Classification Of Urinary Tract Infections
UTIs are classified into 6 categories. The first category is an uncomplicated infection this is when the urinary tract is normal, both structurally and physiologically, and there is no associated disorder that impairs the host defense mechanisms. The second category is an complicated infection this is when infection occurs within an abnormal urinary tract, such as when there is ureteric obstruction, renal calculi, or vesicoureteric reflux. The third category, an isolated infection, is when it is the first episode of UTI, or the episodes are 6 months apart. Isolated infections affect 2540% of young females. The fourth category, an unresolved infection, is when therapy fails because of bacterial resistance or due to infection by two different bacteria with equally limited susceptibilities. The fifth category, reinfection, occurs where there has been no growth after a treated infection, but then the same organism regrows two weeks after therapy, or when a different microorganism grows during any period of time.9,10 This accounts for 95% of RUTIs in women. Bacterial persistence happens when therapy is impaired by the accumulation of bacteria in a location that cannot be reached by antibiotics, such as infected stones, urethral diverticula and infected paraurethral glands. The sixth category, relapse, is when the same microorganism causes a UTI within two weeks of therapy however, it is usually difficult to distinguish a reinfection from a relapse.11
How Do Utis Affect Pregnancy
Changes in hormone levels during pregnancy raise your risk for UTIs. UTIs during pregnancy are more likely to spread to the kidneys.
If you’re pregnant and have symptoms of a UTI, see your doctor or nurse right away. Your doctor will give you an antibiotic that is safe to take during pregnancy.
If left untreated, UTIs could lead to kidney infections and problems during pregnancy, including:
- Premature birth
- Low birth weight
Can Recurrent Utis Be A Sign Of Cancer
Both UTIs and bladder cancer can cause similar symptoms, such as a frequent need to urinate and even blood in the urine, according to the University of Rochester Medical Center.
According to the American Cancer Society, urinary tract infections, kidney and bladder stones, and other causes of chronic bladder irritation have been linked to bladder cancer. However, its not clear whether recurrent urinary or bladder infections can actually cause bladder cancer or whether they constitute a true risk factor for bladder cancer.
The biggest known risk factor for bladder cancer is smoking. The risk of bladder cancer also increases with age. Most people who get bladder cancer are over the age of 55.
If you think you may have chronic or recurrent UTIs, its best to get checked out by your doctor. Your provider can rule out other health issues, including bladder cancer, and get you the treatment you need to get rid of chronic UTIs.
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Diagnosing A Urinary Tract Infection In Older Adults
Vague, uncommon symptoms such as confusion make UTIs challenging to diagnose in many older adults. Once your doctor suspects a UTI, its easily confirmed with a simple urinalysis.
Your doctor may perform a urine culture to determine the type of bacteria causing the infection and the best antibiotic to treat it.
There are home UTI tests that check urine for nitrates and leukocytes. Both are often present in UTIs. Because bacteria are often in the urine of older adults to some degree, these tests arent always accurate. Call your doctor if you take a home test and get a positive result.
Antibiotics are the treatment of choice for UTIs in older adults and younger people. Your doctor may prescribe amoxicillin and nitrofurantoin .
More severe infections may require a broad-spectrum antibiotic such as ciprofloxacin and levofloxacin .
You should start antibiotics as soon as possible and take them for the entire duration of treatment as prescribed by your doctor. Stopping treatment early, even if symptoms resolve, increases the risks of recurrence and antibiotic resistance.
Antibiotic overuse also increases your risk for antibiotic resistance. For this reason, your doctor will likely prescribe the shortest treatment course possible. Treatment typically lasts no more than 7 days, and your infection should clear up in a few days.
Its important to drink plenty of water during treatment to help flush out the remaining bacteria.
Why Are Women More Commonly Affected By Utis
Women are more commonly affected by UTIs because of:
- The female anatomy
- The female urethra is short which allows easier entry of skin and surface bacteria into the bladder.
- The female urethra is close to the vagina and back passage that normally contain bacteria and makes it easier for bacteria to enter the urinary system.
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What Can I Do To Prevent Recurrent Utis
The majority of UTIs, about 90%, are caused by E. coli, a bacteria that naturally occurs in your intestines where its helpful. When this bacteria comes in contact with your urinary tract system, however, it can be harmful and lead to a UTI.
For most people, simple hygiene and lifestyle changes can help prevent recurrent UTIs. To help stop a UTI before it starts, try implementing these tips:
- Avoid spreading E. coli by washing your genitals with warm water and mild soap before and after sex.
- Drink plenty of fluids to flush out any wandering bacteria from the urinary system.
- Be sure to urinate after having sex to keep bacteria from lingering in the urethra.
- When you feel the urge to urinate, go postponing urination increases your risk of developing a UTI.
- Be sure to wipe from front to back to avoid spreading E. coli to the vagina.
Ready to learn more about UTIs and how they affect older women? Experiencing symptoms of a UTI? Contact our Littleton office or book an appointment online now and the help you need!
