Expected Duration

Urinary tract infection

A urinary tract infection (UTI) is a bacterial infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a simple cystitis (a bladder infection) and when it affects the upper urinary tract it is known as pyelonephritis (a kidney infection). Symptoms from a lower urinary tract include painful urination and either frequent urination or urge to urinate (or both), while those of pyelonephritis include fever and flank pain in addition to the symptoms of a lower UTI. In the elderly and the very young, symptoms may be vague. The main causal agent of both types is Escherichia coli, however other bacteria, viruses or fungi may rarely be the cause. Urinary tract infections occur more commonly in women than men, with half of women having at least one infection at some point in their lives. Recurrences are common. Risk factors include female anatomy, sexual intercourse and family history. Pyelonephritis, if it occurs, usually follows a bladder infection but may also result from a blood borne infection. Diagnosis in young healthy women can be based on symptoms alone. In those with vague symptoms, diagnosis can be difficult because bacteria may be present without there being an infection. In complicated cases or if treatment has failed, a urine culture may be useful. In those with frequent infections, low dose antibiotics may be taken as a preventative measure. In uncomplicated cases, urinary tract infections are easily treated with a short course of antibiotics, although resistance to many of the antibiotics used to treat this condition is increasing. In complicated cases, longer course or intravenous antibiotics may be needed, and if symptoms have not improved in two or three days, further diagnostic testing is needed. In women, urinary tract infections are the most common form of bacterial infection with 10% developing urinary tract infections yearly.

Signs and symptoms

Urine may contain pus (a condition known as pyuria) as seen from a person with sepsis due to a urinary tract infection. Lower urinary tract infection is also referred to as a bladder infection. The most common symptoms are burning with urination and having to urinate frequently (or an urge to urinate) in the absence of vaginal discharge and significant pain. These symptoms may vary from mild to severe and in healthy women last an average of six days. Some pain above the pubic bone or in the lower back may be present. People experiencing an upper urinary tract infection, or pyelonephritis, may experience flank pain, fever, or nausea and vomiting in addition to the classic symptoms of a lower urinary tract infection.^[2] Rarely the urine may appear bloody or contain visible pyuria (pus in the urine).

In children

In young children, the only symptom of a urinary tract infection (UTI) may be a fever. Because of the lack of more obvious symptoms, when females under the age of two or uncircumcised males less than a year exhibit a fever, a culture of the urine is recommended by many medical associations. Infants may feed poorly, vomit, sleep more, or show signs of jaundice. In older children, new onset urinary incontinence (loss of bladder control) may occur.

In the elderly

Urinary tract symptoms are frequently lacking in the elderly. The presentations may be vague with incontinence, a change in mental status, or fatigue as the only symptoms. While some present to a health care provider with sepsis, an infection of the blood, as the first symptoms. Diagnosis can be complicated by the fact that many elderly people have preexisting incontinence or dementia.

Cause

E. coli is the cause of 80–85% of urinary tract infections, with Staphylococcus saprophyticus being the cause in 5–10%. Rarely they may be due to viral or fungal infections. Other bacterial causes include: Klebsiella, Proteus, Pseudomonas, and Enterobacter. These are uncommon and typically related to abnormalities of the urinary system or urinary catheterization. Urinary tract infections due to Staphylococcus aureus typically occurs secondary to blood born infections.

Gender

In young sexually active women, sexual activity is the cause of 75–90% of bladder infections, with the risk of infection related to the frequency of sex. The term "honeymoon cystitis" has been applied to this phenomenon of frequent UTIs during early marriage. In post-menopausal women, sexual activity does not affect the risk of developing a UTI. Spermicide use, independent of sexual frequency, increases the risk of UTIs. Women are more prone to UTIs than men because, in females, the urethra is much shorter and closer to the anus. As a woman's estrogen levels decrease with menopause, her risk of urinary tract infections increases due to the loss of protective vaginal flora.

Urinary catheters

Urinary catheterization increases the risk for urinary tract infections. The risk of bacteriuria (bacteria in the urine) is between three to six percent per day and prophylactic antibiotics are not effective in decreasing symptomatic infections. The risk of an associated infection can be decreased by catheterizing only when necessary, using aseptic technique for insertion, and maintaining unobstructed closed drainage of the catheter.

