Essentially, we could separate the manifestation of UTI into two significant categories: upper UTIs and lower UTIs. The lower urinary tract is mainly composed of the urethra and the bladder, while the upper urinary tract primarily indicates the kidneys. Upper urinary tract infections are usually dangerous as infections in the kidney may lead to the movement of bacteria towards the blood – causing a systemic disease that could eventually lead to sepsis. This is commonly known as urosepsis, and this often presents with dangerously low blood pressure, shock, and ultimately, death.

Lower Tract UTI

An infection in the lower urinary tract would often precipitate symptoms that may include:

• Pyuria or a burning sensation during urination
• Urinary frequency
• Urinary urgency
• Blood in the urine
• Cloudy urine consistency
• Discolored urine, which may appear like tea or cola in color
• Urine with a strong odor
• Pelvic pain, particularly in women
• Rectal pain, particularly in men

Upper Tract UTI

On the one hand, an infection in the upper urinary tract, also known as the more severe stage or manifestation of UTI, will often present with the following symptoms:

• Pain and tenderness in the upper back and within the side areas
• Chills
• Fever
• Nausea and vomiting

Although an upper tract and lower tract UTI are the most common categories when defining the presentations of this particular condition, UTI cases may likewise be characterized depending on the structure that it primarily affects during its manifestation. For instance, the urinary tract has four significant structures, and three of them, namely, the bladder, kidney, and urethra, all have their respective categories that may likewise cause distinct presentations. This, however, is still not an indicator to use symptoms as a diagnostic tool as it remains unreliable without any visual or laboratory confirmation.

Cystitis or Bladder Infection

Cystitis, an infection within the bladder, is often characterized by urinary frequency or instances where one constantly feels the urge to pee every few minutes. It may likewise be described by cases where a patient may experience pain when urination, along with a painful sensation along the lower abdominal area, as well as cloudy or bloody urine.

Pyelonephritis or Kidney Infection

On the one hand, pyelonephritis, or a kidney infection, would mainly be characterized by symptoms commonly associated with systemic infections. This may include fever, chills, nausea, vomiting, and some pain along the back or sides. Please do note, however, that pain along both sides of the lower back area may likewise be indicative of kidney stones, albeit it comes with other distinct symptoms that your physician will again note during your consultation.

Urethritis or Urethral Infection

Lastly, urethritis, or urethral infection, is the most common type of UTI due to the proximity of the urethra with the external environment – leaving it highly susceptible to pathogenic microorganisms from the environment. When a patient experiences urethritis, one might usually experience symptoms such as discharge from the genitalia itself, along with a painful and burning sensation during urination. Again, these symptoms, while common in such UTI classifications, could likewise indicate other conditions that could not be ruled out with the proper diagnostic procedure. Avoid self-medication at all costs.

UTI Diagnosis and Testing Procedures

To verify whether a general urinary tract infection causes the symptoms that you are experiencing with no underlying complications, respective laboratory tests are necessary – assessing either the quality of your urine for the presence of any bacterial species or the structure of the urinary tract itself to determine whether any damages might be causing the symptoms that you are experiencing. Do note that damages to the structure may likewise be a risk factor for UTI and may have caused the UTI along with the symptoms being precipitated by the damage itself.

Urinalysis

A urinalysis test is essentially an analysis of the quality of your urine. Your doctor would often ask for a sample of your urine, preferably the first clean catch of your urine stream, usually defined as the mid-stream sample while you are urinating. It is also essential to ensure that your genitalia is clean with an antiseptic wipe before collecting the sample to avoid any contamination that could otherwise result in either a false positive or false negative test upon analysis. Following collection, a lab technician will analyze your urine for any white blood cells, red blood cells, bacteria, and other biomolecules that might be essential in determining what caused your current presentations.

Bacterial Culture

A bacterial culture is defined by precisely what its name suggests – your physician would attempt to grow a bacterial culture out of your clean catch urine sample, determining the presence of any bacterial species within your urine after a few days of waiting time. This is the test that is often performed following a urinalysis as it helps the doctor determine the bacterial species and provide a prescription of the most effective antimicrobial against it.

