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  1. 1. Urinary tract infection Dr Yousef Elshrek
  2. 2. • The urinary system is composed of as following 1. Kidneys ‫الكلى‬ 2. Ureters ‫الحالب‬ 3. Bladder ‫المثانة‬ 4. Urethra. ‫القناة البولية‬ • This system plays an important role in removing wastes from body. • The kidneys are a pair of beanshaped organs that lie in the middle of the back, just below the rib cage.
  3. 3. • One of their functions is to filter waste from blood. • Tubes called ureters carry these wastes or urine from kidneys to bladder, where it is stored until it exits the body through the urethra. • All of these components can become infected, but most infections involve the lower tract — the urethra and the bladder.
  4. 4. • What is unary tract infection? • A urinary tract infection, also known as UTI, is usually a bacterial infection that affects the urinary system. • The urinary system produces, stores and eliminates urine and consists of two kidneys, two ureters, the bladder, the urethra and two sphincter muscles. • A urinary tract infection can affect any part of the urinary tract. • UTI is nearly always caused • The urinary tract is also known as the by bacteria, specifically urinary system. Escherichia coli (E. coli). • UTI is nearly always caused by bacteria, specifically Escherichia coli (E. coli).
  5. 5. • Urine contains a range of salts, fluids and waste products, but is usually bacterium-free. • When bacteria enter the urinary tract, e.g. the bladder or kidney, they can reproduce rapidly in the urine, causing urinary tract infection • Adult women are most commonly affected as their urethra is shorter than men and opens nearer to the anus. • This means it is easier for bacteria to enter the urinary system and cause an infection. • About 40% of women get at least one attack of cystitis in their lifetime. • It is more common in sexually active women, during pregnancy, after surgery and menopause. • Bladder infections are common and usually not serious if treated promptly. • But if the infection spreads to the kidneys, it can cause more serious illness.
  6. 6. • There are usually no germs (bacteria) in normal urine. • However, sometimes bacteria from outside or inside the body can get into the urinary system and cause inflammation and infection. • Any part of the urinary tract may be infected: • Urethritis is infection of the urethra. • Urethritis is infection of a ureter. • Pyelonephritis is infection of the kidneys. • Cystitis is infection of the bladder.
  7. 7. • Cystitis, often referred to as a bladder infection, is the most common type of UTI. • A kidney infection is potentially more serious. • Infections of the bladder and/or urethra are known as lower urinary tract infections; if it occurs in the kidneys or ureters they are known as upper urinary tract infections. • Urinary tract infections are generally easily and effectively treated with a short course of antibiotics. • However, infection can cause discomfort, with the patient experiencing pain during urination, a frequent urge to urinate, and cloudy urine.
  8. 8. • What are the signs and symptoms of urinary tract infection? • Signs and symptoms of a urinary tract infection depend on whether the lower or upper urinary tract is affected. • Lower urinary tract infection (affects bladder and/or urethra): 1. 2. 3. 4. Cloudy urine The urine may have an unpleasant smell Hematuria - blood in urine Frequent need to urinate - this may occur during the waking hours, sleeping hours, or both 5. Holding the urine in may become harder to do 6. Discomfort and sometimes pain when urinating 7. Abdominal pain 8. Back pain 9. General malaise; generally feeling unwell 10. Tenderness around the pelvic area
  9. 9. • Upper urinary tract infection (affects kidneys and/or ureters): 1. 2. 3. 4. 5. 6. Fever, usually high (at least 38C or 100.4F) Shivering Vomiting Nausea Diarrhea Pain on the side (flank), upper back or groin - this may become more uncomfortable when urinating 7. Lower UTI symptoms - if the infection spreads to the lower urinary tract, the patient may also have those symptoms. • Older patients are more likely to have urinary tract infection with no symptoms.
  10. 10. • How does doctor know, someone has urinary tract infection? 1.Testing of the urine may reveal pus cells or red blood cells. 2. A urine culture (clean catch) or catheterized urine specimen may be performed to determine the type of bacteria in the urine and the appropriate antibiotic for treatment. 3.The specimen must be fresh. 4. It is also important that the woman has separated her labia (lips) during urination, to avoid bacteria from the skin and vagina contaminating the specimen.
  11. 11. 5. Further investigations may be required to check the urinary system including the kidneys 6. Suffering from recurrent urinary infection or if urine shows more than 30 blood cells, may be advised to have a cystoscopy in which the inside bladder is examined using a camera. 7. Need to an ultrasound scan to check kidneys, ureters and bladder. 8. Urinary tract infections in children are unusual and most doctors would recommend careful investigation in this case.
  12. 12. • Diagnosing UTIs • The first step in diagnosing a UTI is usually a simple urine test called a urinalysis. • It looks for bacteria, as well as abnormal counts of white and red blood cells. • The dipstick test provides quick results. • Doctor may also send the urine to a lab for culture to confirm the type of bacteria. • At-home test kits can help detect a UTI, but are not 100% accurate. • Be sure to go over the results and symptoms with your doctor.