A Pharmacist Can Help With Utis
You can ask a pharmacist about treatments for a UTI.
A pharmacist can:
- offer advice on things that can help you get better
- suggest the best painkiller to take
- tell you if you need to see a GP about your symptoms
Some pharmacies offer a UTI management service. They may be able to give antibiotics if they’re needed.
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The Absence Of Recurrent Uti Guidelines
Because there are no guidelines on managing complex or recurrent UTI, primary care doctors are generally not in a position to help.
| Most UTI guidelines are aimed at management of simple uncomplicated UTI. It can be very difficult to successfully manage complex or recurrent UTI in primary care. If symptoms persist, or where there is diagnostic uncertainty GPs will need to make a referral for specialist assessment.” |
For females that progress from a single UTI, to recurrent UTI or chronic urinary tract infection, or to a diagnosis of Interstitial Cystitis, there has historically been very little hope of effective treatment. We hope to help change this.
You Wipe From Back To Front
Wiping from back to front can transport E. coli, the bacteria thats behind most UTIs, from the rectal region to the urethra. Moral of the story: Always wipe from front to back. Al-Badr A, et al. . Recurrent urinary tract infections management in women: A review.
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Other Ways To Prevent Some Utis Coming Back
If you keep getting a bladder infection , there is some evidence it may be helpful to take:
- D-mannose a sugar you can buy as a powder or tablets to take every day
- cranberry products available as juice, tablets or capsules to take every day
Speak to your doctor before taking any of these during pregnancy.
Be aware that D-mannose and cranberry products can contain a lot of sugar.
If you’re taking warfarin, you should avoid cranberry products.
Page last reviewed: 22 March 2022 Next review due: 22 March 2025
Deterrence And Patient Education
Several preventive measures can be taken to reduce further recurrences of UTI. Patients should be advised to increase fluid intake to at least 2 liters per day. In a study on 140 women, increased water intake resulted in decreased incidence of cystitis episodes by 1.5 . Topical vaginal estrogen is recommended in postmenopausal women with vulvovaginal atrophy to reduce the risk of future UTIs, provided there are no contraindications to estrogen therapy. Other behavioral modifications include wiping from front to back and early postcoital voiding. There is no conclusive evidence on the beneficial role of cranberry juice in reducing episodes of recurrent UTI.
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What Are The Signs And Symptoms Of Utis
Every child can present UTI symptoms differently and symptoms may vary by age, but typically they will include:
- urinary frequency or an increased urge to pee
- bad odor to urine
- pain in the lower abdomen
- urinary accidents when they were previously completely potty trained
- blood in the urine
- pain with urination
For infants, they may show nonspecific signs such as a fever, irritability or poor appetite, but other signs may also include a failure to gain weight or develop normally and a bad odor to their urine, Dr. Kronborg added.
How Is A Uti Diagnosed
To find out whether you have a UTI, your doctor or nurse will test a clean sample of your urine. This means you will first wipe your genital area with a special wipe. Then you will collect your urine in midstream in a cup. Your doctor or nurse may then test your urine for bacteria to see whether you have a UTI, which can take a few days.
If you have had a UTI before, your doctor may order more tests to rule out other problems. These tests may include:
- A cystogram. This is a special type of x-ray of your urinary tract. These x-rays can show any problems, including swelling or kidney stones.
- A cystoscopic exam. The cystoscope is a small tube the doctor puts into the urethra to see inside of the urethra and bladder for any problems.
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What Is A Uti
Before we talk about recurrent UTIs, lets talk about UTIs in general.
A UTI is an infection in any part of your urinary tract, the Mayo Clinic explains. The infection usually starts when bacteria normally found in your bowels get into the urethra, where pee exits from. Instead of urine flushing out the bacteria or your immune system fending it off like its supposed to, the bacteria begin to colonize the urinary tract, according to the National Institute of Diabetes and Digestive and Kidney Diseases . Most UTIs stay in the urethra and bladder , per the Mayo Clinic.
Sometimes a UTI keeps coming back, which is called a recurrent UTI or a chronic UTI. Most people would say a true recurrent UTI is either two within six months or three within a year, Sandip Vasavada, M.D., urologic director of the Center for Female Urology and Reconstructive Pelvic Surgery at the Cleveland Clinic within the Glickman Urological Institute, tells SELF.