Others

A predisposition for bladder infections may run in families. Other risk factors include diabetes, being uncircumcised, and having a large prostate. Complicating factors are rather vague and include predisposing anatomic, functional, or metabolic abnormalities. A complicated UTI is more difficult to treat and usually requires more aggressive evaluation, treatment and follow-up. In children UTIs are associated with vesicoureteral reflux (an abnormal movement of urine from the bladder into ureters or kidneys) and constipation. Persons with spinal cord injury are at increased risk for urinary tract infection in part because of chronic use of catheter, and in part because of voiding dysfunction. It is the most common cause of infection in this population, as well as the most common cause of hospitalization. Additionally, use of cranberry juice or cranberry supplement appears to be ineffective in prevention and treatment in this population.

Pathogenesis

The bacteria that cause urinary tract infections typically enter the bladder via the urethra. However, infection may also occur via the blood or lymph. It is believed that the bacteria are usually transmitted to the urethra from the bowel, with females at greater risk due to their anatomy. After gaining entry to the bladder, E. Coli are able to attach to the bladder wall and form a biofilm that resists the body's immune response.

Prevention

A number of measures have not been confirmed to affect UTI frequency including: the use of birth control pills or condoms, urinating immediately after intercourse, the type of underwear used, personal hygiene methods used after urinating or defecating, or whether a person typically baths or showers. There is similarly a lack of evidence surrounding the effect of holding one's urine, tampon use, and douching.

In those with frequent urinary tract infections who use spermicide or a diaphragm as a method of contraception, they are advised to use alternative methods. Cranberry (juice or capsules) may decrease the incidence in those with frequent infections, however, long term tolerance is an issue with gastrointestinal upset occurring in more than 30%. As of 2011, intravaginal probiotics require further study to determine if they are beneficial. Condom use without spermicide or use of birth control pills does not increase the risk of uncomplicated urinated tract infection.

Medications

For those with recurrent infections, a prolonged course of daily antibiotics is effective. Medications frequently used include nitrofurantoin and trimethoprim/sulfamethoxazole. In cases where infections are related to intercourse, taking antibiotics afterwards may be useful. In post-menopausal women, topical vaginal estrogen has been found to reduce recurrence. As opposed to topical creams, the use of vaginal estrogen from pessaries has not been as useful as low dose antibiotics. A number of vaccines are in development as of 2011.

In children

The evidence that preventative antibiotics decrease urinary tract infections in children is poor. However recurrent UTIs are a rare cause of further kidney problems if there are no underlying abnormalities of the kidneys, resulting in less than a third of a percent (0.33%) of chronic kidney disease in adults.

Diagnosis

Multiple bacilli (rod-shaped bacteria, here shown as black and bean-shaped) shown between white blood cells in urinary microscopy. These changes are indicative of a urinary tract infection. In straightforward cases, a diagnosis may be made and treatment given based on symptoms alone without further laboratory confirmation. In complicated or questionable cases, it may be useful to confirm the diagnosis via urinalysis, looking for the presence of urinary nitrites, white blood cells (leukocytes), or leukocyte esterase. Another test, urine microscopy, looks for the presence of red blood cells, white blood cells, or bacteria. Urine culture is deemed positive if it shows a bacterial colony count of greater than or equal to 10³ colony-forming units per mL of a typical urinary tract organism. Antibiotic sensitivity can also be tested with these cultures, making them useful in the selection of antibiotic treatment. However, women with negative cultures may still improve with antibiotic treatment.^[1] As symptoms can be vague and without reliable tests for urinary tract infections, diagnosis can be difficult in the elderly.

Classification

A urinary tract infection may involve only the lower urinary tract, in which case it is known as a bladder infection. Alternatively, it may involve the upper urinary tract, in which case it is known as pyelonephritis. If the urine contains significant bacteria but there are no symptoms, the condition is known as asymtomatic bacteriuria. If a urinary tract infection involves the upper tract, the person has diabetes mellitus, is pregnant, is male, or immunocompromised, it is considered complicated. Otherwise if a woman is healthy and premenopausal it is considered uncomplicated. In children when a urinary tract infection is associated with a fever, it is deemed to be an upper urinary tract infection.