  13. 13. • Infections during Pregnancy • Pregnant women seem no more prone to UTIs than other women. • However, when a UTI does occur in a pregnant woman, it is more likely to travel to the kidneys. • According to some reports, about 4 to 5 percent of pregnant women develop a UTI. Scientists think that hormonal changes and shifts in the position of the urinary tract during pregnancy make it easier for bacteria to travel up the ureters to the kidneys and cause infection. • For this reason, health care providers routinely screen pregnant women for bacteria in the urine during the first 3 months of pregnancy. •
  14. 14. • UTIs and Menopause • Estrogen has a protective effect in the urinary tract, but levels of this hormone drop off significantly during menopause. Low estrogen levels can make it easier for bacteria to thrive in the vagina or urethra. • For this reason, women may be more susceptible to UTIs after menopause. • The menopause is associated with a dramatic fall in the production of oestrogens, which causes a rise in vaginal pH from a reduction in lactobacilli. • This makes the lower genitourinary tract more susceptible to infection with pathogenic organisms.
  15. 15. • Colonization of the vaginal introitus with pathogenic bacteria is more common and heavier in women who are susceptible to recurrent urinary tract infection (UTI). • The epithelium of the bladder and urethra also undergo atrophic changes and this can lead to atrophic cystitis and the formation of a urethral caruncle. • The lower part of the urethra is sensitive to oestrogens. • In some cases the cause of symptoms is interstitial cystitis. • Postmenopausal women are therefore at increased risk not only of recurrent urinary tract infections, but also of dyspareunia, vaginal irritation, pruritus, pain and also symptoms of urgency, frequency, dysuria and urinary incontinence.
  16. 16. • UTIs and Diabetes • People with diabetes are more vulnerable to UTIs for several reasons. • First, their immune systems tend to be weaker. • Second, high blood sugar can spill into the urine and encourage the growth of bacteria. • Also, nerve damage related to diabetes can prevent the bladder from fully emptying. • People with diabetes should talk with their doctor at the first sign of a UTI
  17. 17. • Why Elders Are More Likely to Get UTIs • The population most likely to experience UTIs is the elderly. • Elderly people are more vulnerable to UTIs related to a suppressed immune system that comes with age and certain agerelated conditions • Unlike younger persons who empty the bladder completely upon urination, elderly men and women experience a weakening of the muscles of the bladder. • Urine can be retained in the bladder resulting in accumulating bacteria and subsequent. • Elderly people with serious urinary tract infection don't exhibit the hallmark sign of fever because their immune system does not mount a typical response to infection due to the effects of aging.
  18. 18. • In fact, elders typically don't exhibit any of the common symptoms nor do they express symptoms their caregivers. • The major symptoms of UTIs in the elderly are behavioral changes that resemble the early stages of dementia or Alzheimer's because symptoms may include: 1. Confusion, or hallucination -like state 2. Nervousness 3. Hallucinations 4. Other behavioral changes such as social inappropriateness • Other distinctive symptoms involve poor motor skills or dizziness and falling, frequently touching themselves, or a new onset of incontinence.
  19. 19. • UTIs in Infants • Babies occasionally develop UTIs, but they can’t tell you what they feel. • Here are some signs to watch for: 1. An unexplained fever 2. Strange-smelling urine 3. Poor appetite or vomiting 4. Fussy behavior • It’s vital to treat a baby’s UTI quickly to prevent kidney damage. • Promptly changing a dirty diaper can help prevent bladder infections. • And of course, wipe from front to back whenever changing a baby's diaper.
  20. 20. • UTIs in Children • About 1% of boys and 3% of girls develop UTIs by age 11. • This includes some children who repeatedly delay a bathroom trip. • Their muscles may not relax enough later to fully empty the bladder and flush away any bacteria. • More regular bathroom trips and drinking plenty of liquids may help. • A small number of children have a structural problem that obstructs urine flow or lets urine flow back from the bladder to the kidneys, triggering chronic kidney infections. • This can lead to kidney damage.
  21. 21. • Symptoms and signs • Infants and children presenting with unexplained fever of 38°C or higher should have a urine sample tested after 24 hours at the latest. • Infants and children with symptoms and signs suggestive of urinary tract infection (UTI) • should have a urine sample tested for infection. • Table 1 is a guide to the symptoms and signs that infants and children present with.
