What UTI Solutions Are Available to You After a Diagnosis

What UTI Solutions Are Available to You After a Diagnosis?

Urinary tract infections can make an absolute mess of your day. Between constantly needing to rush to the bathroom and struggling to urinate when you get there, UTIs can really ruin your life. Fortunately, there are UTI solutions available to you!

What are some common UTI treatments that you should ask your doctor about?

If you struggle with UTIs, you don’t have to live your life in the bathroom. Here’s what you need to know about UTI diagnosis and treatments.

What is a UTI?

UTI, or urinary tract infection, is a type of infection that occurs within the urethra, bladder, or kidneys. Most often, the UTI will occur in the lower parts of the urinary tract, such as the bladder or urethra. UTIs develop when microbes enter the urinary tract, commonly through the urethra; while bacteria are the leading cause of UTIs, fungal UTIs are also possible to get.

UTI Causes

The most common type of bacteria responsible for UTIs is E. Coli. However, there are many ways that you can develop a UTI. 

Women are more likely than men to get UTIs due to their anatomy. It is easier for bacteria to get into the urethra due to the fact that it is shorter than a man’s urethra. It is also closer to the anus, making it more prone to infections. 

Some forms of birth control can also increase your risk of developing a UTI. Spermicides can dry out the vaginal area, leaving it open to growing bacteria, as can unlubricated condoms. Sexual intercourse, in general, can increase the likelihood of developing a UTI, as bacteria is transferred from one person to another in a vulnerable location; the best way to avoid this is by urinating following sex.

There are other factors that may increase bacterial growth in or near the urethra. This includes, but is not limited to:

  • Poor hydration
  • Holding in urine for long periods of time
  • Other medical conditions, such as kidney stones or tumors, that block the flow of urine
  • Diabetes
  • Catheters
  • Hormonal changes

If you are concerned that you may be at risk of developing a UTI, talk with your doctor about potential treatment options right away.

Common UTI Symptoms

There are some signs that you can watch out for that may indicate a developing UTI. These include, but are not limited to:

  • Persistent urge to urinate
  • Urinating small amounts frequently
  • Burning sensations while urinating
  • Cloudy or strange-colored urine
  • Urine with a strong odor
  • Severe pelvic pain

Pay close attention to any of the above signs. If you do notice any symptoms of a UTI, you should visit your doctor right away. The longer you leave a urinary tract infection untreated, the worse it may become. Bacteria ascending into the bladder through the urethra is the most common cause of UTIs. There are several risk factors that may promote or encourage bacterial ascent.

Risk factors for UTIs

  • Reduced Urine Flow 
    • outflow obstruction with incomplete bladder emptying (prostatic hyperplasia, prostatic carcinoma, urethral stricture, pelvic organ prolapse or foreign body)
    • neurogenic bladder
    • inadequate fluid uptake
    • voiding dysfunction
  • Promote Colonization 
    • sexual activity – increased inoculation
    • spermicide – increased binding
    • estrogen depletion – increased binding
    • antimicrobial agents – decreased indigenous flora
  • Facilitate Ascent 
    • catheterization (chronic or intermittent)
    • urinary incontinence
    • fecal incontinence
    • residual urine with ischemia of the bladder wall

How to Get Tested

The moment you start noticing symptoms, you should go in to get a proper UTI diagnosis. When you visit your doctor, you will be asked for a urine sample. They will then test the urine for white blood cells, bacteria, and blood.

Should the doctor notice abnormal levels of bacteria or blood in your urine, you will be given a UTI diagnosis. You can then work with your doctor to decide what UTI treatments will work best for you.

UTI Solutions

The exact UTI treatment you receive will depend on the type of UTI you have. There are four main types of UTIs: uncomplicated UTIs, complicated UTIs, recurrent UTIs, reinfection UTIs and [A2] persistent UTIs. Each type needs its own special care and treatment.

Uncomplicated UTI

·       infection in a healthy, non-pregnant, pre-menopausal female patient with anatomically and functionally normal urinary tract

·       Uncomplicated infections include acute cystitis in a non-pregnant, premenopausal female and acute pyelonephritis in an otherwise healthy patient. Young post–pubertal females are susceptible to uncomplicated UTIs because of sexual intercourse in combination with delayed post–coital bladder emptying. The use of the diaphragm and spermicidal contraceptives alters the normal vaginal flora and may allow colonization by pathogenic E. coli.

·       The mainstay of treatment of acute UTI, either non-complicated or complicated infections, is antibiotics. Local antibiograms are useful for determining the prevalence of local resistance patterns and determining optimal antibiotic strategies for patients with complicated UTIs and particularly for nosocomial infections. Additionally, the use of antibiotics in pregnancy should be tailored according to the American Board of Obstetrics and Gynecology committee’s opinion, and local consultation with the treating obstetrician is often necessary to determine an optimal and safe strategy for therapy.