In children

To make the diagnosis of a urinary tract infection in children, a positive urinary culture is required. Contamination poses a frequent challenge depending on the method of collection used, thus a cutoff of 10⁵ CFU/mL is used for a "clean-catch" mid stream sample, 10⁴ CFU/mL is used for catheter-obtained specimens, and 10² CFU/mL is used for suprapubic aspirations (a sample drawn directly from the bladder with a needle). The use of "urine bags" to collect samples is discouraged by the World Health Organization due to the high rate of contamination when cultured, and catheterization is preferred in those not toilet trained. Some, such as the American Academy of Pediatrics recommends renal ultrasound and voiding cystourethrogram (watching a person's urethra and urinary bladder with real time x-rays while they urinate) in all children less than two year old who have had a urinary tract infection. However, because there is a lack of effective treatment if problems are found, others such as the National Institute for Clinical Excellence only recommends routine imaging in those less than six month old or who have unusual findings.

Differential diagnosis

In women with cervicitis (inflammation of the cervix) or vaginitis (inflammation of the vagina) and in young men with UTI symptoms, a Chlamydia trachomatis or Neisseria gonorrheae infection may be the cause. Vaginitis may also be due to a yeast infection. Interstitial cystitis (chronic pain in the bladder) may be considered for people who experience multiple episodes of UTI symptoms but urine cultures remain negative and not improved with antibiotics. Prostatitis (inflammation of the prostate) may also be considered in the differential diagnosis.

Treatment

Phenazopyridine may be used in addition to antibiotics to help with the burning of a bladder infection. However, it is no longer commonly recommended due to safety concerns with its use, specifically an elevated risk of methemoglobinemia (higher than normal level of methemoglobin in the blood). Acetaminophen (paracetamol) may be used for fevers. Women with recurrent simple UTIs may benefit from self-treatment upon occurrence of symptoms with medical follow-up only if the initial treatment fails. A prescription for antibiotics can be delivered to a pharmacist by phone.

Uncomplicated

Uncomplicated infections can be diagnosed and treated based on symptoms alone. Oral antibiotics such as trimethoprim/sulfamethoxazole (TMP/SMX), cephalosporins, nitrofurantoin, or a fluoroquinolone substantially shorten the time to recovery with all being equally effective. A three-day treatment with trimethoprim, TMP/SMX, or a fluoroquinolone is usually sufficient, whereas nitrofurantoin requires 5–7 days. With treatment, symptoms should improve within 36 hours. About 50% of people will recover without treatment within a few days or weeks. The Infectious Diseases Society of America does not recommend fluoroquinolones as first treatment due to the concern of generating resistance to this class of medication. Despite this precaution, some resistance has developed to all of these medications related to their widespread use. Trimethoprim alone is deemed to be equivalent to TMP/SMX in some countries. For simple UTIs, children often respond to a three-day course of antibiotics.

Pyelonephritis

Pyelonephritis is treated more aggressively than a simple bladder infection using either a longer course of oral antibiotics or intravenous antibiotics. Seven days of the oral fluoroquinolone ciprofloxacin is typically used in areas where the resistance rate is less than 10%. If the local resistance rates are greater than 10%, a dose of intravenous ceftriaxone often prescribed. In those who exhibit more severe symptoms, admission to a hospital for ongoing antibiotics may be needed. Complications such as urinary obstruction from a kidney stone may be considered if symptoms do not improve following two or three days of treatment.

Epidemiology

Urinary tract infections are the most frequent bacterial infection in women. They occur most frequently between the ages of 16 and 35 years, with 10% of women getting an infection yearly and 60% having an infection at some point in their lives. Recurrences are common, with nearly half of people getting a second infection within a year. Urinary tract infections occur four times more frequently in females than males. Pyelonephritis occurs between 20–30 times less frequently. They are the most common cause of hospital acquired infections accounting for approximately 40%. Rates of asymptomatic bacteria in the urine increase with age from two to seven percent in women of child bearing age to as high as 50% in elderly women in care homes. Rates of aysmtomatic bacteria in the urine among men over 75 are between 7-10%. Urinary tract infections may affect 10% of people during childhood. Among children urinary tract infections are the most common in uncircumcised males less than three months of age, followed by females less than one year. Estimates of frequency among children however vary widely. In a group of children with a fever, ranging in age between birth and two years, two to 20% were diagnosed with a UTI.

Society and culture

In the United States, urinary tract infections account for nearly seven million office visits, a million emergency department visits, and one hundred thousand hospitalizations every year. The cost of these infections is significant both in terms of lost time at work and costs of medical care. In the United States the direct cost of treatment is estimated at 1.6 billion USD yearly.