  22. 22. • Table 1 Presenting symptoms and signs in infants and children with UTI Age group Symptoms and signs Most common ------------------> Least common Infants younger than 3 months Abdominal pain Loin tenderness Vomiting Poor feeding Preverbal Dysfunctional voiding Changes to continence Abdominal pain Loin tenderness Fever, Malaise , Vomiting Haematuria, Offensive urine Cloudy urine Fever Infants and children, 3 months or older Verbal Lethargy Irritability Haematuria Offensive urine Failure to thrive Frequency Dysuria
  23. 23. • What boosts UTIs risk? • UTIs are most common in sexually active women. • Other factors that may increase UTIs risk include: 1. Not drinking enough fluids 2. Taking frequent baths 3. Holding your urine 4. Kidney stones. Other risk factors include: 1. One study found an increased risk of UTIs in postmenopausal women with sexual activity, previous history of UTI, treated diabetes and incontinence. 2. Other risk factors associated with recurrent UTI in postmenopausal women are vesical prolapse, cystocele and post- voidal residue. 3. Diabetes and cerebrovascular event (as well as other neurological conditions) can lead to incomplete emptying of the bladder with a predisposition to recurrent UTI. 4. Poor mobility and being confined to bed also increases the risk.
  24. 24. • UTI or Something Else? • Although burning during urination is a telltale sign of a UTI, it can also be a symptom of certain sexually transmitted diseases (STDs.) These include chlamydia, gonorrhea, and trichomoniasis. • Simple lab tests are available to distinguish a UTI from an STD. • UTI vs. STD • A UTI infection has many of the same symptoms as common STDs chlamydia and gonorrhea. And interestingly, both UTI infections and STDs can be triggered by sex, especially in younger women. • While only STD and chlamydia testing will let you know for sure which one you have, it’s a good idea to know as much as you can about the differences between the two.
  25. 25. • How Does Sex Affect UTI Infections? • It’s no secret that sex can lead to chlamydia and other STDs, but many people don’t realize that sex can trigger UTI infections. Here’s why: • Female anatomy. Women have shorter urethras compared to men. • This anatomical difference makes it easier for the bacteria to travel to the bladder and cause an infection. • Movement. UTI infections happen when bacteria get in the urinary tract. • The more foreign objects and substances come in contact with the urethra, the more opportunities bacteria have to spread. • That’s why sex and use of spermicides can lead to UTI infections in women. • Certain birth control methods. The use of diaphragms or spermicidal agents can increase the likelihood of contracting a UTI. • Keep in mind that these methods don't protect against common STDs like chlamydia.
  26. 26. • Chlamydia Symptoms vs. UTI Symptoms • Common chlamydia symptoms in women include: • Painful urination • Lower abdominal or pelvic pain • Abnormal vaginal discharge • Pain during sex • Low-grade fever • UTI symptoms may include: • Painful urination • A strong, persistant need to urinate • Pelvic pain in women • Low-grade fever • Based on the symptoms, it can be difficult it differentiate between these two ailments, especially if you have never experienced a UTI before.
  27. 27. • Should someone Get STD Testing or UTI Infection Testing? • STD symptoms and chlamydia symptoms can look a lot like UTI symptoms. • Both conditions can cause abdominal or stomach pain, along with painful urination. • When experiencing possible chlamydia or STD symptoms, it's critical to get tested for STDs, since untreated chlamydia and gonorrhea can cause infertility in women. • The tricky thing is that chlamydia symptoms (which also include vaginal discharge, nausea, fever, and spotting) often don’t show up. • At all. That means that a lot of people with chlamydia never get the STD testing they need. And to make things even more confusing, chlamydia symptoms often mimic symptoms of gonorrhea, another common and potentially harmful STD.
  28. 28. • Whether you have symptoms of an STD or a UTI infection, it’s important to seek medical care. • Untreated chlamydia and gonorrhea can lead to long-term complications like infertility or ectopic pregnancies. • Untreated UTI infections can become painful and lead to kidney complications. Luckily, both are fairly common conditions and can be cured with antibiotics, but a proper diagnosis is the first step to a cure. • Urinary Tract Infection (UTI) and Nutrition Therapy • Recommended Foods 1. Fruit juices, such as cranberry juice 2. Yogurts made with “live active cultures” (this term will be listed on the 3. package or ingredient list) 4. Lots of water
  29. 29. • Meal Planning Tips • In general, you can eat the same foods you usually eat. • Have cranberry juice and other berry juices instead of the drinks you usually choose. • Have yogurt with live cultures in place of milk or other milk products. • Eat it with fruit or cereal. • Try fruit smoothies made with yogurt. • Choose fresh fruit drinks that list fruit juice first on the ingredient list. • Try to drink 8cups of water daily. • Sample 1-Day Menu in the following table
  30. 30. Meal Breakfast Manu ½ cup fruit juice 1 cup corn flakes ½ cup yogurt (with live cultures) 1 slice whole wheat toast ½ cup milk 1 cup coffee At least 1 cup water Lunch 100 grams sliced turkey 2 slices whole wheat bread Lettuce and tomato ½ cup cucumber salad with oil and vinegar 1 medium orange At least 1 cup water Dinner ½ cup fruit juice 100 gm baked fish 1 cup rice 1 cup carrots 21 cup salad with oil and vinegar At least 1 cup water Snack ½ cup yogurt (with live cultures) Small size fruit like orange or peach or half banana. At least 1 cup water