URINARY SYSTEM HEALTH

Our education promotion for better urinary health, is known as.......
Wee Week - Sunday 15 to Saturday 21 July, 2012

• Urinary Tract Infections are common, particularly with increasing age*
• Women are more likely to get a UTI than men*
• About 1 in 3 women and 1 in 20 men will get a UTI in their lifetime*
• Nearly 1 in 3 women will have a UTI needing treatment before the age of 24*

*Stats reference: Meta-analyses in Prevention and Treatment of Urinary Tract Infections
Vol 23 Issue Pgs 355-385 (June 2009) PMID:19393914 [PubMed - indexed for MEDLINE] Philip Masson MBChB, BA (Hons) MA (Oxon) MRCP (UK), Sandra Matheson BSc (Hons) MPHb, Angela Webster MBBS MM (Clin Epi) PhD MRCP (UK), Jonathan Craig MBChB DCh MM (Clin Epi) PhD FRACP

How does your urinary system work?
Your urinary system is made up of the kidneys, ureters, bladder and urethra. Your kidneys do many important jobs. One is to remove waste and extra fluid from the blood to make urine. Narrow tubes called ureters carry urine from the kidneys to the bladder. Urine is stored in your bladder and emptied through the urethra - the tube that drains the bladder.

What is a Urinary Tract Infection?
Urinary tract infections (also known UTIs) are one of the most common reasons for visiting a doctor about an infection. A UTI can range from an infection of the bladder, to an infection of the kidney

• If the infection is in the urethra, it is called urethritis
• Infection in the vagina is called vaginitis
• Pyelonephritis describes an upper urinary tract infection, which is very serious as it may affect the kidneys
• If it is in the bladder, causing urinary bladder inflammation, it is called cystitis.

Cystitis is the most common lower urinary tract infection and causes the bladder lining to become raw and inflamed. While it is painful and annoying, a urinary tract infection isn’t contagious and the infection can’t be passed on to your partner during sex. However, if left untreated, the infection can ‘backtrack’ deeper into the urinary system and reach the kidneys.

A kidney infection is serious and needs prompt medical attention - it is important to see a doctor if a kidney infection or kidney stones are suspected. If these conditions are left untreated, they can become more serious.

Useful weblinks: View excellent 3D animations from Virtual Renal Centre WA and see Bladder infection * Urinary Tract Infection * Kidney Stones

What causes Urinary Tract Infections? Bacteria do not normally live in the urinary tract. When bacteria enter the urinary tract and multiply, they can cause a UTI. There are many germs that can cause urine infections or cystitis. Germs are also called bacterium or microorganisms. Some people may be more susceptible to infections because the urinary flow is blocked or the urine is backed up as it flows from the bladder to the kidneys.

• The most common germ causing UTIs is found in your digestive system, Esherichia coli (E.coli). It can easily spread to the urethra and sticks to the lining of your urinary system.
• Other germs such as Mycoplasma and Chlamydia can cause urethritis in both men and women. These germs can be passed on during sexual intercourse so both partners need medical treatment to avoid re-infection.

Useful weblink: Our Fact Sheet - Urinary reflux in children

Why are they more common in women? UTIs are more common in women, particularly with increasing age. Nearly 1 in 3 women will have a UTI needing treatment before the age of 24.*

• Women get more UTIs than men because of the length of their urethra - the longer the urethra, the more protection you have. In women the urethra is fairly short and straight, making it easier for germs to travel into the bladder.
  
• Sometimes UTIs relate to changes in female hormonal levels - some women are more likely to get an infection during certain times in their menstrual cycle, such as just before a period or in pregnancy.
  
• In older women - the tissues of the urethra and bladder become thinner and drier with age as well as after menopause or a hysterectomy. This can be linked to increased UTIs. If you are taking hormone replacement therapy in tablet or patch form, you may wish to speak to your doctor about using a hormone replacement therapy cream as a supplement in the genital area for relief of dryness.
  
• During pregnancy - the drainage system from the kidney to the bladder widens so urine does not drain as quickly. This makes it easier to get a UTI and sometimes germs can move from the bladder to the kidney causing a kidney infection. UTIs during pregnancy can result in increased blood pressure and a smaller, premature baby so it is very important to have them treated promptly.