History

Urinary tract infections have been described since ancient times with the first documented description in the Ebers Papyrus dated to circa 1550 BC. It was described by the Egyptians as "sending forth heat from the bladder". Effective treatment did not occur until the development and availability of antibiotics in the 1930s before which time herbs, bloodletting and rest were recommended.

In pregnancy

Urinary tract infections are more concerning in pregnancy due to the increased risk of kidney infections. During pregnancy, high progesterone levels elevate the risk of decreased muscle tone of the ureters and bladder, which leads to a greater likelihood of reflux, where urine flows back up the ureters and towards the kidneys. While pregnant women do not have an increased risk of asymptomatic bacteriuria, if bacteriuria is present they do have a 25-40% risk of a kidney infection. Thus if urine testing shows signs of an infection—even in the absence of symptoms—treatment is recommended. Cephalexin or nitrofurantoin are typically used because they are generally considered safe in pregnancy. A kidney infection during pregnancy may result in premature birth or pre-eclampsia (a state of high blood pressure and kidney dysfunction during pregnancy that can lead to seizures).

Urinary tract infection in women

Introduction:

Urinary tract infections (UTIs) are caused by bacteria and are 10 times more common among women than men. More than 50% of women will have at least one UTI during their lifetime; for most of these infections, patients need to see a doctor and be treated with antibiotics. About 30 - 40% of UTIs recur within 6 months after the initial episode. When UTIs do recur, it is often because the treatments used to suppress bacteria seem to work at first, but do not produce a lasting cure. UTIs can also recur when a woman is infected again by different bacteria.

Signs and Symptoms:

• Pain or burning during urination
• The need to urinate more often than usual
• A feeling of urgency during urination
• Blood or pus in the urine
• Cramps or pain in the lower abdomen
• Chills or fever (fever may be the only symptom in infants and children)
• Strong smelling urine
• Pain during sexual intercourse
• Nausea, vomiting, and malaise

What Causes It?:

Risk factors include:

• A new sex partner or multiple partners
• More frequent or intense intercourse
• Diabetes
• Pregnancy
• Escherichia coli (E. coli)
• Staphylococcus saprophyticus
• Use of irritating products, such as harsh skin cleansers
• Use of irritating contraceptives, such as diaphragms and spermicides
• Use of birth control pills
• Heavy use of antibiotics
• A blockage in the urinary tract (benign masses or tumors)
• A history of UTIs, especially if the infections were less than 6 months apart

What to Expect at Your Provider's Office:

Your health care provider will feel your abdomen and kidneys for changes and use laboratory tests, such as a urine culture, to find out if you have a UTI. If the usual treatments do not work, your provider will explore the possibility that you have some other condition. Other illnesses can cause symptoms that mimic a UTI, such as sexually transmitted diseases.

Treatment Options:

Drug Therapies

Several antibiotics and other drugs may treat UTIs. The course for most antibiotics is 7 - 10 days. Shorter courses of treatment are available, and your health care provider may prescribe an antibiotic that you take for 1 - 3 days.

Complementary and Alternative Therapies

Always tell your health care provider about the herbs and supplements you are using.

Nutrition and Supplements

Following these nutritional tips may help reduce symptoms:

• Drink a lot of fluids, such as herbal teas and water. Avoid sweetened fruit juices and other sweetened drinks.
• Cranberries and blueberries contain substances that inhibit the binding of bacteria to bladder tissue. Drinking unsweetened cranberry juice regularly helps lower the risk of UTIs.
• Try to eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.If you are susceptible to UTIs, drinking cranberry juice or taking cranberry pills may help prevent recurrence.
• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
• Eat more high fiber foods, including beans, oats, root vegetables (such as potatoes and yams), and psyllium seed.
• Avoid refined foods such as white breads, pastas, and especially sugar.
• Eat fewer red meats and more lean meats, cold water fish, tofu (soy, if no allergy is present) or beans for protein.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans fatty acids, found in commercially baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, 5 days a week.

