Frequent Bladder infections
What is a Urinary Tract Infection (UTI)?
A urinary tract infection (UTI) is an infection in any part of the urinary system. The urinary system includes the kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract, mainly the bladder and are also referred to as a bladder infection or cystitis. Hence the terms UTI, cystitis and bladder infections are often used interchangeably.
How common are UTIs?
Women aged 15 to 29 have the highest frequency of infection (approximately 20% per year). Approximately 60% of women will experience UTI in their lifetime. Of these women, 20% to 40% will experience more than one infectious episode.
What are the most common symptoms of a UTI?
The typical symptoms are urinary urgency, frequency, burning while urinating, discomfort in the bladder area during urination, feeling of incomplete bladder emptying. If this persists, the urine then may become cloudy or may have an odor and eventually there may be frank blood in the urine.
If the infection tracks up to the kidneys, then the patient may also notice backache and fever with chills.
E coli is the most common bug that causes bladder infections.
How is UTI diagnosed?
In most cases, the diagnosis is made based upon symptoms without any testing.
If, however, the infections are happening frequently or the patient has other urogynecologic conditions such as prolapse or medical conditions such as uncontrolled diabetes, then further assessment may be required. In this case, the urine should be sent for culture and cystoscopy, or upper kidney imaging study may also be recommended.
How do we treat UTI in our practice?
Uncomplicated urinary tract infections could be treated with or without an antibiotic based upon the patient’s symptoms. At AUGM, we follow the Infectious Disease Society of America (IDSA) guidelines for the proper selection of the antibiotic. We always consider the patient’s history, what medications she is taking and her comorbidities, before we decide on the antibiotic.
Some of the antibiotics such as ciprofloxacin should not to be considered first line therapy for bladder infections as they have a very high risk to benefit ratio or high collateral damage.
How to prevent UTIs from recurring?
In our practice, we diligently make sure that there is no underlying cause for the frequent bladder infections. Once we have done the proper assessment and testing, we then institute appropriate measures for prevention of bladder infections.
This could involve non antimicrobial prevention or antimicrobial prevention.
We make sure that we follow our patients diligently so that they do not keep getting bladder infections.
What are the special features in the elderly women?
In the elderly, vague symptoms such as mental confusion are blamed on a bladder infection and these patients get indiscriminately treated with antibiotics. If a patient does not have specific bladder symptoms such as urinary urgency, frequency or new onset urinary incontinence, she should not be treated with an antibiotic. Also, in the elderly patient who has no bladder symptoms, the urine should not be indiscriminately sent for culture as there is a high likelihood of getting a positive urine culture – a condition known as asymptomatic bacteria.
Should the urine be routinely tested for infection when the woman goes to the doctor’s office?
If a patient does not have symptoms of a bladder infection, a urine sample should never be taken and tested. This only increases the risk of over diagnosis and unnecessary antibiotic use.
Why do women get UTIs after sex?
This happens because the UTI producing bacteria that are “harmlessly” sitting at the opening of the urethra or inside part of the urethral tube, get pushed into the bladder during the propulsive act of coitus. Once inside the bladder, the bacteria cause cystitis or a bladder infection with full blown symptoms. This is not a sexually transmitted disease but the patient’s own bacteria that are being pushed into the bladder.If a patient gets frequent bladder infections after sex, we do a proper history, examination and evaluation and once this has been done, we put her on specific treatment so that she does not get the infections.
Summary:
Bladder infections or urinary tract infections are a vexing problem in women and one of the leading indications for women going to urgent care centers. Therefore, promptly taking care of these symptoms and then avoiding getting them in the future is critical so that women can get back to living a normal life without fear of these infections.
We make sure that our patients understand why infections happen and what can be done to prevent these infections. We are also very judicious in the use of antibiotics and follow the antibiotics stewardship program. Unnecessary use of antibiotics can increase bacterial resistance and increase the risks of subsequent infections and can also cause complications from drug interactions and side-effects.