Urinary Tract Infection (UTI): Types of UTI, Risk Factors and Treatment

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A urinary tract infection (in short UTI) is an infection in any part of your urinary system, that can be in your kidneys, bladder, ureters, and urethra.

  • Urinary tract infection is the most common clinical infection, accounts for about 25% of all infection.
  • UTI is more common in females than in males.
  • 50-60% of females present UTI at least once in their lifetime.
  • E.coli and Klebsiella pneumonia are the two common pathogens that cause UTIs.
  • 80% of UTIs are recurrent infection.

How does the Urinary Tract function?

The urinary tract is the body drainage system, which comprises of kidney, bladder, ureters, and urethra. 

Urine formed in the kidney by filtration of blood then ureters a thin tube carry urine from the kidney to the bladder. The bladder is a muscular, balloon-shaped organ that stores urine until the individual urinates. The urethra is a tube that connects the bladder to the external meatus for the removal of urine from the body. 

It helps to balance the chemical, manage the blood acidity in the body. Signals and hormones which regulate urinary track help to control blood pressure, and boost red blood cell production.

 Urinary Tract Infection:

Urinary tract infection is described as the entry of the microbial pathogen in tissues of the urinary tract. Normally, the urinary tract is sterile, but the pathogen can invade from an external source and cause infection.

Females are at greater risk to develop UTI than males because the length of the female urethra is smaller than males and bacteria have a short distance to travel to reach the bladder.    

   UTIs are categorized into upper or lower according to where they occur along the urinary tract.

Lower urinary tract infection:

Lower urinary tract infection (LUTI) refers to a group of infection that involves the bladder, urinary sphincter, urethra, and in men, the prostate gland. Lower UTI’s symptoms called lower urinary tract symptoms (LUTS) which affect approximately 40% of older men.  

Upper urinary tract infection:

Upper urinary tract infection refers to a group of infection that involves kidney and ureter. Upper urinary tract infection mostly relates to lower urinary tract infections.

The pathogen which causes UTIs:

UTIs occur when any infectious agent enters in the urinary tract through the urethra and travels into the bladder and begins colonization or multiply.

E.coli:

National Kidney Foundation estimated that 80-90% of UTIs are caused by bacteria name Escherichia Coli (E.coli).

E.coli is not the normal flora of the body, it enters into the urinary tract through the fecal-oral route by raw or undercooked ground beef, from drinking raw milk(without boil). 

 Klebsiella:

  • Klebsiella infection is the distinguishing form of UTIs caused by other common organisms.
  • It also causes community-acquired pneumonia, nosocomial infection, chronic genital ulcerative disease, and colonization. 
  • Klebsiella’s common UTI symptoms are urgency, dysuria, hesitancy, lower back pain, and suprapubic discomfort.

Candida: 

Candida is a common fungal infection, which forms colonies infect the kidneys as part of a systemic or disseminated mycotic infection. It usually occurs in patients with urinary catheterization for a long time.  Candida’s complication includes cystitis, pyelonephritis, prostatitis, and upper and lower tract obstruction.

Virus:

The virus is an uncommon cause of UTIs, which usually affect lower urinary tract infections, especially hemorrhagic cystitis in immunocompromised individuals, after stem cell and solid organ transplantation.

 As E.coli is the most common etiological pathogen of UTIs, some other bacterial agents are klebsiella, staphylococcus saprophyticus, and pseudomonas aeruginosa.

Sexually active individuals, frequently urinary catheterizations, and unhygienic environments increase the risk of UTIs. STDs may also cause inflammation and infection of the urethra. 

Symptoms of UTIs:

Urinary tract infections usually asymptomatic or present silent symptoms, but when they do they may include;

  • Burning micturition.
  •  Oliguria (small amount of urine).
  • Cloudy appearance in the urine. 
  • Strong and persistent urges to urinate.
  • Blood in the urine.
  • A strong smell of urine.
  • Strong Pelvic pain.
  •   Side pain.
  • Urge incontinence.
  • nocturia.

UTI and COMPLICATED UTI EXPLAINED:

Risk factors related to UTIs:

 Some of the risk factor which can increase the chance of UTIs;

Body factor:

Women after menopause have a higher risk of getting UTIs because the lining of the vagina changes and loses the protection provided by the estrogen level. Some females are genetically predisposed to UTIs, which make it easier for a pathogen to cling.

Birth control:

Females who use a diaphragm, are found to have a higher risk of UTIs. and males who excessively use a condom and unhygienic lifestyle also enhance the UTIs.

Abnormal anatomy:

Abnormal anatomy means using a device like a catheter for drainage if you are not able to urinate. Other anatomical abnormalities include diverticula, harbor bacteria in the bladder or urethra, and enlarge the bladder which blocks the urinary tract.

Immune system:

The immunocompromised patient is a higher risk of UTI. Medical condition which decreases the immune power include;   

  • Diabetes
  • Kidney transplant 
  • Large prostate
  • menopause.
  • Spinal cord injury
  • The uncircumcised individual pronto increases UTI.

How to diagnose UTI?

After discussing the signs and symptoms of UTIs, your doctor will guide you to do lab test like;

  • Urinalysis: look for evidence of infection, like bacteria and WBCs in a urine sample. A positive result with increase WBCs or presence of nitrate in urine indicates the UTIs.
  • Urine culture: use to identify the specific organisms causing the infection.

Other lab test is done in certain cases include;

  •  blood culture (for bacteremia)
  • STDs test (for chlamydia and gonorrhea)
  • Glucose and hemoglobin A1c (for diabetes)
  • Kidney stone analysis

Non-laboratory test use to see blockage and obstruction which causing UTIs include;

  • X-ray (IVP) test.
  • Kidney and bladder ultrasound
  • Voiding cystourethrogram (VCUG)
  • Cystoscopy
  •  Intravenous pyelogram (IVP)
  • CT scan
  • MRI

Prevention:

 Some steps will help you to prevent UTIs and recurrent UTIs are;

  • Don’t hold urine, use the restroom if you feel urge to urinate.
  • Drink at least 8 or more glass of water to make yourself hydrated.
  • Urinating before and after intercourse may help to prevent UTIs.
  • Vaginal estrogen gels or creams should be used by postmenopausal women.
  • Wash and wipe after bowel movements.
  • Cranberry juice and supplements help to prevent UTIs. 
  • Avoid wearing tight underpants and cloths.

Treatment:

 Antibiotics normally are the first line defense treatment for UTIs. Drugs that commonly recommended are;

The uncomplicated UTI, the shorter the course of treatment.

If you face recurrent UTIs then the doctor may make certain treatments like;

  • Low dose antibiotics for around six months.
  • Vaginal estrogen therapy to postmenopausal women.
  • A dose of antibiotics after intercourse if your infection is related to sexual activity. 

Q. Can pregnant women have UTIs symptoms?

UTI is common in pregnant women because the growing fetus puts pressure or tension on the bladder and urinary tract, which catches bacteria or causes urine leak. A pregnant women’s urine is more concentrated ( having hormone and sugar ), which encourages bacterial growth and decreases the body’s ability to fight. 

Takeaway: 

A UTI happens when bacteria or other infectious agent gain access into your urine and travels up to the bladder. UTI is a common and treatable infection if you see the doctor at the right time.

Men are less likely to develop UTIs, but if they get one than they are likely to develop another because bacteria will remain hidden inside the prostate.