You may address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins and trace minerals, such as magnesium, calcium, zinc, and selenium.
• Vitamin C, 500 - 1,000 mg 1 - 2 times daily, as an antioxidant and for immune support.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil 1 - 2 times daily, to help decrease inflammation and promote general health. Cold water fish, such as salmon or halibut, are good sources. Fish oil supplements can increase the effects of certain blood thinning medications.
• IP-6 (Inositol hexophosphonate), 1 - 8 grams daily on an empty stomach, for kidney health. Check with your health care provider for proper dosing.
• L-glutamine, 500 - 1,000 mg 3 times daily, for support of gastrointestinal health and immunity.
• Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. There is strong scientific evidence to support the use of probiotics for urological conditions. Refrigerate probiotic supplements for best results.
• Grapefruit seed extract (Citrus paradisi), 100 mg capsule or 5 - 10 drops (in favorite beverage) 3 times daily, for antibacterial, antifungal, and antiviral activity.

Natural hormone replacement therapy may help prevent UTIs. Ask your health care provider about this treatment.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted. Many herbs interact with medications, so you should always tell your doctor about any herbal therapies you are using or considering using. The following herbs may be useful for short term treatment of a urinary tract infection.

• Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant, anticancer and immune effects. Use caffeine free products. You may also prepare teas from the leaf of this herb.
• Cat's claw (Uncaria tomentosa) standardized extract, 20 mg 3 times a day, for anticancer, immune and antibacterial or antifungal activity. Cat's claw can interact with many different medications. Speak to your health care provider. Do not take cat's claw if you have Leukemia.
• Reishi mushroom (Ganoderma lucidum) standardized extract, 150 - 300 mg 2 - 3 times daily, for anticancer and immune effects. You may also take a tincture of this mushroom extract, 30 - 60 drops 2 - 3 times a day. High doses of Reishi may have a blood thinning effect, so speak to your doctor if you are on blood thinning medications.
• Milk thistle (Silybum marianum) seed standardized extract, 80 - 160 mg 2 - 3 times daily, for detoxification support.
• Uva-ursi (Arctostaphylos uva-ursi) standardized extract, 250 - 500 mg 3 times daily for no more than 4 days. You may also prepare teas from the leaf of this herb.
• Buchu (Barosma betulina) 200 mg 1 - 3 times daily for antibacterial effects. Buchu can interact with Lithium and with blood thinning medications.

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for UTI based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Apis mellifica -- for stinging or burning pains that tend to worsen at night and from warmth. This remedy is appropriate for people who feel an intense urge to urinate, yet can only do so in drops.
• Aconitum -- for early symptoms of UTI, particularly with extremely painful urination that is often described as a hot sensation.
• Berberis -- for UTIs with burning or shooting pain during urination that may radiate to the pelvis or back. When not urinating, an aching sensation is present in the bladder that worsens with movement. Pain may also extend to legs and abdomen.
• Cantharis -- this is the most common and considered the most effective homeopathic remedy for UTI. This remedy is most appropriate for people who are restless, experience a burning sensation and decreased urine flow (despite a strong desire to urinate), and have increased sexual desire despite symptoms.
• Mercurius -- for burning urination and a strong urge to urinate. Symptoms worsen at night and tend to be accompanied by chills and sweating. Urine is dark and only small amounts pass. Burning sensation is often worse when the individual is not urinating.
• Nux vomica -- for people who have a constant urge to urinate. Pain is described as needle like. The urge to have a bowel movement may accompany urinary urgency. Some people experience mild, temporary relief from urination and warm baths. Symptoms may begin following ingestion of alcohol, coffee, drugs, or overeating.
• Pulsatilla -- for bladder inflammation that begins after an individual develops a sudden chill in hot weather. This remedy is most appropriate for people with an urgent desire to urinate who may be emotional, crave attention, and dribble urine after laughing, coughing, sneezing, or being surprised.
• Sarsaparilla -- for women who experience severe pain at the end of urination and who, occasionally, feel compelled to stand to urinate.
• Staphysagria -- for UTIs usually associated with sexual intercourse or following extreme embarrassment or humiliation, particularly from sexual abuse. This remedy is most appropriate for those who have an urgent desire to urinate and have the sensation that a single drop of urine is still present even following urination.

Following Up:

Preventive measures you can follow:

• Urinate both before and after intercourse.
• Have your health care provider recheck the fit of your diaphragm if you use one.
• Avoid sex while you are being treated for a UTI.

Special Considerations:

If you are pregnant, you are at higher risk of developing a UTI.

Urinary Tract Infection in Men

What Is It?

