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Urinary Tract Infections

Urinary tract infections (UTIs) are among the most frequent conditions treated by gynecologists and are a common problem encountered by family physicians. Studies have revealed that more than 60 percent of women will have a UTI at some point in their life with most occurring by age 35.

In 2007, more than 20 million prescriptions for outpatient care were written in the U.S. Most women can tell the physician that they think they have a UTI because the symptoms are usually very specific. The best reassurance that can be given is that a UTI is rarely serious and usually does not lead to more serious diseases. Infections of the urinary system can be divided into two specific conditions: infection of the lower tract, which is the bladder and urethra, and infections of the upper tract, which is the kidney and ureters.

Symptoms of lower urinary tract infections (cystitis):

  • Dysuria – pain with urination
  • Urgency – often described by the patient as a sensation of not being able to get to a restroom in time
  • Frequency – the sensation that one needs to empty the bladder more often than she usually does
  • Lower back pain
  • Sensation of fullness but can only urinate a small amount
  • Pain in the mid/lower abdomen
  • Hematuria – blood in the urine

Symptoms of upper urinary tract infections (pyelonephritis):

  • Similar symptoms of cystitis
  • Mid back pain – found over the kidney region, usually one sided
  • Flank pain – pain inside in the mid region of the abdomen
  • Chills and fever
  • Nausea and vomiting

Diagnosing a UTI
The most common way to diagnose UTI is urinalysis. This is a simple test done on a urine sample in the physician’s office and determines whether an infection is present. A urine culture can identify the bacterium, and at that time testing is done to determine if the bacterium is sensitive or resistant to common antibiotics that are used to treat UTI. If infections are occurring frequently – within six months to a year – evaluation by an urologist may be needed.

The most common bacteria that cause UTI are E. coli and Staphylococcus. These produce more than 90 percent of infections with E. coli producing almost 80 percent of these. Approximately 20 percent of women will have a recurrence of symptoms within various periods of time and most of these are reinfections. Most UTIs are associated with sexual intercourse, use of vaginal products, vaginal dryness, diabetes, obesity, urinary stones and anatomical congenital conditions.

Treating a UTI
Currently the therapies for UTI include the follow approaches:

  • Fluids and cranberry juice or tablets – Pushing fluids may help flush the bladder, thereby reducing the concentration of bacteria. Cranberry juice or tablets have been used for many years. These seem to work by reducing the ability of the bacteria to adhere to the bladder wall and seem to work for nonsymptomatic bacteria in the urine and for decreasing recurrent infections.
  • Antibiotic therapy – The first antibiotic for UTI was introduced in the early 1950s and is still used. For non-severe infections, sulfa (Bactrim and Septra) and nitrofurantion (Macrobid) have been the mainstay of therapy and continue to work well. In severe cases, newer antibiotics are often used such as Cipro, Levaquin or cenphalosporins (Keflex and Ceftin).

If vaginal dryness is present and seems to possibly be contributing to the risk of infection, vaginal estrogen therapy has been helpful in decreasing recurrence of the infections.

If you have a problem that might be a UTI, contact your physician.

More about Dr. Aulds

Donald G. Aulds, MD is an Obstetrician and Gynecologist and currently serves as the Medical Director for both the Women's Center and the Best Start Program of North Alabama. He is a Diplomat of the American Board of Obstetrics and Gynecology and Fellow of the American College of Obstetricians and Gynecologists.

Dr. Aulds completed his medical education at Louisiana State University School of Medicine, New Orleans, LA and his Internship and Residency in Obstetrics and Gynecology at Ochsner Medical Foundation, New Orleans, LA.

Dr. Aulds has been an active member of the Huntsville Hospital Medical Staff since 1980.