Lower Urinary Tract Infection (Lower UTI, cystitis)

Infection of the lower urinary tract occurs when the inner lining of the bladder becomes infected and the urine is full of bacteria. In pregnancy, 5 – 10% of women have bacteria in their bladder and some will have no symptoms at all.

How common?

Up to 40 – 50% of women will have at least one attack in their lifetime and 25% will have recurrences.

Causes

  • Bacteria can reach the bladder from the genital and anal area, or through the bloodstream.
  • Injury to the urethra or the bladder.
  • Prolonged use of a urinary catheter to empty the bladder, such as during childbirth or surgery.

Risk factors

  • Sexual activity.
  • Infection in other parts of the genitourinary system.
  • Pregnancy.
  • Poor hygiene.
  • Menopause.
  • Diabetes mellitus.
  • Underlying abnormalities of the urinary tract, such as tumours, calculi (stones), and strictures.
  • Incomplete bladder emptying.
  • During or after major surgery

Common symptoms and signs

  • Burning or stinging pain or discomfort during urination.
  • Frequent urination, although the urine amount may be small. A need to wake up to urinate more often at night.
  • Sensation of incomplete bladder emptying.
  • Pain or discomfort over the bladder area.
  • Low back pain.

  • Blood in the urine; foul-smelling urine or discoloured urine.
  • Fever and occasional chills.
  • Painful sexual intercourse.
  • Incontinence (loss of urinary control).

Investigations and diagnosis

Investigations may include urinalysis and collection of mid-stream urine collection for bacterial culture. Cystoscopy (examination of the bladder with a lighted optical instrument) and an ultrasound scan of the urinary system are both reserved for complicated cases or for those with recurrent infection. Other blood and imaging tests will depend on the findings after the above preliminary investigations. The diagnosis is confirmed when the urine culture showed the presence of significant microorganisms.

Complications

Inadequate treatment can lead to chronic bladder infections, kidney infection and, in rare cases, kidney failure. In untreated or poorly treated patient with a compromised immune system, this can lead to widespread infection to other parts of the body.

Treatment

  • Treatment is usually with antibiotics. You should complete the course of antibiotics. Some antibiotics may cause certain side effects. If the side effects are troubling you, you should let your doctor know about this so that another type can be chosen to eradicate the infection.
  • A repeat urine culture may be requested after treatment to ensure that the infection is no longer present.
  • Warm baths may help relieve discomfort.
  • Avoid sexual intercourse until you have been free of symptoms for at least 1 weeks to allow the inflammation to subside.
  • Avoid dehydration. In general, you should aim to drink 6 to 8 glasses of water daily. Avoid caffeine and alcohol during treatment.

Prevention

  • If possible, you should try to urinate right after intercourse.
  • Use a water-soluble lubricant if you have vaginal dryness, such as K-Y lubricating jelly during intercourse. Avoid spermicides.
  • Do not douche or use feminine hygiene sprays or deodorants. Avoid bubble baths, chlorinated pools, and spas if you have recurrent infections.
  • Clean the anal area thoroughly after bowel movements. Wipe from the front to the rear, rather than rear to front to avoid spreading faecal bacteria to the genital area.
  • Use cotton underwear.
  • Avoid postponing urination.
  • In women with frequent recurrence of infection associated with intercourse, antibiotics may be prescribed for use prior to or right after sexual intercourse.
  • For menopausal woman, vaginal oestrogen cream may be recommended in those with recurrent infections.
  • Cranberry juice has been extremely popular as a remedy to treat or even prevent bladder infection. Unfortunately, there are no strong evidence from good research data to suggest that it is effective. If you want to try cranberry products for your infection, there is probably not much harm in doing so. However, you should be aware of any worsening symptoms or ineffectiveness and must consult your doctor immediately while taking cranberry product. It should not be a substitute for medical consultation if you are not getting any better.

SEE YOUR DOCTOR IMMEDIATELY IF THERE IS:

  • Blood appears in the urine.
  • Discomfort and other symptoms did not improve after you have taken the antibiotics for 48 hours.
  • Worsening fever or pain.
  • New, unexplained symptoms develop.
  • Symptoms recur after treatment.

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