UTI – Causes, Symptoms, Treatment & More

What is UTI(Urinary Tract Infection)?

UTI stands for urinary tract infection. In simple words, it is the infection of your urinary system which comprises your urethra, prostate (in the case of male patients), bladder and kidneys.

What causes a UTI?

UTIs are caused by bacterial colonization of the urinary system. Most of the infections are ascending in nature i.e. the infection ascends from your external urine passage (urethra) to affect the urinary system/organs. This leads to cystitis(bladder infection), prostatitis (prostate infection) or in advanced cases pyelonephritis (kidney infection). The bacterias causing infection eg. E.coli are already present in our gut flora. Whenever they get a chance to invade our urinary system, especially if the immunity is weak they lead to infection. Women are especially prone to bacterial infections as both the urine passage and stool passage are very close to each other thereby allowing the bacteria to invade the urinary system. This is quite common post sexual intercourse.

What are the symptoms of UTI ?

• Burning sensation while passing urine
• Pain while passing urine
• Feeling feverish/ high-grade fever
• Loss of appetite
• Pain in lower back
• Pain in bilateral flanks(sides of your body)
• Foul smelling urine
• At times there may be a little blood mixed with urine
• The feeling of urgency i.e. frequent desire to pass urine

How to diagnose UTI ?

UTIs are diagnosed firstly based on the history of symptoms provided by the patient and clinical examination to look for fever, pain/tenderness in the lower abdomen (cystitis) or in flanks (pyelonephritis). To support the clinical diagnosis your urologist will order some basic tests such as your urine routine and microscopic examination and urine culture. At times an ultrasound or a CT scan is also required to complete the diagnosis especially in people who have recurrent infections.

How do you treat UTI?

UTIs can be treated with antibiotics based on your urine culture sensitivity report i.e. the antibiotic that your causative bacteria is susceptible to. Most cases can be treated with oral medicines though at times in cases of severe infections or high-grade fever one may need to initially start injections. 

Why do some people keep on having  UTIs?

It is very important to distinguish between a recurrent urinary tract infection and a residual urinary tract infection. A residual urine infection is the one which has never been fully treated/eradicated in the first place. As a result after a symptom-free period, the patient is again troubled with similar symptoms although the severity may differ. The most common cause of a residual UTI is an incomplete treatment of the initial episode. Unfortunately, this has got a lot to do with patient compliance. After a day or two of taking medicines/antibiotics once the patients’ symptoms disappear, they discontinue the medicines. As a result, the bacteria that was getting under control get an opportunity for the resurgence. You should almost never start or stop any treatment without consulting your doctor. Recurrent UTIs, on the other hand, are repeated episodes of infection.

What are the causes of recurrent UTIs?

In case a patient has recurrent UTIs (male or female), a few things should be considered.
a) Local genital hygiene of the patient
Does the female patient have a history of vaginal discharge(curdy, frothy whitish discharge)? If so this is a potential cause of recurrent infections and needs to be treated first. You have to consult your gynecologist for same.
Does the male patient have any issue with a penile foreskin like redness and discharge from foreskin, cracking and fissuring of the skin or inability to fully retract foreskin in either erect or flaccid state? If so this needs to be addressed, either with medicines or surgery (circumcision).
b) Rule out diabetes
High blood sugar levels/undiagnosed diabetes is a very common but often unsuspected cause of repeated urine infections. It can be easily diagnosed with blood tests and treated using medicines exercise and dietary modifications.
c) Kidney stones
Infection can lead to the formation of stones and also infection stones can, in turn, lead to recurrent infections. In patients with repeated infections, imaging studies (ultrasound, x-ray, CT scan) should be done to rule out the presence of stones. If stones are present they should be removed via endoscopic/key-hole surgeries using lasers.
d) Obstruction in urine passage
In male patients with narrowed urine passage (stricture urethra), the urinary bladder is unable to empty itself completely. This residual urine is the cause of repeated infections. Such patients should also consider urological procedures (such as optical internal urethrotomy) to correct their obstructions which in turn will decrease the chances of repeated urine infections.

In general to prevent repeated urine infections patients should be careful. First of all, to treat a documented (via urine culture) infection the prescribed antibiotic course should be taken completely. Water intake should be adequate (around 2.5-3 liters a day). A rough guideline is that the color of urine that you pass should be the same as that of water. No need to drink 6-7 liters of water as your friends/relatives may suggest. Local genital hygiene should be well maintained i.e. regular cleaning of genitalia with soap and water, trimming of pubic hair etc. Last but not the least some people have a habit of popping in a dose or two of antibiotics at the slightest feeling of dysuria(burning). This should never be done.