Whether the symptoms disappear or not, you should continue your antibiotics for the entire prescribed time. That way, you will kill off any bacteria remaining after the symptoms subside. If you choose to discontinue your antibiotics early, the infection may come back.

Complicated UTI

·       infection associated with factors increasing colonization and decreasing efficacy of therapy

Complicated UTIs are those that occur when certain predisposing factors are present, but in general, should be considered in pregnant or post-menopausal females and men. Patients with complicated UTIs are more likely to have medical co-morbidities or conditions that require special consideration. In addition, they may have a greater variety of pathogenic bacteria, more drug resistance, and require a longer duration of antibiotic therapy.

Complicated UTIs require one or more of the following:

  • Anatomic or functional abnormality of the urinary tract (outlet obstruction, stone disease, diverticulum, neurogenic bladder, VUR, etc.)
  • Urinary instrumentation or foreign bodies in the urinary tract (i.e., catheters, stents, nephrostomy tubes)
  • Systemic disease (renal insufficiency, diabetes, immunodeficiency, organ transplantation)
  • Pregnancy
  • Multidrug-resistant bacteria

·    Host Defenses:

Several factors relating to host defenses determine susceptibility to UTIs. Mechanical issues such as urethral length (female shorter than male), completeness of bladder emptying (leading to residual urine in the bladder) and the integrity of the natural uretervesical junction “valve” (leading to vesicoureteral reflux; VUR) are important anatomic issues that predispose to UTIs. Biochemical properties are normally important in making bacterial survival difficult in urine: acid pH, high urea content, and high osmolality. In addition, mucosal mucopolysaccharide within the lining of the urinary tract as well as systemic and local antibody production may be protective for UTIs. Finally, there may be a genetic predisposition to UTIs, as certain HLA and Lewis blood group (non-secretor status) factors may put patients at higher risk due to increased colonization ability or increased adherence by bacteria to the urinary tract epithelium.

Natural Defenses of Urinary Tract

  • Periurethral and Urethral Region – Normal flora in these areas contain: lactobacilli, coagulase negative staph, corynebacterium and streptococci that form barriers against colonization. Changes in estrogen, low vaginal pH and cervical IgA affect colonization by normal flora.
  • Urine – High osmolality, high urea concentration, low pH, high organic acids are protective. Glucose in urine may facilitate infections. Tamm Horsfall proteins may be protective.
  • Bladder – Epithelium expresses Toll-like receptors (TLRs) that recognize bacteria and initiate immune/inflammatory response (PMNs, neutrophils, macrophages, eosinophils, NK cells, mast cells and dendritic cells). Adaptive immune response then predominates (T and B lymphocytes). Induced exfoliation of cells also occurs to allow excretion of bacterial colonization.
  • Kidney – Local immunoglobulin/ antibody synthesis in the kidney occurs in response to infections (IgG, IgA).

Alterations in Host Defense Mechanisms

  • Obstruction – Key factor in increasing susceptibility to UTI but does not necessarily predispose to infection.
  • VUR – Hodson and Edwards (1960) described association of VUR, UTI, and eventual renal scarring.
  • Underlying Disease – Diabetes mellitus (DM), sickle cell disease (SCD), nephrocalcinosis, gout, analgesic abuse, aging, hyperphosphatemia, and hypokalemia. 
    • DM: Glycosuria may contribute to severity of infections due to immune compromise. Majority of infections (80%) are in the upper tracts.
    • Papillary Necrosis: due to DM, pyelonephritis, obstruction, analgesics, SCD, transplant rejections, cirrhosis, dehydration, contrast media, renal vein thrombosis.
    • HIV: UTIs 5x more prevalent in this population and they recur more frequently.
  • Pregnancy – Bacteriuria in pregnancy = 4–7% and incidence of acute clinical pyelonephritis = 25–35% in untreated patients.
  • Spinal Cord injury with High Pressure Bladder – High morbidity and mortality from bacteriuria.[A4] 

Your doctor may recommend a further urological workup by a Urologist who is trained in determining the what may be causing your complication and offer you options to mitigate the issue causing your complications.  

Surgery for UTIs is a rare and often unnecessary form of treatment. However, if you suffer from frequent UTIs due to an abnormal urinary tract, then surgically fixing the issue may help with prevention in the future. 

