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Understanding The Causes And Management Of Chronic Urinary Tract Infections

A most common infection in the urinary system, urinary tract infection (UTI) can occur in any area of the urinary tract. Bacteria are the main cause of UTIs, E. coli in particular. Usually, chronic UTIs recur within weeks of being treated or can happen several times annually, especially when they do not respond well to treatment. 

A UTI can result in cystitis if it affects the bladder, pyelonephritis if it impacts the kidneys and urethritis if it reaches the urethra. If the infection is localised only to the bladder, it is generally minor and easy to treat. However, recurring urinary infections may lead to severe complicationswhen the kidneys are affectedand require hospitalisation. Nonetheless, options are available to treat the same.

Symptoms could include the urge to urinate frequently, pain while urinating or pain in the side and/or lower back. Most UTIs are treated with antibiotics. While UTIs could occur at any age with anyone, females have a higher prevalence.

Urine is a byproduct of the blood-filtering functions performed by the kidneys when they eliminate excess water and waste products from the blood. Typically, the urine passes via the urinary system without being contaminated. But if bacteria enter the urinary tract, it could cause UTIs.

Risk Factors for Chronic UTIs

Gender: Females are more prone to chronic UTIs because the urethra lies close to their rectum. This makes it easy for bacteria to travel from the rectum to the urethra if one wipes from back to front after passing bodily waste. Moreover, since the urethra is shorter in females, bacteria must move a short distance only to reach their bladder, making it easier to multiply and cause more infections.

0Lifestyle: Factors like the use of a diaphragm during sex can raise the risk of developing chronic UTI. As these contraceptions push against the urethra, it’s more difficult to empty the bladder. The residual urine is more likely to nurture bacteria. Constant changes in the vagina’s bacterial composition can also inflate the likelihood of contracting infections. This could happen if a woman uses vaginal douches, specific oral antibiotics and spermicides regularly.

Menopause: This could trigger hormonal changes that, in turn, affect the bacterial composition in the vagina, raising the risk of chronic UTIs. 

Signs, Symptoms and Causes

UTI could lead to inflammation in the urinary tract lining. This may cause problems such as pain in the abdomen, lower back or pelvic area; pressure in the lower pelvic region; foul-smelling, cloudy urine; frequent urination; urinary incontinence; dysuria (pain when urinating); and haematuria (blood in the urine). Additional UTI-linked symptoms may include pain in the penis, fever, fatigue, chills, nausea and vomiting, confusion and mental changes.

Diagnosis and Tests

To diagnose UTI, the following tests may be done:

Urinalysis: The patient’s urine sample will be sent to a lab to check for signs of UTI by examining variables like nitrites, white blood cells and leukocyte esterase.

Urine culture: Laboratory technicians will test a urine sample to grow and identify any resident bacteria. Urine cultures are also crucial since they help determine the best line treatment.

If the infection cannot be controlled by treatment, additional tests could be undertaken to ascertain if there is any ailment or injury:

Ultrasound: This painless imaging test that needs no preparation offers a view of the internal organs.

CT scan: A computed tomography scan or X-ray is another imaging test that takes cross-section images of the body,creating 3D images of internal sections.

Cystoscopy: A cystoscope – a thin instrument with a lens and light at one end – is used to PEEK inside the bladder via the urethra.

If UTIs recur frequently, a doctor may undertake tests to detect other health problems that can cause these infections such as an abnormal urinary system or diabetes.

Managing and Treating UTIs

Antibiotics are the treatment of choice for UTIs. Patients must adhere to the prescribed regimen. The full antibiotics course must be completed even if the symptoms subside and one begins feeling fine. If the entire course is not finished, the infection could soon return and become tougher to treat.

Additionally, the doctor may recommend these antibiotics be taken daily, every alternate day, after sex and at the very first sign of any symptoms. After beginning an antibiotic regimen to treat UTI, most people notice improvement within days. However, each time UTI is treated with antibiotics, the infection is harder to combat since it adapts and develops antibiotic resistance.

In such cases, a doctor could recommend alternative treatments for those with frequent UTIs. This could include waiting and IV (intravenous) treatment. In the first case, a wait-and-watch approach is recommended for symptoms. During this period, one is told to consume plenty of water to flush one’s system.

In the second, IV treatment may be used for complex cases with antibiotic resistance or when the infection travels to the kidneys. In such scenarios, hospitalisation may be necessary, where drugs will be given intravenously. On returning home, one may need to consume oral antibiotics for some time to eliminate the infection.

Basic Guidelines for Prevention

A few lifestyle changes can be useful in preventing UTIs:

Good hygiene: Preventionof UTIs is best done through good hygiene practices. For example, females should always wipe the vagina with a front-to-back motion after bowel movements to avoid the spread of bacteria from their rectum into the body. Furthermore, during the monthly cycle, menstrual products like pads and tampons must be changed regularly. Avoid spraying deodorant on the vagina. 

Fluid consumption: It is best to drink at least six to eight glasses of water daily. Fruit juices and other healthy fluids can also be consumed.

Frequent urination: Urinating frequently can curb the threat of developing an infection, especially for people prone to UTIs. Immediately before and after sex, women must always urinate. Intercourse could allow bacteria entry into the urethra and urination before and after the act helps in flushing them out. If there is no pressure to urinate, the area can simply be washed with warm water.

Medications: Postmenopausalwomen can use a vaginal cream with oestrogen that changes the pH of their vagina, limiting the risk of UTI.

Besides the above, use a water-based lubricant during sex and birth control options other than a diaphragm or spermicides. The doctor can guide one on these aspects. Also avoid tight clothes,which create a moist environment, encouraging bacterial growth. Loose garments and cotton underwear are great to prevent moisture from accumulating around the urethra.

Long-term Prognosis

Most UTIs are manageable with proper treatment. Nevertheless, all antibiotic treatments must be followed diligently. Infections resistant to antibiotics need IV antibiotics and other treatment options. Even after UTIs are eliminated, monitoring should continue for further symptoms as these could recur.

The moment any signs of a new infection are noted, treatment should be sought immediately. Timely treatment is the best means of lowering the risk of serious, long-term issues.