Useful weblink: Our Fact Sheet - Finding problems before your baby is born

Women are more at risk of repeated UTIs if they have:

• used spermicide jelly or diaphragm for contraception
• had a new sexual partner in the last year (UTIs caused by bacteria are not usually passed on during sex, however an increase in sexual activity may trigger symptoms of a UTI in some women)
• been diagnoised with their first UTI at or before 15 years of age
• a mother who has a history of UTIs
• who suffer from constipation

Do men get UTIs? 1 in 20 men will get a UTI in their lifetime*. Men can get UTIs particularly if they have trouble with urine flow. Older men who experience prostatitis (an inflammation of the prostate) are in a higher risk group. If the bladder is not emptying properly, the residual urine makes it harder to cure the infection but is not itself a cause. A small number of young men may get a urinary tract infection. In males, urethritis is usually the result of a sexually transmitted disease (STD).

What is the link with Diabetes? UTIs are more common in women than men and more likely in women with diabetes. A high level of glucose, a type of sugar, in the blood or urine is a clear sign of diabetes. Diabetes may also change your body’s defence system making it harder to fight a UTI. The higher your blood sugar, the less effectively your white blood cells work. Refer to our webpage - Diabetes and CKD.

Why are older people more at risk? With age, both men and women are more likely to get a UTI. Chronic conditions, some medications and problems with urinary incontinence put older people in a higher risk group. People using bladder catheters including the elderly and those with spinal cord injuries, are more likely to develop a UTI. A catheter is a soft plastic tube inserted into your urethra. The longer the catheter is in place, the higher the risk of a UTI.

Do babies and young children get UTIs? Babies and children are also more at risk of UTIs. These infections always need to be investigated as they may indicate a serious underlying condition such as urinary reflux. Reflux is caused by a bladder valve problem allowing urine to flow back into the kidneys from the bladder. Reflux can cause the urine to stay inside the body and may become a pool for infection. Infections may lead to kidney scarring, which in turn leads to high blood pressure and sometimes kidney problems. It is important to have children tested as early as possible if another family member has reflux. An ultrasound is often used to examine the kidney and urinary tract. Circumcision can help to protect male babies under six months of age against UTIs. Research is ongoing. Refer Fact Sheet webpage - Urinary reflux in children.

What are the symptoms of a UTI? A faint prickly feeling during urination is usually the first sign of a urinary tract infection. Bacteria can be present in a urine sample without causing any symptoms. This is more common in women who have diabetes, repeated UTIs or in the elderly. This type of UTI may not always need treatment except in special situations, such as in pregnant women. UTIs with symptoms are most common among sexually active women.

Common symptoms include:

• burning sensation when passing urine
• wanting to urinate more often, if only to pass a few drops
• cloudy, bloody or very smelly urine
• pain in the lower part of your body

Signs of UTIs in children can also include:

• low fever
• irritability
• new day or night wetting in a child who has been dry
• feeding problems in babies

If the infection moves to the kidneys, you may also have a high fever, back pain and vomiting. It is important to see a doctor if a kidney infection or kidney stones are suspected because lasting damage or even kidney failure can occur, if these conditions are left untreated. Infection which has spread from cystitis or pyelonephritis is a much more serious condition. A kidney infection is serious and needs prompt medical attention.

How can urinary tract infections be treated? Because UTIs can be the result of more serious medical condition, it is important to seek prompt medical advice for proper diagnosis and treatment. Besides the use of prescription drugs, sometimes mild cystitis can be treated by:

• Drinking plenty of fluids, particularly water - drink water instead as it can help to flush out bacteria!
  
• Taking a commercial urinary alkaliser or one teaspoon of baking soda or bicarbonate of soda in water. This may help to alleviate the discomfort of burning and scalding when passing urine. It is important to refer to your doctor if symptoms persist.
  
• Avoid acidic food or drinks (caffeine, acidic foods, spices, citrus fruits, tomatoes, alcohol and chocolate) as these foods may increase your discomfort and can aggravate the burning sensation when passing urine. They also cancel out the effect of the urinary alkaniser.
  
• Use a heating pad on your abdomen to minimize bladder pressure or discomfort.

These treatments may reduce symptoms but an infection can still be present and need different treatment. Medical advice is needed if self-help treatments aren't working. The doctor usually tests the urine to check for blood, white blood cells and acidity. UTIs respond well to antibiotics.

If a UTI comes back again Your doctor can order a ‘culture’ which is a test to see which germs are present in your urine. The identification of the germ assists with the choice of antibiotic to treat the infection. Sometimes a low dose antibiotic may be prescribed for long-term use if the UTI is persistent. Test results may not always be reliable as there is a chance of a false negative result.

