Wednesday 16 October 2019

'UTIs are the second most common type of infection and many will experience a few'

Ask the Doctor

Doctor using digital tablet
Doctor using digital tablet

Dr Nina Byrnes

I'M 22 and consider myself fairly healthy, but I have had to attend my GP three times in the last year with kidney infections. Why am I getting these and should I worry?

Dr Nina Byrnes replies: THE urinary tract acts as a drainage system to help the body rid itself of toxins and excess fluid. Urine is produced in the kidney and travels down a tube called the ureter to the bladder, where it is stored until a person decides to pass urine. It then travels from the bladder down another tube, called the urethra, and out of the body.

Urine is normally sterile. A urinary tract infection (UTI) occurs when bacteria enter the urine. This most commonly occurs when bacteria travel from outside the body up the urethra, although rarely infection can enter from the blood.

An infection occurring in the urethral area is called urethritis; if it ascends to the bladder, it's called cystitis and if it passes higher towards the kidneys it's called pyelonephritis. When we talk about kidney infections or urinary infections, we are normally referring to infections of the urethra or bladder. Infections of the higher urinary tract or kidneys are less common but often more severe.

Untreated serious UTI's can cause infection of the blood and kidney failure.

UTI's are the second most common type of infection in the body. They occur more commonly in women. This is due to the fact that the urethra is much shorter than in men and is also located near to the anal area. This facilitates the passage of bacteria into the body. Intercourse can also facilitate this transfer and thus UTI's in newly sexually active women were often referred to as 'honeymoon cystitis'.

Most women will have some bacteria in their urine post intercourse, but this usually clears itself within 24 hours. UTI's when they occur in men, are often more serious and may be a sign of an underlying problem such as prostate disease.

If you have a UTI you may feel the urge to urinate more frequently, but only pass a small amount. There may be pain or stinging passing urine and urine may appear cloudy, foul-smelling or blood-tinged.

Other symptoms include back pain, fever, nausea or pressure or pain in the abdomen. In pregnant women, the elderly or children, symptoms may be very vague and so doctors will often check for this even if no urinary symptoms occur.

In order to diagnose a UTI your doctor will dip the urine to check for white cells, protein or blood and may also send the urine to the lab to see what bacteria grows. E Coli is the most common bacteria found when checking urine. This normally lives in the bowel but can pass to the urethra, causing infection.

If a UTI is confirmed, an antibiotic will be prescribed. Lower UTI's usually settle with three to five days of treatment, but more severe infections may require hospital admission for intravenous antibiotic therapy.

The lifetime risk of having a UTI is 50% in women. Many will experience a few UTI's in their lives. About 20% of young women who experience a UTI will have a recurrent infection. For each UTI you experience, the chance of recurring infection increases. Most typically, a woman may experience a year or two where she has more frequent infections, after which these cease. If you are experiencing frequent UTI's, further tests are normally arranged. These may include blood tests, swabs or tests such as an ultrasound or other specialised scans. In younger women an underlying STI may be the culprit, whereas in post-menopausal women, vaginal changes due to low levels of oestrogen can increase the risk.

Causes of recurrent UTI's include Chlamydia, Mycoplasma, Kidney stones, prostate problems (in men), abnormalities of the urinary tract, use of catheters, diabetes or other conditions that suppress the immune system

For those with recurrent infections a low dose of antibiotic taken at night may be prescribed for several months. Another remedy may include taking a single dose of antibiotic after sexual intercourse or taking a short course of antibiotics as soon as symptoms appear. In most cases, simple preventive measures can be helpful. Cranberry juice or Vitamin C make the urine more acidic and so make it harder for urine to grow. They are good at preventing a UTI but will not normally cure one once it occurs. Local intra-vaginal oestrogen therapy can help reduce symptoms in post-menopausal women.

It is essential to drink plenty of water. This helps keep the urinary tract flushed through and makes it more difficult for bacteria to grow. It is important to pass urine when the urge occurs and avoid resisting the urge to go. Passing urine after intercourse will help flush out any bacteria that may have entered the body. Women should always wipe themselves from the front to the back to prevent the transfer of bacteria from the anal area.

As you have had three infections recently, it is worth attending your doctor for a check-up, but I would not be too concerned. It is most likely that with time and the simple measures mentioned above, your symptoms will not continue to reoccur.

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