Urinary Tract Infections (UTIs)

• Symptoms: strong urge to urinate, burning feeling during urination, change in frequency of urination, cloudy urine; red, bright pink or bloody urine; unusual discharge, pelvic pain, chills, fever, cramping or pressure in the groin or lower abdomen, nausea and vomiting, lower back pain
• Causes: harmful bacteria inside the vagina, infection of the bladder, urethra, or kidney
• Risk Factors: unprotected sexual activity, a history of UTIs, menopause, urinary tract blockages, weak immune system, improper urinary tract exam or surgery, use of a catheter, use of birth control pills, enlarged prostate, decrease in oestrogen levels, pregnancy, diabetes, old age
• Severity: Mild to severe (depending on how long the infection is left untreated)
• Which doctor to consult: General Physician, Urologist or OB-Gynaecologist

Overview

Urinary tract infections (UTIs) can be of two types. These can either be infections of the bladder or urethra. These are microbe infections and are caused most often by bacteria, fungi, and in very rare cases, viruses.

While most UTIs occur in the lower tract, i.e., the urethra and the bladder, at times, these can also involve the ureters and kidneys in the upper urinary tract. The latter are usually more severe forms of the disease warranting a visit to a urologist or an OB-Gynaecologist.

Symptoms of a UTI include:

• Frequent urge to urinate
• Burning sensation while urinating
• Cloudy, red, bright pink or bloody urine 
• Strong-smelling urine 
• Pelvic pain
• Pressure or cramping in the lower abdomen or groin

If an individual starts experiencing any of these symptoms, he/she should consider reaching out to a primary care provider or general physician. The doctor will likely prescribe the patient antibiotics that will cure the infection. Women have a much higher risk of UTIs than men since they have a much shorter urethra.

Young children are also at risk of getting a UTI. However, they may be unable to tell that they have the infection. Hence, it is crucial for the parents to look for additional symptoms like fever, as it is often the most prevalent sign of a UTI in toddlers and infants.

When to Consult a Doctor?

Individuals must consult a doctor for UTI as soon as they notice one or more of the many symptoms associated with the disease. In addition, it might be a good idea to see a general physician if the symptoms are related to an upper tract UTI or if the existing symptoms haven't improved. Those who get frequent UTIs should also consult a GP or a urologist, for they can signal a severe kidney infection.

Diagnosis

1. Physical Examination

The first step to diagnosis is a physical examination. Once a patient schedules an appointment, the doctor will review the symptoms, prescribe a physical examination to test the urine for any microbes. These can include a whole range of lab tests and even imaging tests.

2. Lab Tests

• Urinalysis: This involves the complete study of a mid-stream urine sample. The sample is taken to a laboratory to check for white blood cells (WBCs), red blood cells (RBCs), and bacteria. The patient may be asked to use a disinfectant pad to prevent contamination of the sample with bacteria or yeast from the skin.
• Urine Culture: A doctor can also suggest a urine culture to determine precisely what microbe is causing the urinary tract infection. Depending on whether it's a bacteria, fungi, or in very rare cases, a virus, the doctor will suggest treatment. However, the patient may be asked to undergo a few more special tests if the UTI is viral.

3. Imaging Tests

• IVP (Intravenous pyelogram): This entails injecting a dye into the body that travels through and highlights the urinary tract. Then an X-ray image of the patient's abdomen is taken that shows the extent of the infection.
• Ultrasound: Ultrasound is a process where a transducer is used over the abdomen. It produces ultrasound waves that build a live image of the urinary tract and display it on the monitor.
• Cystoscopy: A cystoscopy entails the insertion of a thin tube with a lens, known as a cystoscopy, through the urethra up the bladder to see inside it. During a cystoscopy, the doctor may remove a small part of the bladder tissue to test it to rule out bladder inflammation or cancer as causes of the symptoms.
• CT scan: A patient may require a CT scan if he/she has recurrent UTIs. A CT or computerised tomography scan offers detailed images of the urinary system. A CT scan is a variant of an X-ray. However, it is far more precise. It takes cross sections of the body to offer more detailed insight into the ailment.

Treatment

1. Home Care

There are no specific home remedies to cure a UTI. Nevertheless, individuals can take certain steps to ease the discomfort and shorten the duration of the infection. These include drinking lots of water and cranberry juice. This does not cure an existing UTI but helps prevent future UTIs.

2. Medication

Once the infection has been established, doctors will typically prescribe antifungal or antiviral medication based on the type of microbe that has caused the infection. Some of the most commonly used antibiotics for treating UTIs include Nitrofurantoin, Amoxicillin, Doxycycline and Quinolones. Antiviral cidofovir is often utilised to remedy viral UTIs.

Most of these treatments only last about a week. However, it is imperative to stick to the treatment and the course regimen for the best results.

3. Hospitalisation

In rare cases, a patient may require hospitalisation. This can involve IV antibiotics if the infection becomes antibiotic-resistant or the UTI has travelled to the kidney. The medicines are injected directly into the veins. The patient may still have to take oral antibiotics post-discharge to flush out the infection thoroughly.

Risks & Complications if Left Untreated

It is critical to address a UTI as soon as possible. Untreated UTIs grow severe as they spread. Lower urinary tract infections are typically the quickest and easiest to cure. An infection that extends to the upper urinary tract is far more challenging to treat. It is also likely to cause sepsis which can be potentially life-threatening.

Moreover, untreated UTIs can also cause repeat bouts of infection. They can also cause permanent kidney damage. Those who experience a UTI while pregnant can be at risk of delivering  a premature infant or an infant with low birth weight.

Additional Information

While there are no foolproof home remedies to cure a UTI, certain habits can help prevent them.

• Drink more fluids: Dehydration can often lead to UTIs. Hence, healthcare experts suggest increasing water intake when diagnosed with a UTI. Unsweetened cranberry juice can effectively prevent and flush out a UTI.
• Consume vitamin C: Increasing the intake of vitamin C can also be quite helpful in protecting against UTIs. It helps increase the acidity of the urine and kills off the bacteria that cause the infection.
• Take appropriate hygiene measures: UTIs are most often a result of poor hygiene. Hence, it becomes imperative to maintain proper hygiene. Regularly cleaning genitals, urinating after sexual intercourse, and avoiding using harsh chemicals should be practised.
• Consume suitable supplements and probiotics: Taking supplements and probiotics can be beneficial in protecting against a UTI. Natural supplements such as garlic extracts, D-mannose, and cranberry extract are known to prevent the development of UTI-causing bacteria.