At some point in their lives, most people face the problem of agonising lower abdominal pain with an urgent, frequent, painful desire to urinate and unbearable pain as the last few drops of high coloured (and sometimes bloody) urine is voided.
The urinary bladder is technically just a muscular sac with nerves. It collects the waste fluid excreted by the kidneys. When it becomes full, the urine is expelled involuntarily in babies and voluntarily as we grow older. This should be a painless procedure.
The bladder can become infected with bacteria. The anal area always has bacteria and these can find their way up the urethra into the urinary tract. This is commoner in women because of the shorter length of the female urethra. Older women are also more prone to this owing to the thinning of the mucosa of the pelvic organs after menopause. During pregnancy too infections (sometimes without symptoms) are common as the uterus acts as an impediment to the free flow of urine. Sexual activity increases the risk of developing urinary tract infection (UTI) in both men and women.
The chances of developing UTI are greater in women if they restrict their fluid intake or if they hold the urine without voiding because of a dislike for strange toilets.
When UTI sets in, a child who previously had good urine control suddenly has accidents. He or she may come back from school with damp or wet underclothes. The urine may be voided before reaching the toilet. In adults, there may be a feeling of heaviness, pain or discomfort in the lower abdomen. There may be an overwhelming desire to pass urine even when the bladder is not really full. The frequency of voiding increases. There may be pain while voiding, especially as the last few drops come out. The urine may be high coloured, smelly or blood stained. There may be low grade fever.
If the infection is not tackled appropriately, it can spread upwards into the kidneys causing "pyelonephritis". This is a more serious infection, with high fever, chills and flank pain. It can be fatal in three per cent of the elderly if it is ignored, misdiagnosed or inadequately treated.
In both men and women, diabetes, or obstructions like stones, an enlarged uterus or prostate can result in infections.
If UTI is uncomplicated by other disease processes, it can be treated at home. Hospital treatment is required if there are structural abnormalities in the urinary tract, an obstruction, an underlying disease or the patient is immunocompromised.
Treatment of cystitis usually involves taking antibiotics. Symptoms may clear up within a day if analgesics (paracetemol) and anti-inflammatory agents (ibuprofen) are also added. The full prescribed course needs to be finished even if symptomatic improvement occurs. Otherwise the infection can recur with resistant bacteria. In men treatment needs to be continued for 14 days.
Cranberry or tomato juice has long been touted as a cure for UTI. While they might not actually cure an existing infection, regular use might prevent repeated infections.
To avoid urinary tract infection:
- Always lean back when using the toilet
- Wipe and wash front to back after using the toilet
- Bacteria can colonise the surface of bar soaps; use liquid soap
- Strengthen bladder and pelvic muscles by attempting to stop the flow of urine several times while urinating.
- Do not use antiseptics, deodorant sprays and harsh chemicals in the genital area.
- Do not sit in wet swimsuits or underwear
- Wear loose clothes and cotton underwear that allow circulation of air.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in