What is urinary tract infection?
A urinary tract infection is the collective name for all infections related to the urinary system: kidney, kidney calyx, ureter, bladder and urethra (urethritis). The most important cause of urinary tract infection and intestinal cystitis is the bacterium Escherichia coli. It can enter the urethra and bladder.
In the (normally sterile) urine in the bladder multiplying bacteria, which also attacks the lining of the bladder. One speaks of bacteriuria when significant amounts of bacteria are found in the urine.
About half of the women make at least once in her life cystitis. About 20% of women have at least once a year suffer from, especially during their most sexually active period (25-29 years), or after menopause (associated with estrogen deficiency). But men (1.5%) may be due to eg prostate problems suffer from a bladder infection.
Urinary tract infection causes
Because the access to the urinary tract is anatomically closed, the content thereof is sterile. Various barriers to protect against entry of micro-organisms in the urinary tract; the urine flow removes any presence of bacteria in the urethra. Also, the inside of the bladder is protected against micro-organisms by release of antibodies by the mucosal membrane. The transition from the ureter (tube between the kidney and bladder) into the bladder of a valve mechanism is provided, so that the urine can not return from the bladder to the kidney calyx. If this mechanism fails, one speaks of vesico-ureteral reflux. This may have the effect of a kidney infection (pyelonephritis).
Cystitis is more common among women than men because they have a shorter urethra and because of the much greater risk of infection from their own intestines. For this reason, it is important for women to never wiping buttocks from back to front of the after stool. This bacteria come forward which may lead to a bladder infection.
Infections after catheterization are common. Often, the above drawing said bacterial pathogens in question. A patient who has an indwelling catheter long time, actually has always bacteriuria and usually no complaints there. So long as the catheter remains seated treatment is useless.
Also, anatomical abnormalities or the presence of kidney stones in the ureter or bladder can lead to infections.
Worse hygienic conditions (such as may occur during holidays) may also increase the risk of urinary tract infection.
Interstitial cystitis is a rather frequent and very painful form of bladder infection whose cause is not known. Also known as painful bladder syndrome, or bladder pain syndrome.
Also, sexual intercourse can be a common cause of bladder infections.
Causers
*Bacterial pathogens
About 90% of urinary tract infection is caused by the gram-negative bacterium Escherichia coli, a normal inhabitant of the human gut, but which are easily collected from the area around the anus can migrate to the vagina and urinary tract. It usually relates to specific strains of the bacterium, belonging to the serotypes K, R or H. Other pathogens are gram negative Proteus, Klebsiella, and Pseudomonas to the rarer. Also, Chlamydia trachomatis and Neisseria gonorrhoeae may cause urinary tract infection in sexually active men who have sex without a condom with someone who carries the bacteria. These generally give no real cystitis but only an infection of the urethra (and in women of the cervical canal, the canal in the cervix).
At-risk groups should be aware of an STD such as gonorrhea or chlamydia infection.
The bacteria can colonize only when they are not washed away with the urine. To this end, the bacteria possess hairs (fimbrae) having thereon a binding substance (adhesin, a lectin) that specifically attaches to mannose on the epithelium of the bladder wall and the urinary tract (at the E. coli bacterium is that it FimH adhesin). When the bacteria manage to bond, they will try to penetrate the cell, where they can live and reproduce in relative calm, protected from many of the immune responses of the body, and often to antibiotics. In such cases UTI comes in time so come back (relapse).
*Viral pathogens
Also, a herpes simplex virus can give rise to a urethritis (inflammation of the urethra). This is a sexually transmitted disease. Often this is accompanied with ulceration of the mucous membrane of the vulva and urethra (urethra).
Symptoms of urinary tract infection
Rarely does a urinary tract infection without symptoms. Symptoms of a UTI include
- A burning or painful sensation when urinating (dysuria)
- Less pressure
- Frequent urination (urinary frequency)
- Cloudy and strong smelling urine, sometimes with traces of blood.
- Other possible symptoms include abdominal pain and red discharge from the urethra.
Urinary tract infection diagnosis
The diagnosis of urinary tract infection is made on the basis of both symptoms and on the basis of the analysis of urine, preferably collected in the mid-stream urine (middle stream portion) in a sterile receiving bottle and immediately sealed. Upon microscopic analysis of the urine high numbers of white blood cells and bacteria can be found (bacteriuria). For the detection of bacteria, however, usually be test strips used in the urine, in which the presence of nitrite is determined. The most reliable results are obtained when the analysis takes place within hours, but refrigerated storage (5 degrees Celsius) is possible, provided that it does not exceed 24 hours.
When one speaks of bacteriuria found in a urine sample more than 105 bacteria per cc. With less than 103 per cc urine is considered normal. Bacteriuria may indicate a urinary tract infection, but not necessarily. It therefore did not make much sense people with active bacteriuria detect.
Test strips
Usually a test strip in the urine stabbed, which after a minute the most important properties of the urine can read off, by the colors similar to the example on the box. Testing on the Strip that are important in a search for a urinary tract infection include:
- Nitrite: reduce nitrate to nitrite in the urine many bacteria, whereby this can be used as an indicator for the presence of bacteria (bacteriurie). Nitrite is created by many, but not all, bacteria.
- Leukocytes, blood, albumin suggest an inflammation somewhere in the urinary tract.