Urinary tract infections involve the parts of the body -- the kidneys, ureters, bladder and urethra -- that produce urine and carry it out of the body. Urinary tract infections often are classified into two types based on their location in the urinary tract:

· Lower tract infections. These include cystitis (bladder infection) and urethritis (infection of the urethra). Lower urinary tract infections commonly are caused by intestinal bacteria, which enter and contaminate the urinary tract from below, usually by spreading from the skin to the urethra and then to the bladder. Urethritis also may be caused by microorganisms that are transmitted through sexual contact, including gonorrhea and chlamydia. Another form of male urinary infection is prostatitis, which is an inflammation of the prostate.

· Upper tract infections. These involve the ureters and kidneys and include pyelonephritis (kidney infection). Upper tract infections often occur because bacteria have traveled upward in the urinary tract from the bladder to the kidney or because bacteria carried in the bloodstream have collected in the kidney.

Most cases of urinary tract infections occur in women. Of those that occur in men, relatively few affect younger men. In men older than 50, the prostate gland (a gland near the bottom of the bladder, close to the urethra) can enlarge and block the flow of urine from the bladder. This condition is known as benign prostatic hyperplasia, or BPH. This condition can prevent the bladder from emptying completely, which increases the likelihood that bacteria will grow and trigger an infection. Cystitis is more common in men who practice anal intercourse and in those who are not circumcised. Other factors that increase the risk of urinary infections include an obstruction, such as that caused by a partial blockage of the urethra known as a stricture, and non-natural substances, such as rubber catheter tubes (as may be inserted to relieve a blockage in the urethra).

Symptoms

A urinary tract infection usually causes one or more of the following symptoms:

· Unusually frequent urination

· An intense urge to urinate

· Pain, discomfort or a burning sensation during urination

· Awakening from sleep to pass urine

· Pain, pressure or tenderness in the area of the bladder (in the middle of the abdomen, below the navel)

· Bedwetting in a person who usually had been dry at night

· Urine that looks cloudy or smells foul

· Fever, with or without chills

· Nausea and vomiting

· Pain in the side or upper back

Diagnosis

Your doctor will ask about your symptoms and about any previous episodes of urinary tract infection. To fully assess your risk factors, your doctor may ask about your sexual history, including your history and your partner's history of sexually transmitted diseases, condom use, multiple partners and anal intercourse.

Your doctor will diagnose a urinary tract infection based on your symptoms and the results of a physical examination and laboratory tests of your urine. In a typical urinary tract infection, your doctor will see both white blood cells (infection-fighting cells) and bacteria when he or she examines your urine under a microscope. Your doctor probably will send your urine to a laboratory to identify the specific type of bacteria and specific antibiotics that can be used to eliminate the bacteria.

In men, a rectal examination will allow your doctor to assess the size and shape of the prostate gland. If you are a young man with no sign of an enlarged prostate, your doctor may order additional tests to search for a urinary tract abnormality that increases the likelihood of infection. This is because urinary tract infections are relatively rare in young men with normal urinary tracts. Additional tests may include intravenous pyelography or a computed tomography (CT) scan, which shows an outline of your urinary tract on X-rays; ultrasound; or cystoscopy, an examination that allows your doctor to inspect the inside of your bladder using a thin, hollow tubelike instrument.

Expected Duration

With proper treatment, most uncomplicated urinary tract infections begin to improve in one to two days.

Prevention

Most urinary tract infections in men cannot be prevented. Practicing safe sex by using condoms will help to prevent infections that are transmitted through sexual contact. In men with benign prostatic hypertrophy, cutting out caffeine and alcohol or taking certain prescription medications may help to improve urine flow and prevent the buildup of urine in the bladder, which increases the likelihood of infection.

Treatment

Doctors treat urinary tract infections with a variety of antibiotics. The results of laboratory tests on your urine can help your doctor pick the best antibiotic for your infection. In general, most uncomplicated lower tract infections will be eliminated completely by 7 to 10 days of treatment. Once you finish taking the antibiotics, your doctor may ask for a repeat urine sample to check that bacteria are gone. If an upper tract infection or infection of the prostate is diagnosed, your doctor may prescribe antibiotics for three weeks or longer.

Men with severe upper tract infections may require hospital treatment and antibiotics given through an intravenous catheter (in a vein). This is especially true when nausea, vomiting and fever increase the risk of dehydration and prevent the use of oral antibiotics.

If you are an older man with an enlarged prostate causing an obstruction in your urine flow, treatment options include medications or prostate surgery.

Дата добавления: 2015-10-29