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HealthTalks Facts and Myths About Women’s Urological Issues Sawsan Alkass, M.D. Glickman Urological Institute Cleveland Clinic Appointments: 216.444.5600 Urinary Tract Infections The urinary tract makes and stores urine, one of the body’s liquid waste products. The urinary tract includes the following parts: Kidneys, which produce urine by removing waste and water from the blood Ureters, the tubes that carry urine from the kidneys to the bladder Bladder, the sac-like container for storing urine Urethra, the tube that carries urine from the bladder out of the body What is a urinary tract infection? Normal urine contains no bacteria (germs). Sometimes, however, bacteria from outside the body get into the urinary tract, and cause infection and inflammation. This is a urinary tract infection, which can involve the urethra (a condition called urethritis), kidneys (a condition called pyelonephritis) or bladder, (a condition called cystitis). Cystitis is the most common type of urinary tract infection. What are the symptoms of a urinary tract infection? A urinary tract infection causes the lining of the urinary tract to become red and irritated, producing the following symptoms: Pain in the flank (side of the body), abdomen, or pelvic area Pressure in the lower pelvis Frequent need to urinate (frequency) Painful urination (dysuria) Urgent need to urinate (urgency) Incontinence (urine leakage) The need to urinate at night Abnormal urine color (cloudy urine) Blood in the urine Strong or foul-smelling urine Other symptoms that might be associated with a urinary tract infection include: Pain during sex Penis pain Fatigue Fever (temperature above 100oF) Chills Vomiting Mental changes or confusion What causes a urinary tract infection? Urinary tract infections are caused by microorganisms—usually bacteria—that enter the urethra and bladder, causing inflammation and infection. The bacteria also might travel up the ureters and infect the kidneys. More than 90 percent of cystitis cases are caused by E. coli, bacteria normally found in the intestines. Other organisms—including chlamydia and mycoplasma—also cause urinary tract infections. Infections by these organisms usually are limited to the urethra and reproductive organs. Chlamydia and mycoplasma infections might be sexually transmitted, in which case both partners must be treated. How common are urinary tract infections? Urinary tract infections are very common, occurring in two out of every 100 people. One percent to 2 percent of children develop urinary tract infections. Each year, 8 million to 10 million visits to doctors are for urinary tract infections. Who gets urinary tract infections? Anyone can get a urinary tract infection, but they are more common in women. This is because the urethra in females is shorter and closer to the anus, where E. coli bacteria are common. Older adults also are at higher risk for developing cystitis. This increased risk might be due to incomplete emptying of the bladder related to various medical conditions, including an enlarged prostate or a narrowing of the urethra. If you get frequent urinary tract infections, your doctor might do tests to check for other health problems— such as diabetes or an abnormal urinary system—that might be contributing to your infections. How are urinary tract infections diagnosed? Your doctor will use the following tests to diagnose a urinary tract infection: Urinalysis to examine the urine for red blood cells, white blood cells, and bacteria (The number of white and red blood cells can indicate an infection.) Urine culture to determine the type of bacteria in the urine, which is important for determining the appropriate treatment If your infection does not respond to treatment or if you get repeated infections, your doctor might use the following tests to examine your urinary tract for disease or injury: Intravenous pyelogram (IVP), a series of X-rays of the bladder, kidneys, and ureters after a special dye is injected (The dye helps the structures to show up better on the X-ray.) Ultrasound, a test that uses sound waves to form images of internal organs Cystoscopy, a test that uses a special instrument fitted with a lens and a light source (cystoscope) to see inside the bladder from the urethra How are urinary tract infections treated? Antibiotics, medicines that kill the bacteria, are used to treat urinary tract infections. Your doctor will choose a drug that best treats the bacteria causing your infection. Commonly used antibiotics include: Nitrofurantoin Sulfonamides (sulfa drugs) Amoxicillin Cephalosporins Trimethoprim/sulfamethoxazole Doxycycline Quinolones It is very important that you follow your doctor’s directions for taking the medicine. Do not stop taking the antibiotic because your symptoms go away and you start feeling better. If the infection is not treated completely, with the full course of antibiotics, it can return. What are the complications of a urinary tract infection? A urinary tract infection that is not treated can lead to recurrent infections and a more serious infection of the kidneys. Can urinary tract infections be prevented? There are some steps you can take to reduce your risk of developing a urinary tract infection: Good hygiene of the genital area—especially in women—might help reduce the chances of introducing bacteria into the urethra. After a bowel movement, the genitals should be wiped from front to back to reduce the chance of dragging E. coli bacteria from the rectal area to the urethra. Urinating frequently, which flushes bacteria out of the bladder, might reduce the risk of cystitis in those who are prone to urinary tract infections. Drinking plenty of fluids encourages frequent urination. Avoid fluids that irritate the bladder, such as alcohol, citrus juices, and drinks containing caffeine. Urinating immediately after sex might help flush out bacteria that might have been introduced during intercourse. Practicing safe sex (using a condom) can reduce the risk of a sexually transmitted infection. What is the outlook for a person with a urinary tract infection? While urinary tract infections might be uncomfortable, they generally respond well to treatment. When should I call my health care provider? Call your health care provider if you have symptoms of a urinary tract infection. Also call if you have been diagnosed with an infection and your symptoms get worse or you develop new symptoms, especially fever, back pain, and vomiting. Notes This information is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. 9500 Euclid Avenue Cleveland, Ohio 44195 .......... GLICKMAN UROLOGICAL INSTITUTE Appointments: 216.444.5600; 1.800.223.CARE (1.800.223.2273) .......... www.clevelandclinic.org Produced by the Department of Patient Education and Health Information © Copyright 1995-2007 The Cleveland Clinic Foundation. All rights reserved.