Cystitis and UTIs

The Urine System

The urine system in medical terms is called the Urinary Tract. In most people it is made up of two kidneys, (right and left)  which sit deep in the abdomen. The kidneys filter the blood to produce urine which drains out the kidney into the bladder. The tube that drains the urine from each kidney is called the ureter. The bladder sits  behind your pelvic bone, in the lower part of your abdomen. The urine is stored in your bladder until you are able to empty it. The urine then drains out of your body through another tube called the urethra. In women this tube is very short because there is only a short distnace from the bottom of the bladder to the female genitals. In men, the tube has to pass along the length of the penis and is therefore much longer.

This is one of the reasons why women get more urine infections than men. In the female urinary tract, the bacteria have a much shorter and therefore, easier journey from the outside world, to reach the bladder.

 

                    The anatomy of the Urinary Tract.

 

What is a UTI?

A UTI is short for Urinary Tract Infection. If you are diagnosed with a UTI it means there is an infection somewhere along the urinary tract. UTIs are generally classified as Lower UTIs and Upper UTIs. People who get repeated infections in their urinary tract are said to have Recurrent UTIs.

UTIs are caused by bacteria which most commonly come from the bowel. They can enter through the urethra and settle in the bladder where they multiply and thrive. Your body attempts to get rid of the infection by activating your immune system. This further inflames the bladder and causes the symptoms typical of a UTI. Lower UTIs are infections of the urethra or the bladder. Another term used to describe lower UTIs is cystitis (SIS-STY-TIS) which just means inflammation of the bladder. Upper UTIs are infections in the ureters or more commonly in the kidneys, sometimes called pyelonephritis (PIE-LOW-NEF-RITE-IS)



Sometimes, in lower UTIs, the infection is not severe and the symptoms may pass after a few days.  Medications from the pharmacy can help by neutralising the urine and make it less painful when you go to the toilet. Drinking plenty of fluids also helps by diluting the urine and flushing it out of your body.

If the infection does not settle or the symptoms gets worse, antibiotics are prescribed to kill off the bacteria. This also helps reduce the chances of the bacteria travelling out of the bladder, up the ureters and towards the kidneys. Once the infection moves upwards, out of the bladder, it becomes an upper UTI.

This is more serious and can cause kidney damage if left untreated. This requires a longer course of antibiotics to ensure the infection is truly killed off.







 

Symptoms of Lower UTI

Most people will have at least one or two of these symptoms when they have a Lower UTI

  • Burning or stinging when you pass urine

  • Frequently needing the toilet but only passing a small amounts of urine 

  • Cloudy, pink-tinged or blood-stained urine 

  • lower abdominal discomfort or lower backache

  • sense of urgency of needing to go 

  • leaking small amounts of urine or not getting to the toilet in time

  • difficulty in passing urine 

  • Strong or offensive smelling urine

  • Low Grade Fever (less than 38'C)











Symptoms of Upper UTI

Upper UTI symptoms may not always be obvious. Sometimes you may just feel very unwell and have a high fever (especially in children and the elderly). The more common symptoms are

  • Very high fever (usually over 38'C)

  • Shivering, shaking episodes

  • Feeling cold

  • Nausea and/or vomiting

  • Pain overlying one or both kidneys, usually felt in the lower back, at the sides

  • Abdominal pain

  • Acute Confusion (especially in the elderly)



 

What causes UTIs?

It depends on a number of factors. UTIs are more common in people with

  • Abnormalities of their urinary tract (like a kidney malformation, kidney stones, poorly draining bladder)

  • Medical illnesses such as diabetes

  • Neurological disorders such as MS (multiple sclerosis)

  • who are pregnant

  • who have had a recent catheter or other medical instrument put in their bladder

  • Men with enlarged Prostate Glands







UTIs are also extremely common in otherwise healthy people who have no underlying problem. There are certain things that can increase your chances of getting a UTI such as

  • After sex

  • Having a new sexual partner

  • Using spermicide during sex

  • if you suffer from vaginal dryness, especially after the menopause

  • If there is a history of UTIs in the women of your family

 

Some Interesting UTI facts


  • 1-3% of all GP consultations are for UTIs

  • over 85% of UTIs are caused by the bacteria E.coli

  • 1 in 3 women have experienced a UTI by the age of 24y

  • More than half of all women will have at least one UTI in their lifetime

  • UTIs are much more common in women but men do get them, especially as they get older

 

Treatment of Lower UTI

Lower UTIs are usually easy to treat because most of the infections are caused by bacteria which respond to antibiotics. 

The commonly used antibiotics in lower UTIs are

  • Trimethoprim (try-meth-o-prim)

  • Nitrofurantoin (ny-trow-fur-an-toe-in)

You usually take these antibiotics for three days, but sometimes antibiotics are prescribed for seven days or more. You may need the longer course of antibiotics if you are a man, are pregnant, have diabetes or suffer from repeated infections.