Recurrent Urinary Tract Infection In Pregnancy
UTI is the most frequent medical complication of pregnancy. The risk factors of preterm delivery, low infant birth weight and abortions are most commonly associated with symptomatic and asymptomatic bacteriuria during pregnancy.77 In pregnancy, factors that contribute to UTI risk are ureteric and renal pelvis dilation increased urinary pH decreased muscle tone of the ureters, and glycosuria, which promotes bacterial growth. Treatment of asymptomatic bacteriuria in pregnancy reduces the risk of pyelonephritis. As RUTIs are common in pregnancy, they need prophylactic treatment if they occur. Screening for bacteriuria is recommended in all pregnant women at their first prenatal visit and then in the third trimester.82,83 They should subsequently be treated with antibiotics such as nitrofurantoin, sulfisoxazole or cephalexin.21,24,8284 Antibiotic prophylaxis for RUTI in pregnant women is effective using continuous or post-coital regimens. The causative organisms of UTI in pregnancy are similar to those found in non-pregnant patients, with E. coli accounting for 8090% of infections.85,86 Urinary group B streptococcal infections in pregnant women need to be treated and followed by intrapartum prophylaxis.21
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What If The Infection Does Not Clear Up With Treatment
Most infections clear up with treatment. However, if an infection does not clear up, or if you have repeated infections, you may be given some special tests such as:
-
a type of x-ray called an intravenous pyleogram , which involves injecting a dye into a vein and taking pictures of your kidney and bladder
-
an ultrasound exam, which gives a picture of your kidneys and bladder using sound waves
-
a cytoscopic exam, which uses a hollow tube with special lenses to look inside the bladder.
What Is A Recurrent Uti
UTI is a type of bacterial infection. It can affect the bladder, kidneys, ureters, or/and urethra. Chronic, recurrent, or repetitive UTI means developing 2 or more infections in 6 months or 3 infections in 1 year.
Having recurrent UTI symptoms usually means there are new infections with different bacterial organisms.
If the organism stays the same, this is a relapsing infection. The patient didnt properly get rid of the source, which could be prostatitis, urinary stone, or abscess.
Its crucial to differentiate a UTI relapse from rapid reinfection .
Relapsing infections refer to a recurrence within 2 weeks of finishing therapy with the same organism. In comparison, reinfection is when a new infection is more than 2 weeks upon completing the treatment, even if the organism remains the same. Most recurrent UTIs are reinfections that dont need a thorough evaluation.
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Check If Its A Urinary Tract Infection
Symptoms of a UTI may include:
- pain or a burning sensation when peeing
- needing to pee more often than usual during the night
- pee that looks cloudy
- needing to pee suddenly or more urgently than usual
- needing to pee more often than usual
- lower tummy pain or pain in your back, just under the ribs
- a high temperature, or feeling hot and shivery
- a very low temperature below 36C
Can I Prevent A Urinary Tract Infection
You can usually prevent a urinary tract infection with lifestyle changes. These tips can include:
In some post-menopausal women, a healthcare provider may suggest an estrogen-containing vaginal cream. This may reduce the risk of developing a UTI by changing the pH of the vagina. Talk to your healthcare provider if you have recurrent UTIs and have already gone through menopause.
Over-the-counter supplements are also available for UTIs. These are sometimes recommended for people who have frequent UTIs as another way to prevent them. Talk to your healthcare provider before starting any supplements and ask if these could be a good choice for you.
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Cranberry Juice And Tablets
Cranberry juice and tablets have been shown to reduce RUTIs as they contain a compound called tannin, or proanthocyanidin, which reduces E. coli vaginal colonisation.65,66 Although earlier, smaller studies have shown that consuming cranberry juice or tablets can prevent RUTIs, an updated Cochrane review showed that evidence for its benefit in preventing UTIs is small therefore, cranberry juice cannot be recommended any longer for UTI prevention.21,6769
Why Does My Dog Throw Up At 3am
Vomiting is usually seen in the morning or late night just before eating, especially in dogs that are fed once daily. This might be due to prolonged periods between meals, or to related stomach inactivity, which aggravates the bile reflux. This condition is commonly seen in older dogs but can occur at any age.
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What Are The Symptoms Of A Uti
If you have a UTI, you may have some or all of these symptoms:6,7
- Pain or burning when urinating
- An urge to urinate often, but not much comes out when you go
- Pressure in your lower abdomen
- Urine that smells bad or looks milky or cloudy
- Blood in the urine. This is more common in younger women. If you see blood in your urine, tell a doctor or nurse right away.
- Feeling tired, shaky, confused, or weak. This is more common in older women.
- Having a fever, which may mean the infection has reached your kidneys
Reframing A Diagnosis Of Interstitial Cystitis
We shouldnt think of IC as a specific condition, after all, those who have been diagnosed with it experience a vast range of different symptoms. And a cause for the onset of those symptoms has not been identified.
Instead, we should think of the term as a placeholder, while we wait for a specific cause to be identified.
A diagnosis of exclusion leaves a lot of room for misdiagnosis. Some researchers now believe the insensitivity of standard testing methods may have led to large numbers of unnecessary diagnoses of IC.
| “…if the test is negative, the sensitivity is such that there is no justification for claiming you do not have an infection… if the culture is negative it is again wrong to claim this proves an absence of infection the culture is too insensitive. For these reasons, negative tests are unhelpful and a cause of terrible suffering.” |
And this isnt just theoretical. Hundreds of females previously diagnosed with Interstitial Cystitis that is, the absence of infection have been able to receive better testing that has identified an infection.
With an infection identified these individuals have gained long term treatment that relieves their painful symptoms and has often led to complete resolution of the issue.
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