- Glucose: glucosurie (sugar in the urine), gives a greater chance on bacteriurie. Glucosurie can be a phenomenon of diabetes mellitus but can also have other causes.
- Specific gravity: normal urine has a specific gravity (sg) of about 1010 g/L. The sg is very low then the urine strongly diluted (pure water has 1000 g/L), it is strongly increased then the urine are highly concentrated and the patient may be dehydrated.
- Ph: a pH higher than 7.6 is strongly suspected of contamination of the urine with an ammonia-forming bacteria: Proteus mirabilis or some e. coli strains.
Because of the urine for a few minutes to run off in a special centrifuge, bags all the cells to the tip of the test tube. This can be viewed under the microscope one can then see the bacteria and inflammatory cells. Previously there have been a Gram stain. This is more or less replaced by other techniques.
Grow
When the urine is put in a medical microbiology laboratory in culture, can exact numbers and the type of bacteria to be determined, as well as antibiotics for which it is sensitive. The bacterium E. coli is found by far the most. A dip slide is a picture where there is provided a breeding ground for bacteria on both sides. After 24 hours, one can already determine whether bacteria grow and if so how much.
Urinary tract infection treatment
In general, it is recommended in the event of recurrent bladder infections much to drink, so they need to urinate more frequently and bacteria are washed away. The good puddles of urine all (especially after intercourse) is important. Many women go to bladder infections intercourse beforehand. When the sex bacteria also be massaged through the urethra into the bladder.
Treatment according to generally accepted guidelines
In the treatment of urinary tract infection will distinguish between uncomplicated urinary tract infection and complicated urinary tract infections. An uncomplicated UTI is defined as a urinary tract infection in a woman who is not pregnant is of childbearing age without signs of ascending infection.
In accordance with the NHG-standard "UTI" treating doctors in the Netherlands uncomplicated urinary tract infection often with antibiotics orally and in addition be concentrated in the urine, so that the remaining bacterial flora untouched. Nitrofurantoin (cure of 5 days), fosfomycin (single dose) and trimethoprim (cure of 5 days) are usually prescribed. For better effectiveness of the treatment can be extended for two more days.
All other types, such as urinary tract infection in men and boys, pregnant women and young (pre-adolescent tale) girls are by definition complex. In complicated infections, often antibiotics are prescribed which is not only in urine but also in the tissue for bacteria to reach a lethal concentration, such as amoxicillin with or without clavulanic acid, ciprofloxacin and so on. For sulfonamides, the most of the pathogens are resistant, but in a substantial portion of the patients who are prescribed antibiotics for the treatment of urinary tract infection occurs resistance to these agents on. Furthermore, antibiotics are not always necessary. The GP will be spontaneous healing generally but not to wait.
A bladder infection in a young child is basically a reason for referral to the pediatrician, not so much because of the bladder itself but to identify possible anatomical factors work cystitis in hand, such as vesicoureteral reflux, a double constructed kidney calyx system, kidney stones or obstructive valves in the urethra.
Urinary tract infection prevention
Preventive for uncomplicated infections in women are to consider the following measures:
- Ample drinking; the puddle not stop too long, particularly after intercourse
- cranberry; from these berries has been proven that they impede the adhesion of the bacterium E. Coli of the urinary epithelium, making the use prevents infections
- Some women avoid a UTI by taking trimethoprim or nitrofurantoin after coitus
- It is also worth considering that the patient has a cure at home ready to begin at the first appearance
- Sometimes it is prescribed preventive chronic (up to six to twelve months), low dose trimethoprim, or nitrofurantoin. This has proven effect, also the period after ingestion. Sulfa is no longer recommended.
In children and men with recurrent urinary tract infection depends on the policies of the underlying causes. Often, the cause is residual urine in the bladder, for example, by an enlarged prostate. Many doctors advise these men to urinate sitting; that the body position has an impact on the urination was described earlier. However, a meta-analysis showed that men with prostate problems:
- The amount of urine remaining in the bladder (post-void residual volume) is significantly reduced,
- The power of the radius (maximum urinary flow) increases,
- The total time of the urination (voiding time) decreases
Alternative approach
The above treatment guidelines as much as possible based on the results of well-conducted research and consensus among experts from multiple disciplines. In addition, there unsurveyable many alternative therapies, for which the evidence (yet) has been unable to deliver. Light urinary tract infection can also go away.
Some examples:
- There is agreement on the preventive effect of cranberries, not about applying the treatment, as recommended by some
- D-Mannose is, in grams, at the same time, evneens applied to E. coli infections
- Finally belong to the urinary tract ailments for which many expected by some to be a lot of vitamin D.
Complications
Each bladder infection can ascend to the upper urinary tract and may cause a kidney infection or prostatitis in men. Also, bacteria can migrate to the bloodstream and cause a blood poisoning. In that case, one speaks of a complicated urinary tract infection. Obviously, these complications occur especially in patients with weakened immune systems, such as the elderly or people with serious diseases, but also in small children they need to follow suspect. In kidney infection is usually made high fever, there is pain in one or both of the loins and enters a proper disease feeling. When a patient with fever and (presumably) bacteriuria low blood pressure is found, it is often treated in the hospital on suspicion of urosepsis.
After complicated urinary tract infection will usually do a urological research for the cause. These include vesicoureteral reflux or other birth defects in children, prostatitis in men with urethral strictures or stones.