CT Scan or MRI

These visualization tests are commonly done to determine whether there are structural damages to the urinary tract, either causing the UTI or causing the symptoms you are experiencing. Your physician may likewise administer a contrast dye to highlight the structures of your urinary tract better.

Cystoscopy

A physician may request a cystoscopy in cases where a patient frequently experiences UTI. This test uses a long thin tube with a lens known as a cystoscope and then passes it through the urethra and into your bladder to get a closer look into the structures of your urinary tract.

Urinary Tract Infection: Management Strategies

For most cases, urinary tract infections do not induce severe complications and are often only managed with simple medications directed towards eliminating the causative microorganism. However, do note that self-medication is never encouraged due to the possibility that your infection might be caused by a pathogenic microorganism that is not bacterial. With this in mind, we could prevent the growing antimicrobial resistance issue within the medical field and avoid any untoward effects towards the patient that may even do more harm than good. Once again, do not self-medicate.

Simple Infections

In most cases, physicians would often recommend the following medications to address uncomplicated UTI cases:

• Trimethoprim/Sulfamethoxazole
• Fosfomycin
• Nitrofurantoin
• Cephalexin
• Ceftriaxone

Do note, however, that the use of these medications would still depend on the causative microorganisms and the patient's status. In most instances, a patient’s UTI symptoms would clear up within the first few days of treatment, but almost remember that you should continue the regimen to ensure that the bacteria are completely eradicated from the patient's system. Some physicians may also prescribe analgesics if the patient’s pain affects their everyday lives.

Frequent/Chronic Infections

Physicians would often recommend a personalized treatment plan for frequent or chronic infections that would focus more on addressing your individual needs instead of relying on standardized treatment plans, albeit they are still based on sufficient scientific evidence. For instance, they may recommend low-dose antibiotics for six months, vaginal estrogen therapy, or even a single dose of antibiotic following sexual activity if your symptoms are commonly tied with sexual intercourse.

Complementary and Alternative Medicine

There is no “home cure” for UTI per se, but there are specific home remedies that physicians sometimes recommend due to their ability to aid the patient's treatment process. Cranberry juice, for instance, contains a particular molecule found in some studies to prevent the growth of specific bacterial species that are known to cause UTI infections. According to the American Urological Association, physicians often recommend cranberry juice for patients with recurrent UTI cases.

Frequently Asked Questions (FAQs)

What habits will make a UTI case worse?

One of the things that you should steer away from if you have an existing UTI are sweet foods, caffeinated drinks, citrus, spicy foods, and alcohol, as these consumables may irritate your urinary tract and worse the symptoms that you are experiencing.

How long does it usually take to treat UTI completely?

Symptoms of UTI often resolve within the first 24-48 hours of treatment, but a complete resolution would usually require the completion of the prescribed therapy.

How much water is recommended to be consumed when a patient has a potential UTI?

1.5 to 2 L of water is recommended every day, albeit this is likewise recommended for patients without UTI as a healthy habit.

Can stress cause UTI?

Partially yes. Stress often results in higher cortisol levels, resulting in a slightly “muted” immune system that has less efficacy against incoming infections. As such, it might put the body at a higher risk for UTI, but there is no established direct causality between the two.

Can dehydration cause UTI?

Yes, especially as it may cause incomplete bladder emptying and deposits of minerals and nutrients within the urine – all of which are precipitants of bacterial growth.

What are the complications of having Urinary Tract Infection?

For pregnant women, having UTI can lead to premature infants or low birth weight. The physical pain and discomfort people feel during urination is a significant thing that affects a person’s life on a daily basis.

I have been diagnosed with UTI, is it possible to be infected again?

Yes. Most women who have been infected with a urinary tract infection have recurrent infections. It is possible to experience UTI more than three times in a year.

Are there any other symptoms presented if Urinary Tract Infection is left untreated?

Permanent Kidney Damage. If urinary tract infections are left untreated, it is possible for the infection to crawl up to the kidney and cause permanent kidney damage or chronic kidney infection.

Sepsis. A serious and life-threatening complication response of the body to compensate for the damage caused by the infection. It is essentially defined as the presence of bacteria in the body’s systemic circulation.