You should start to feel better within 2-3 days of starting antibiotics.


There is a growing problem called antibiotic resistance, where bacteria have evolved and developed defences against the most commonly used antibiotics. It is estimated that 10-20% of E.coli bacteria (the bacteria that causes the majority of UTIs) are now resistant to both of these antibiotics.


This is why it is important to provide your doctor with a urine sample if your symptoms fail to settle. The urine can be tested to check which bacteria are causing your symptoms and if the bacteria is resistant to the antibiotic prescribed. Your may need a different antibiotic.


It’s important to complete the full course of antibiotics, even if your symptoms seem to have cleared up.
A newer antibiotic, proving to be successful in treating UTIs and with a low incidence of antibiotic resistance is called Pivmecillinam (PIV-MESS-SILL-EE-NAM). Many areas of the UK are introducing it as a standard treatment for UTI.




Ebisu Clinicians


Ebisu can provide treatment for some cases of cystitis as your urine does not necessarily need testing if you have the classical symptoms of a UTI.

We can't treat the following people

  • someone who's symptoms have failed to settle on the first course of antibiotics

  • Someone who has  symptoms suggestive of an upper UTI

  • Pregnant women

  • Children

  • Men

  • Anyone with a medical condition that could worsen with a UTI



Our clinicians will be very happy to advise you on the best course of action. They will assess your symptoms and decide if they are able to treat you or if you should be seen in a face to face setting.

 

Treatment of Upper UTI

Upper UTIs are also responsive to antibiotics. Upper UTIs are treated with different antibiotics and for a longer period of time

The commonly used antibiotics in upper UTIs are

Ciprofloxacin (sip-row-flox-a-sin)

Co-amoxiclav (co-amoxi-clav)

These antibiotics are prescribed for at least 7 days depending on your local area guidelines. If you are feeling very unwell e.g vomiting and unable to keep tablets down, have another medical condition or are pregnant, the doctors may decide to admit you to hospital. The antibiotics can be given through a drip and you will be closely monitored. You may need additional tests to find out why you developed the infection.


 

Complications of a UTI

If the bacteria causing the UTIs are very aggressive, resistant to antibitoics or the UTI is left untreated, the infection may cause damage to the tissue in and around the kidney. This causes complications such as;

  • Pyelonephritis (severe kidney infection affecting  the main body of the kidney)

  • Abscess in the kidney (collection of pus in a section of the kidney)

  • Kidney scarring and long term damage (varying stages of chronic kidney failure)

  • Acute kidney failure

  • Enlarged kidney due to blockage of the ureters (urine can't drain out of the kidney

  • Premature labour in pregnant women

  • Sepsis



 

Red Flags

You should see a doctor if

  • you have mild cystitis which is not settling after 2-3 days

  • You develop a  fever

  • You start having lower back pain or loin pain

  • You start feeling sick or vomiting 




 

Recurrent UTI

Recurrent UTI may be due to a partially treated infection, a relapse or a re-infection. 

It is defined as two proven infections within six months, or three infections in a year.

Most of the time there is no particular reason for developing recurrent cystitis. You may have to have some tests to check for an underlying problem.

It is a much more common condition in women than in men.


Antibiotics are usually needed for each episode of recurrent cystitis. It is better to send a urine sample before taking antibiotics to determine if there is antibiotic resistance.  But if your symptoms are severe or getting worse you should start the antibiotics immediately.

Some people with recurrent cystitis have a supply of antibiotics in standby to take when symptoms start

Other people are prescribed a low dose antibiotic to take every day and which may continue for at least 6 months.

People who suffer UTI after sex may be prescribed a single dose of antibiotic to take just after sex.



One of the causes of recurrent cystitis in older women is vaginal dryness caused by the hormone changes after the menopause. A medication that may help this, and also reduce the number of times you get cystitis is vaginal oestrogen. It is a tablet containing an oestrogen that you insert into your vagina at night twice a week or as a ring that releases it continuously. This allows it to stay in the vagina for approximately three months .


Some women suffer recurrent cystitis after sex.This is due to the movements during sex which may help the bacteria into the urethra and up into the bladder. This is more likely if the vagina is dry during sex or if spermicides and/or a diaphragm is used, as they alter the normal mucus in and around the vagina. If you are rone to this tyoe of cystitis, you can help by

  • Going to the loo straight after sex to pass urine

  • Using a water-based, pH-controlled lubricating gel during sex

  • Taking a prescribed dose of antibiotic within two hours after sex

  • Avoiding spermicides and/or a diaphragm- use an alternative method of contraception



Research


There are some new experimental treatments being investigated as potential solutions for severe recurrent cystits. These include

  • a vaccine treatment to prevent episodes

  • oral urinary antiseptics to keep the urine sterile

  • chemical treatments introduced directly into the bladder via a small catheter.

