Urinary infections, a general overview

By Cristiano Antonino Last updated May 25, 2023

Urinary infections are known by the acronym UTI. This term is used to define all infections caused by pathogens multiplying in the urinary tract through the urethra

This part of the body transports urine from the bladder to the outside and is essential for proper functioning of the urinary tract.

Symptoms of urinary infections can occur in the kidneys, bladder, urethra and ureters

The type of infection varies greatly depending on which part of the body is affected.

The ureters are the ducts that connect the kidneys and bladder, the urethra is the duct between the bladder and urinary meatus, and the bladder is the organ in which urine accumulates.

The causes of urinary infections are many, as are the symptoms

The latter can vary depending on the type of pathology diagnosed.

Patients who suffer from these infections usually experience the need to urinate often, pain in the abdomen, cloudy and foul-smelling urine, and difficulty emptying the bladder completely.

Many people suffer from urinary infections, and women in particular are more prone to these conditions.

In fact, between the ages of 20 and 50, there are about 50 times more female patients than male patients.

With increasing age, however, urinary tract infections are more frequent among men, as there are well-known and frequent predisposing conditions such as prostatic hypertrophy.

The wide range of types of urinary infections makes it less easy to make an accurate diagnosis.

However, it can be helpful to know the symptoms, causes and treatment in order to prevent complications and to quickly identify any cases of urinary tract infections.

What are urinary infections

Specifically, urinary infections are infections that affect the urinary system.

More specifically, these infections affect the kidneys, bladder, urethra and ureter.

Urinary infections are named after the location of the problem, i.e. the part of the urinary system affected and infected by the bacteria, e.g. a bladder infection is called cystitis, while a kidney infection is called pyelonephritis.

Early diagnosis of urinary infections is crucial as the complications of these diseases can be very serious.

In fact, an infection affecting only one part of the urinary system can also infect the rest of the system.

Moreover, complications include the spread of bacteria to organs that are essential for the body, not just the urinary system.

It is also crucial to prescribe correct remedies for urinary infections, as incomplete treatment can lead to resistance of the bacteria.

This resistance then causes the infection to reoccur and be stronger and more resistant to treatment.

Also for this reason, many patients, particularly women, may experience urinary infections several times in their lifetime and have to deal with this condition for years.

Types of infections

As mentioned above, there are many types of urinary infections that can change depending on the bacteria responsible or the part of the urinary tract affected.

Often these infections affect the lowest part of the urinary tract, i.e. the bladder and urethra.

There is therefore already a distinction between types of urinary infections:

lower urinary tract infections, i.e. urethra and bladder
high or upper urinary tract infections, i.e. ureters and kidneys

Specifically, the classification can be made according to the precise location of the infection, e.g:

cystitis, an infection that affects the bladder and is the most common, especially among women
urethritis, an infection that affects the urethra and can reach the bladder if neglected
ureteritis, an infection that sees bacteria inside the ureter
pyelonephritis, an infection that affects the kidneys, usually this type is the most serious and requires specific treatment to prevent very serious complications such as loss of kidney function that can lead to a need for transplantation or in extreme cases death

The type of bacteria that is the cause of urinary infections can also lead to further classification, e.g. infections caused by:

Klebsiella
Proteus
Enterococcus faecalis
Pseudomonas
Enterobacter

Causes and risk factors

The causes of urinary infections can vary, but what they all have in common is the presence of the pathogens responsible.

Usually without previous infections or diseases, urine is sterile and so is the male and female urinary tract.

The main cause of infection is the invasion of a colony of pathogens that can travel up the urinary tract.

Pathogens are many and can be divided into bacteria, fungi and viruses.

Among the best known are:

Escherichia coli, which affects about 80% of patients and can be acquired in a community environment.
Staphylococcus saprophyticus, which is rarer and affects about 10% of patients.

In a healthcare environment, Klebsiella bacteria, Candida albicans fungus, Pseudomonas bacteria and Enterococcus bacteria can be contracted.

There are many causes, but there are also several risk factors.

There are in fact other pathologies but also patient behaviour that could favour the proliferation of bacteria responsible for urinary tract infections.

Risk factors include, for example

diseases such as tuberculosis
diabetes, AIDS and other diseases that cause immunodepression and thus increased exposure to infections
congenital malformations
tumours
kidney stones
prostatic hypertrophy
polycystic kidney
bladder-urethral reflux
spinal cord injuries

In addition, patient characteristics that can promote and cause urinary infections include

intense sexual activity
belonging to the female sex
surgical operations
corticosteroid medications and treatments that lead to immunodepression, i.e. increased susceptibility to bacteria and infections
catheter use
menopause and hormonal changes
chemotherapy
intrauterine contraceptive devices such as diaphragms or IUDs
pregnancy

Symptoms

The symptoms of urinary infections can change depending on which part of the urinary tract is affected by the infection.

Generally, however, the symptoms can be summarised as

constant need and urge to urinate
difficulty urinating and emptying the bladder completely
burning or pain while urinating
pain in the lower abdomen
fatigue
malaise
changes in the urine, e.g. traces of blood, foul smell and cloudy colour

In addition, there may be symptoms of more complex urinary infections and manifestations of complications such as

tremors
high fever
nausea
vomiting
agitation
back pain
hip pain
chest pain

Diagnosis

The first step for a correct diagnosis of urinary infections is certainly to have an initial consultation with one’s general practitioner.

Thanks to an initial objective test and a medical history taken by the doctor, it is in fact possible to investigate the patient’s symptoms, but also to check for any previous illnesses, medication intake, other cases in the family and further information that can provide an initial overview of the patient’s state of health.

This anamnesis may also be repeated by a specialised doctor, who may additionally require certain tests, including:

urine test, a diagnostic test that allows several characteristics of urine to be analysed, such as microscopic, physical and chemical characteristics. Various elements can be included in this analysis, such as odour, colour, pH, protein, specific gravity, ketones and glucose;
urinoculture, a microbiological test that is performed by analysing microorganisms in urine. This test is very specific, as it is specially formulated to detect pathogenic microorganisms that may be among the main causes of urinary infections.

These two tests can be requested individually or together to diagnose urinary infections, especially in more complex cases.

Therapies

The first way to treat urinary infections is to prevent them.

In order to do this, there are some medical tips that can be crucial in preventing urinary tract infections.

Among these methods to prevent the proliferation of bacteria in the bladder, kidney or urethra are

consuming plenty of water every day, at least 2 litres for adults
emptying the bladder regularly and thoroughly, especially following sexual intercourse
avoid intrauterine contraceptive methods such as diaphragms and IUDs
avoid particularly aggressive intimate hygiene products and prefer neutral formulas made from plant and natural ingredients
use 100% cotton underwear
follow a balanced diet, rich in fibre and low in animal protein and fat

Treatment for urinary infections is usually simple and can change depending on the type of bacteria responsible.

The part of the urinary tract affected by the infection is also a factor that can influence the type of medication prescribed.

Certainly, most of these treatments for urinary infections are based on the administration of antibiotics.

As mentioned above, it is essential to obtain the correct prescription from the doctor in the ideal dose of antibiotic, as a poorly treated infection can lead to bacterial resistance to the drug and thus to greater difficulty in resolving this issue in the future.

Due to incorrectly followed treatment, there is a high number of recurrences of urinary infections, especially among women.

About 20% of patients who have contracted a bacterial urinary tract infection are in fact at risk of a second infection.

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