Recurrent UTI

·       occurs after documented infection that had resolved. Defined as 2 or more infections in 6 months, or > 3 infections in 12 months (JAMA article)

·       Recurrent UTI is defined as two or more infections in a 6-month period or ≥ 3 culture-proven infections in 12 months. Both reinfection and relapsing infection contribute to the development of recurrent UTIs. Re-infection is the recurrence of a UTI with the same or different organisms rapidly after the cure has been documented. In patients that have reinfection, a test of cure after treatment should be performed to establish clearance of the pathogen. If there is a concern for a relapsing infection or failure to eradicate the pathogen despite a reasonable treatment course, a urologic referral should be made.

Historically, suppressive antibiotic therapy has been utilized for the prevention of recurrent urinary tract infections. Prophylactic antibiotic use has been shown to decrease the likelihood of experiencing recurrent urinary tract infections compared to no antibiotic prophylaxis. However, appropriate antibiotic stewardship remains a concern when long-term antibiotic prophylaxis is utilized. There is also a risk of side effects associated with antibiotic suppressive therapy. Antibiotics that have been studied for the prevention of recurrent urinary tract infections include nitrofurantoin, fosfomycin, trimethoprim, trimethoprim with sulfamethoxazole, and cephalosporins. Fluoroquinolones have also been utilized for prophylaxis, but the FDA has issued warnings regarding the complications associated with fluoroquinolone use. These can include cardiac effects such as QT interval prolongation, seizures, aneurysm rupture, tendon rupture, tendonitis, and neurological side effects.

The American Urological Association Guidelines for recurrent urinary tract infections in female patients acknowledge these concerns and recommend that clinicians prescribing antibiotic prophylaxis discuss the risks and benefits as well as the alternatives to antibiotic prophylaxis in this patient population.

Cranberry supplementation in the diet may be utilized to help reduce the risk of recurrent urinary tract infections, as per the American Urological Association Guidelines. The challenge of applying this recommendation is that cranberry supplementation may come in various forms, including juice, tablets, and cocktails. It is believed that the proanthocyanidins help prevent bacterial adhesion to the urothelium. Increased fluid intake in healthy patients may help reduce the risk of recurrent UTIs. Research on other non-antibiotic prophylaxis options is not robust enough to make strong recommendations in favor of their routine use. Nonetheless, many of these options are utilized by patients and practitioners, including lactobacillus, methenamine, and D-mannose. Healthy female peri- or post-menopausal women with recurrent UTIs can be prescribed intravaginal (not oral) estrogen to decrease the risk of infection, assuming there are no contraindications to estrogen supplementation.

Reinfection UTI is a new event with the reintroduction of bacteria into the urinary tract or by different bacteria.

For reinfection UTI cases, you may need to spend time in the hospital for treatment. Your doctor will provide you with regular doses of antibiotics to stave off the infection. This may be necessary if the infection has spread to the upper parts of the urinary tract or if you are experiencing severe symptoms.

Persistent UTIs

UTI is caused by the same bacteria from the focus of infection  In these cases, your infection may either require a longer duration of treatment on the antibiotic chosen and/or a greater dose of that antibiotic.  In some cases, your doctor may move to utilize molecular diagnostics that can provide a much broader assessment of pathogens present in your urine, detect antibiotic-resistant genes that would prevent certain antibiotics from being effective, and guide the doctor to suggest a different treatment with a new course of antibiotic/s altogether.

Better Wellness Starts Today

The mainstay of treatment for acute UTI, either non-complicated or complicated infections, is antibiotics. Local antibiograms are useful for determining the prevalence of local resistance patterns and determining optimal antibiotic strategies for patients with complicated UTIs and particularly for nosocomial infections. Additionally, the use of antibiotics in pregnancy should be tailored according to the American Board of Obstetrics and Gynecology committee’s opinion, and local consultation with the treating obstetrician is often necessary to determine an optimal and safe strategy for therapy.

With the push towards antibiotic stewardship, increased consideration is being given to non-antibiotic options for UTI prevention. Vaginal estrogen may be useful for post-menopausal women who have recurrent UTIs. It is established that after menopause, there is thinning of the vaginal epithelium and alkalization; the use of vaginal estrogen preparations may reverse these changes. There is low systemic absorption of vaginal estrogen preparation, but consideration should be given to individual patients, risks, and patient preferences. There are numerous supplements that may be used for the prevention of UTIs in some patients, though for many of these, there is little supporting evidence, and recommendation is based more anecdotally. The 2012 Cochrane review concluded that cranberry juice could no longer be recommended, and other cranberry preparations need to be quantified prior to use in clinical studies. The active ingredient of cranberries is proanthocyanidins (PAC), specifically, type A. It has been determined that 36mg of PAC is needed to prevent the binding of E Coli to urothelial cells.[A7] 

There are many UTI solutions that you can use to get rid of those annoying infections. Remember, if you ever think you might be developing a UTI, talk to your doctor right away! The sooner you can get it taken care of, the better.

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