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 May 11, 2005
Urinary Tract Infection (UTI, Cystitis)
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A urinary tract infection (UTI) is an inflammation of the bladder due to infection with a microorganism (such as a bacteria or virus). It is also called Cystitis, and commonly known as "bladder infection." UTIs are second only to respiratory infections in frequency.


The National Kidney Foundation estimates that 10 to 20 percent of women have had at least one episode of UTI, and 80 percent of this group has had it recurrently. Although some cases of UTI are due to fungus or a virus, most are caused by one of several types of bacteria. The most common, Escherichia coli, accounts for about 90 percent of all urinary tract infections. The infection can occur in any part of the path the urine takes as it exits the body. If left unchecked, cystitis can spread upward to the kidneys (called ascending UTI), where it can be associated with fever and chills, and can be even more serious. Cystitis accounts for about 6 million medical visits per year or more. Although they occur in men and children, UTI's are more common in women because their urethras (the passage from which urine exits the bladder) are short, making it easier for organisms to get from outside into the bladder. Most typically, a woman develops a UTI if she has been sexually active (hence the moniker "honeymoon cystitis"), or has been careless with her hygiene habits (for example, wiping from back to front after a bowel movement). Escherichia coli normally live in the intestine and bowel without causing disruption, but once they make their way to the bladder, trouble begins. Bacteria tend to live better in warm, moist places, so the area around the urethra is a common breeding site.


Why do some women seem to develop UTIs more easily than others? Some experts say genetics may be the key, since research has shown that women with certain blood antigens (called the Lewis groups) are more susceptible to cystitis. The cells that line their urinary tracts seem to have far more receptors to which bacteria can adhere. Others may lack glycosaminoglycan, a substance found on the surface of the bladder that is inhospitable to bacteria. Another possible cause of recurrent infections in women is an ill-fitting diaphragm. If it's too big, it can push against the neck of the bladder and interfere with the normal body flow of urine and contribute to incomplete bladder emptying. This can serve as a breeding ground for bacteria. In men, an enlarged prostate can increase the risk for UTIs. Poor hygiene is linked to UTIs in children, and 50 percent of infants and 30 percent of older children with UTIs will have an anatomic abnormality. Individuals who are catheterized are also at risk for UTis. Although there is no scientific evidence linking diet to UTIs, some people have found that alcohol, tomatoes, spices, chocolate, caffeinated and citrus beverages, and high-acid foods might contribute to bladder irritation and inflammation.


The classic symptoms of cystitis include a frequent, urgent need to urinate and a painful burning sensation (called dysuria) upon urination. Lower back pain, lower abdominal pain, pelvic pressure, and urine that is cloudy or blood-tinged are other telltale symptoms. Sometimes there is a mild fever (101° or less) and chills. Upper urinary tract infections may or may not include the same symptoms as cystitis, and are sometimes accompanied by a higher fever, nausea, vomiting and more severe chills. In infants, vomiting, diarrhea, fever and poor appetite can indicate a UTI. Elderly people may have a change in mental state accompanied by fever, poor appetite and lethargy.


Usually, the symptoms of frequent urination associated with burning or pressure sensation is enough to conclude that cystitis is present. Other problems can mimic cystitis, such as vaginal infections with yeast (or other organisms) or some sexually transmitted diseases. Because of this, anything other than the simplest cases of cystitis warrant evaluation by a health professional. Examination of the urine, urine cultures that grow out the responsible microorganisms, and clinical assessment of other possible causes are all valuable in determining the problem.


To help prevent a urinary tract infection, a woman should:

  • Keep the vaginal area clean, including wiping from the front to back after a bowel movement to prevent contamination of the urinary tract.
  • Use tampons and change every three to four hours, instead of sanitary pads. (The pads can act as a culture medium for fecal bacteria, which may then be rubbed against the urinary outlet and invade the bladder.)
  • Wear cotton undergarments, which allow air circulation and discourage the warm, moist environment needed for bacteria growth. Nylon pantyhose should have a cotton crotch.
  • Avoid wearing tight clothes in the genital area, such as control-top pantyhose and skin-tight jeans, as well as extended wearing of a wet bathing suit.
  • Urinate before and after intercourse and make sure that the partner's hands and penis are clean.
  • Drink plenty of fluids (cranberry juice has been shown to help prevent urinary tract infections.)
  • Urinate "when you see a bathroom" rather than when the urge to urinate becomes strong.


What tests need to be done to diagnose the condition and cause? What type of treatment do you recommend? What medication will you be prescribing? What are the side effects? What measures can be taken to help relieve discomfort? What are the chances of the infection traveling upward to the kidneys? Do some juices help more than just water?

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