Urinary Tract Infection

Source: Adapted from Knowing Your Options: The Definitive Guide to Choosing The Medical Treatments, Reader’s

What is a urinary tract infection (UTI)?

Most urinary tract infections are called ‘lower UTIs,’ meaning the germs have taken hold in your urethra (a condition called urethritis) or in your bladder (a condition called cystitis). If the germs travel farther, an ‘upper UTI’ can develop, affecting the narrow tubes (ureters) leading to the kidneys or even the kidneys themselves. This potentially serious infection is known as pyelonephritis.

Between 80 and 90 percent of urinary tract infections are caused by Escherichia coli (E. coli), a bacterium usually confined to the colon and rectum that can spread from the anus to the urethra. Because a woman’s urethra is relatively short, women are more prone to UTIs than men (whose much longer urethra in the penis makes it harder for the bacteria to travel to the bladder). After menopause, some women are increasingly susceptible to infection because of a lack of estrogen.

Treatment for urinary tract infections

The good news for uncomplicated bacterial urinary tract infections, including cystitis, is that doctors will now often prescribe antibiotics over the phone, skipping the need for an in-office urine culture. The bad news is that so many strains of bacteria have become antibiotic-resistant, your initial drug may not work. A recent study of 75,000 UTI patients ages 15 to 44, for example, found that roughly 14 percent needed a second course of treatment within 28 days’regardless of which antibiotic they took initially.

So-called ‘complicated UTIs,’ which strike men and women equally, are a different story. These infections are more likely to occur if you have kidney involvement, are pregnant, have had a catheter put in, or have an abnormally structured urinary tract. Your doctor will want to carefully monitor you and aggressively treat any problem to prevent permanent damage or a system-wide infection. While uncommon, surgery for UTIs is extremely effective if anatomical problems are obstructing urine flow.

Medications for urinary tract infections

Although some doctors prescribe a one-day dose of an antibiotic for a routine urinary tract infection, you’ll probably be given a minimum of three days on the combination drug TMP-SMX (trimethoprim-sulfamethoxazole), best known by its brand names: Bactrim and Septra. If your symptoms warrant it, your doctor may instead choose a class of potent antibiotics called fluoroquinolones (quinolones), which includes ciprofloxacin (Cipro), as well as norfloxacin (Noroxin), oflaxacin (Floxin), and gatifloxacin (Tequin), the newest member of the group. A recent study showed that a single dose of Tequin worked just as well for an uncomplicated UTI as a regular dose taken over three days.

If these standard treatments are ineffective for your urinary tract infection, you may have to move on to the antibiotic cephalexin (Keflex) or, depending on the organism involved, to anti-infective drugs, such as nitrofurantoin (Macrodantin) or methenamine (Prosed). Whichever medication you take and however tedious it becomes, make sure you complete the entire course. If you don’t, germs can fight back and find a way to resist the drug, making future UTIs harder to treat. Here are a few other drug pointers:

• If you still have symptoms after taking antibiotics for a few days, you may need to give a laboratory urine sample. When the specific germ causing your problem is identified, your doctor can suggest customized medication and care.
• If you tend to develop a urinary tract infection after sexual intercourse, a single dose of antibiotics before or after sex may prevent the infection. Vigorous intercourse can sometimes bruise the urethra, making bladder infection more likely.
• If the pain of your infection is really getting to you, try an analgesic. For mild cramps or stomach pain, over-the-counter NSAIDs (aspirin, ibuprofen, naproxen) or acetaminophen may do the job. If burning during urination is intense, your doctor might also prescribe phenazopyridine (Baridium, Eridium, AZO Standard, Pyridium). Limited to short-term use (two to three days), this drug mixes with urine and numbs the urethra to relieve the discomfort. It may also turn your urine a harmless orange.
• If you have what feel like bladder spasms’waves of intense pain’tell your doctor. Prescription antispasmodics, such as flavoxate (Urispas), can provide relief.

Lifestyle Changes

You can do a number of things on your own to make urinary tract infections less overwhelming. At the first sign of an infection, start drinking plenty of fluids: An eight-ounce glass of water once an hour during the day is a great way to flush germs from your urinary tract. Never try to ‘hold it’ when you have to urinate. Delayed urination is a major cause of UTIs. Also, keep your genital and anal areas clean. Wipe from front to back to prevent bacteria around the anus from entering your urethra. Be sure to cleanse your genitals before and after sexual intercourse.

If your vaginal tissues are sensitive, avoid potential irritants. Feminine hygiene sprays and scented douches can aggravate the urethra, making it more susceptible to infection. If you’re postmenopausal and have been experiencing vaginal dryness, consider using a water-based’never a petroleum-based’vaginal lubricant (Astroglide, Lubifax, K-Y Jelly) during sex.

Related Procedures for Urinary Tract Infections

Some women have abnormally shaped urinary tracts that interrupt the flow of urine. Your doctor will likely investigate with an instrument called a cytoscope, which provides a way to examine the bladder via the urethra. Surgical repair might finally liberate you from UTIs.

Alternative Therapies for Urinary Tract Infections

Lab studies have discovered that cranberry juice prevents E. coli from adhering to the bladder walls. A 2001 Finnish study found that women prone to UTIs were half as likely to suffer a recurrence within six months if they drank an eight-ounce glass of cranberry juice every day. If possible, always purchase the unsweetened juice, available at health food stores.

Questions for Your Doctor

• Can a vaginal infection trigger a urinary tract infection?
• Is there a way I can tell if my kidneys are infected?
• Could my recurrent UTIs be due to an anatomical problem?

Living with a Urinary Tract Infection

If you’re living with a urinary tract infection, here are a few quick tips to help you take control:

• Be wary of home tests. Although widely available, home tests can be unreliable, and UTI symptoms always require a call to the doctor, regardless of what the test shows.
• Ask about long-term antibiotics. If you have recurrent UTIs (three or more a year), continuous low-dose antibiotic therapy may be the answer. It’s likely to be cheaper than treating each infection.
• Consider switching your birth control method. Research shows that women who use diaphragms are more susceptible to UTIs. The reason: Spermicides containing nonoxynol-9, often used with diaphragms, can change the bacterial balance in the vagina, enabling E. coli to proliferate.