If a UTI does not improve or are frequently recurring It may be a good idea to get a referral to a specialist from your GP. Regular and severe attacks should be investigated, because an underlying disorder such as kidney stones may be the trigger.

Men should see a doctor If you have trouble with the urine stream, or problems starting and stopping urine flow; it may point to an enlargement of the prostate. As urine infections are less common in men, their doctor should review all men who have had a urine infection.

Refer to our Fact Sheet - Informed consent for medical testing and our webpage Talk to your Doctor.

How can UTIs be avoided?

• Drinking lots of fluid, particularly water, to wash bacteria from the bladder and urinary tract. If you are unsure about how much to drink, ask your doctor. See our webpage - Drink water instead
• Quickly treat a vaginal infection, such as thrush or trichomonias
• Avoiding spermicide-containing products, particularly with a diaphragm
• Include some fresh plain yoghurt regularly in your diet to help control the development of a yeast infection, especially after taking antibiotics for a UTI
• Take a regular probiotic capsule (Lactobacillus acidophilus - this live culture is in fresh plain yoghurt)
• Avoid constipation

Some women have found the following tips helpful although there is no research to support them:

• urinate immediately after sexual intercourse
• do not delay going to the toilet when you need to
• wipe from front to back only after urinating etc
• wear only cotton underwear, rather than nylon and wear loose fitting pants
• use only warm water when washing between your legs
• wash between your legs every day and before having sexual intercourse and encourage your partner to do the same
• don’t use perfumed soaps, talcum powder or any type of deodorant around the genitals
• avoid bubble baths and spas - take a shower instead of a bath

It is important to remember that getting UTIs is not because of lack of cleanliness. Self-help treatments such as vaginal douching do not change the likelihood of getting UTIs.

Quick links on Urinary System Health

• Blood in the urine - Kidney and Urinary Health - Kidney Stones - Urinary incontinence

Information on urinary conditions - weblinks

• Bladder and Bowel Health Dept of Health and Ageing - National Continence Management Strategy
• Continence Foundation of Australia National Continence Helpline 1800 330 066
  *Pelvic Floor First and *National Public Toilet Map (apps available for on the go, mobile phone access)
• HealthInsite: Kidney and Urinary Tract Health Australian Government search engine
• Individual urological conditions Wayne State University USA: Department of Urology
• Information on childhood kidney and urinary tract problems
• International Painful Bladder Association Info and support for painful bladder syndrome, interstitial cystitis, chronic pelvic pain syndrome, overactive bladder, incontinence (Australia)
• Interstitial Cystitis Association International support site USA
• Kidney and Urinary Tract Disorders tools and health info plus 3D Medical Animations (check under Urinary System) Mercksource Health Library

Kidney Stone Information

• Cystinuria Wikipedia information
• Cystine Support Network USA - Support network for Cystinuria
• Kidney Stones in adults National Institute of Diabetes Digestive and Kidney Diseases USA
• Kidney Stone website USA education resource on kidney stones
• Oxalosis and Hyperoxaluria Foundation

Urinary Tract Infections - Guidelines for health professionals

• Urinary tract infections, urinalysis - Guidelines, reviews, statements, recommendations, standards

If you are a health professional, use our Resource Order Form to order copies of any of our fact sheets.

Cranberry juice. For women with recurrent UTIs, advice varies on the effectiveness of using cranberry capsules or juice to reduce the incidence of symptomatic UTIs.

Important note: Your GP should be aware when taking any natural therapy, some can alter the effectiveness of some drugs and antibiotics. Drug-nutrient Interactions with commonly used cardiac medications.

Randomised Controlled Trial conclusions around the use of cranberries or blueberries in preventing UTIs vary. Please consider these reports which present opposite conclusions:

Negative preventive conclusion:
Cranberry juice fails to prevent recurrent urinary tract infection: results from a randomized placebo-controlled trial
Clin Infect Dis. 2011 Jan;52(1):23-30 - Barbosa-Cesnik C, Brown MB, Buxton M, Zhang L, DeBusscher J, Foxman B. - Department of Epidemiology, Center for Molecular and Clinical Epidemiology of Infectious Diseases, University of Michigan School of Public Health, Ann Arbor Michigan 48109–2029 USA

Conclusion: Among otherwise healthy college women with an acute UTI, those drinking 8 oz of 27% cranberry juice twice daily did not experience a decrease in the 6-month incidence of a second UTI, compared with those drinking a placebo.