UTI

Urinary Tract Infections (UTIs) are common infections that can affect any part of the urinary system, including the urethra, bladder, ureters, and kidneys, though most infections involve the lower urinary tract — the bladder and the urethra.

Diagnosis:

Symptoms of a UTI can include:

  • A strong, persistent urge to urinate
  • A burning sensation when urinating
  • Passing frequent, small amounts of urine
  • Urine that appears cloudy
  • Urine that appears red, bright pink, or cola-colored — a sign of blood in the urine
  • Strong-smelling urine
  • Pelvic pain, in women — especially in the center of the pelvis and around the area of the pubic bone
  • Rectal pain in men.

Testing:

  • Urine Dipstick Test: An initial screening test using a urine sample to look for the presence of leukocyte esterase or nitrites, which can indicate infection.
  • Urine Culture and Sensitivity Test: To identify the specific bacteria causing the infection and to determine the most effective antibiotics for treatment.
  • Imaging: Only recommended if
    • there are concerns about urinary tract abnormalities or
    • recurrent UTIs (>1 in men)
  • Cystoscopy: In recurrent cases, a camera might be used to look inside the bladder.

Differential Diagnosis:

  • Sexually Transmitted Infections (STIs): Symptoms of STIs can mimic UTIs, and tests may be conducted to rule these out.
  • Interstitial Cystitis: A chronic condition characterized by bladder pressure, bladder pain, and sometimes pelvic pain.
  • Vaginitis: Inflammation of the vagina that can result in discharge, itching, and pain.
  • Prostatitis: In men, inflammation of the prostate can produce UTI-like symptoms.
  • Bladder Cancer: Rarely, similar symptoms could be attributed to bladder cancer.
  • Kidney Stones: Can cause pain and lead to infection, which can produce similar symptoms.

Treatment:

Antibiotics are the first line of treatment for UTIs. The choice of agent and duration of treatment depend on the type of bacteria present and the severity of the infection:

  • Simple UTI: Often treated with a short course of antibiotics such as trimethoprim or nitrofurantoin
  • Recurrent UTIs: Might require longer courses of antibiotics or a prophylactic or post-coital antibiotic.
  • Complicated UTIs: Infections involving structural or functional abnormalities of the urinary tract or those occurring in patients with underlying diseases like diabetes may require a longer course of antibiotics.
  • Pregnant Women: UTIs during pregnancy require careful choice of antibiotics to avoid harm to the fetus – ie no trimethoprim. Amoxicillin and Cephalexin are both ok.
  • Pain Relief: Urinary alkalinisation with Ural may be used to reduce the pain with urination.
  • Increased Fluid Intake: While not a direct treatment, it’s often recommended to flush out bacteria.
  • Follow-up: After treatment, follow-up tests might be recommended to ensure the infection has cleared.

For frequent UTIs, prevention is important. This might include lifestyle changes such as staying well-hydrated, wiping anus front to back, urinating shortly after intercourse, and for post-menopausal women, using topical estrogen prescribed by a doctor.

It’s also important to treat any underlying conditions that might predispose an individual to recurrent UTIs, such as kidney stones or anatomical abnormalities.

Interstitial Cystitis (IC):

  • Cause: The exact cause of IC is not well understood. It’s considered a chronic, non-infectious bladder condition that may involve a defect in the bladder lining, autoimmune response, infection, or allergy.
  • Symptoms: Symptoms of IC can mimic those of a UTI but without the presence of an infection. They can include chronic pelvic pain, a persistent urge to urinate, frequent urination of small volumes throughout the day and night, and pain during sexual intercourse.
  • Diagnosis: Diagnosing IC can be difficult and often involves ruling out other conditions, including UTIs, and may involve a variety of tests such as cystoscopy, biopsy, and urine tests.
  • Treatment: Treatment options for IC are aimed at symptom relief and may include
    • dietary changes,
    • physiotherapy (pelvic floor),
    • medications (Amitriptyline),
    • bladder hydrodilation, 
    • bladder instillations (DMSO) and
    • urgery in some cases
    • Since IC is a chronic condition, treatment often requires a multifaceted and long-term approach.
  • Duration: IC is a chronic condition with symptoms that can fluctuate in intensity but generally persist over the long term.