Urinary Tract Infections
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Urinary tract infections are one of the most commonly occurring bacterial infections in medicine today and account for 7 million patient visits annually.(1 <#fn107238>) It is estimated that 20% of women will
suffer with symptoms of a urinary tract infection some time in their lives, with many having more than one.(2 <#fn107239>) Infections of the urinary tract cover a wide variety of syndromes including urethritis,cystitis, prostatitis, and pyelonephritis.
Under normal circumstances, the urinary tract is pretty resistant to infection by bacteria. This is partly because of the very nature of urine itself. Urine has a very low pH, which along with its high concentration of urea and the manner in which it sets up or crosses membrane barriers, allows it to kill or at least slow the growth of many organisms. There are several ways in which professionals classify UTI?s.
One of these methods simply refers to where the infection is. Lower urinary tract infections include cystitis (bladder), urethritis (urethra), prostatitis (prostate gland), and epididymitis. Pyelonephritis is considered an upper urinary tract infection and involves the kidneys.
Another way to classify them is as either complicated or uncomplicated. Uncomplicated urinary tract infections involve a patient who lacks structural or functional abnormalities that interfere with normal urine flow. These infections occur most frequently in women of child bearing
age who are otherwise healthy individuals. Complicated UTI's, on the other hand, are the result of something structural or functional such as a birth defect, an injury, a stone or obstruction, to name a few. When
these and other conditions interfere with the normal flow of urine, then the condition is considered to be complicated. Complicated infections occur in both genders and frequently involve the upper and lower urinary tract.(3 <#fn107240>)
UTI's are disorders involving a repeated or prolonged bacterial infection of the bladder or lower urinary tract. Most urinary tract infections occur in the lower urinary tract, which includes the bladder and urethra. Cystitis occurs when bacteria, along with the accompanying inflammation infect the lower urinary tract which is normally a sterile environment. If an individual has frequent infections or if the infection does not respond to treatment, then the condition is considered chronic. Chronic or recurrent urinary tract infections include repeated episodes of cystitis, or urinary tract infections that do not respond to usual therapies or that last longer than two weeks. UTI's are most common in women; however, men and children may experience them as well.
About one in every five women will experience a UTI at least once in their lifetime, and many will have recurring infections. Also, the elderly population is at an increased risk for developing cystitis due to incomplete emptying of the bladder associated with many of the
conditions that accompany aging. Also, a lack of adequate fluids, bowel incontinence, immobility or decreased mobility, and placement in a nursing home, all place the person at increased risk for developing cystitis.(4 <#fn107241>)
The majority of UTI's are caused by a single organism, however in complicated urinary tract infections, more than one organism may be the problem. There are several ways in which the bacteria can enter into the urinary tract with the ascending route being the most common. The source
of those bacteria can be from fecal material, use of spermacides, and the use of diaphragms as contraception.(1 <#fn107238>) The fact that UTI's are more common in females than males due to the anatomic differences in location and length of urethra seems to support the
theory that the ascending route is the most common acquisition route.
Descending (Hematogenous) spread is another route by which infection of the kidney may occur. This generally occurs as a result of the spread of germs from a distant site of infection. Infections involving the descending route are relatively rare and account for less than 5% of UTI's that actually get reported.
A third route that has been proposed is through the lymphatic system. While there are lymphatic ommunications between the bowel and kidney, as well as the bladder and kidney, there is currently no scientific proof that bacteria come through this route. Once bacteria reach the
urinary tract, three factors usually determine whether or not infection will follow. Those are: size of the bacteria, strength of the bacteria present, and how strong the body's defense mechanisms are at the time. Most infections occur because the body is not able to defend itself.
When the bacteria invade the bladder, the bladder wants to empty immediately. If the individual is not able to completely empty their bladder, they have a greater risk of getting an infection. In fact even the slightest amount of residual urine in the bladder makes the infection more difficult to treat successfully. Normally the cells in
the bladder are coated with a marvelous mucus called glycosaminoglycans which keep the bacteria from sticking to the cells in the bladder so the bacteria cannot set up house. If that layer of mucus is removed, the bacteria move in and grow rapidly.
Another amazing feat of the defense mechanism of the bladder is known as Tamm-Horsfall protein. This protein is secreted into urine and contains residues which bind with the hair like projections of bacteria and then the bacteria is washed out with urine flow.
Some invading bacteria have rigid hair like "arms" on their cell wall which is very strong and resists all of the body's efforts to remove it. With this type of bacteria, the infection can grow and invade other tissues like the kidneys.
Additional Links Back to Top <#top>
* Statistics about Urinary Tract Infections (UTI)
* Signs and Symptoms of Urinary Tract Infections (UTI)
Footnotes Back to Top <#top>
^1 Bacheller CD, Bernstein JM. Urinary tract Infections. Med Clin North Am. 1997;81:719-729. View Abstract view-abs.asp?fnid=107238&absid=102980>
^2 Plumridge RJ, Golledge CL. Treatment of urinary tract infection: Clinical and economic considerations. Pharmacoeconomics. 1996;9:295-306. View Abstract view-abs.asp?fnid=107239&absid=102981>
^3 DiPiro JT, et al. Pharmacotherapy, A Pathophysiologic Approach fourth edition. Appleton and Lange. Stamford, Connecticut.1999;1779-1794.
^4 Lara LL, Troop PR, Beadleson-Baird M. The risk of urinary tract infection in bowel incontinent men. J Gerontol Nurs. May1990;16(5):24-6. View Abstract view-abs.asp?fnid=107241&absid=106469>
About Urinary Tract Infections (UTI)
? Introduction
? Statistics
? Signs & Symptoms
*Treatment Options*
Click to View additional treatment options for Urinary Tract Infections (UTI)
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