 

Preventing UTIs

Drink plenty of fluids, daily (although recent studies have failed to show this makes a huge difference to the prevention of recurretn UTI)

  • It is generally advised to drink between 6 and 8 pints of water per day.

  • If you have cystitis and you do not have any medical problems that prevent you from drinking too much water, you should aim to drink 2 litres. 

  • Avoid fruit juices (especially the very acidic ones) , fizzy drinks, caffeine and alcohol.

  • Pass urine frequently, try and not hold it in for long periods especially if you are prone to UTIs

  • After going to the toilet,  wipe from front to back (again, unproven)

  • Use normal toilet roll rather than perfumed wipes

  • Wash with water and only ever use a very mild moisturising wash. Do not use soaps and avoid douching.

  • Avoid anything that makes you constipated.




 

Natural Health Remedies

Health remedies that are supported by evidence from small clincal trials indicate the following may be beneficial in reducing the frequency of recurrent cystitis bouts.

regular vitamin C

probiotics containing lactobacillus (some probiotics are sold as vaginal creams that can be used to restore the normal flora)

grapefruit seed extract and oil of oregano

D-mannose
This is a naturally occurring sugar that you can buy over the counter at health food shops or via the internet. Clinicial trials have suggested that taking 2 grams per day may prevent urine infection, but evidence is still being collected.


Cranberry juice used to be recommended as an effective deterrant. However clinical studies have been unable to prove that it really works. It is no longer recommended as a remedy and many of the supermarket juices contain a lot of  sugars that are unhealthy for other reasons.


 

Cystitis in children




Urinary tract infections can also affect children, especially those under two years old. Children may not always complain of the typical symptoms associsted with UTIs. They may just have a fever, lose their appetite, feel sick or vomit and be genrally under the weather. Older children may complain of tummy ache and other common UTI symptoms.

It’s important to seek medical help as soon as you can. A simple lower UTI could quickly escalate to an upper UTI. If you think your child may have a UTI, it is always recommened to have a sample of urine tested. The easist way to do this is to pick up a sample pot from your GP and ask them to send it for testing. 

Ebisu clinicians will not  be able to treat most children who have a new UTI because they need to have a physical examination. Any child who is unwell or has a fever should always be examined by a clinician, face-to-face.

 

UTI and pregnancy





If you get a UTI when you’re pregnant, you are at a higher risk of it becoming an Upper UTI and developing a kidney infection.

You are also at risk of premature labour and your baby having a low birth weight if the UTI is not treated.

Midwives regularly screen pregnant women for UTI throughout their antenatal appointments. UTIs are picked up early and treated with antibiotics.

Antibiotics commonly used in pregnancy are

  • Nitrofurantoin (except in the last stages of pregnancy)

  • Trimethoprim (if you are under 17 weeks pregnant, you may be advised to take folic acid with this antibiotic)

  • Amoxicillin (only if the urine test has shown that the bacteria is sensitive to this antibiotic)

If used as prescribed, these antibiotics are safe and are not known to cause harm to your baby.

Your baby is more at risk if the UTI is not treated.

 

UTI in men

UTIs are a lot less common in men but they still do occur. They can happen without an apparent cause, as they do in women but overall there is a higher chance of there being an underlying problem such as

  • kidney stones

  • diabetes

  • enlarged prostate gland

  • medical condition affecting immune system

  • recent catheter

Men suffer symptoms similar to women with burning, frequency, urgency and hesitancy being the most common. Another indicator is having fluid constantly seep from the end of the penis. This should always be checked out.

Antibiotics that are used are the same as women but the duration of the course is for at least 7 days. If the testicles or the prostate gland are also affected, the course of antibiotics may be prescribed for upto 4 weeks.

 

Referral

Further investigations are not usually needed in females with uncomplicated lower UTIs. Urinary tract abnormalities are uncommon even in people with recurrent infections.

You may need further tests if

  • you repeatedly do not respond to standard treatments

  • Have a history of urinary tract problems.

  • Have visible blood in your urine

  • You are a man who has had two or more lower UTIs in three months or a single upper UTI.

  • You are a women who has recurrent cystitis that does not settle with preventative measures.



 

Advice and Support

Bladder Health UK www.bladderhealthuk.org

 Bladder Health UK, offer sufferers help and advice to manage their bladder condition.

 Call 0121 702 0820 or visit the Membership page.

 Bladder Health UK  is a Registered Charity: 1149973


Tena         Visit their site at www.tena.co.uk