Preparedness and Urinary Tract Infections

             
     Urinary tract infections are one of the most commonly seen issues by nurse practitioners, general practice physicians and family practitioners.  Since a percentage of women use an obstetrician/gynecologist for their primary health care, they treat an awful lot of them too. Recurrent, confusing, or complex cases wind up as the purview of the urologist.    Although men can and do develop urinary tract infections, most of the cases seen are in women.  The reasons for this are purely anatomical.  A woman's urethra has a length of about 4 cm. while a male urethra is about 20 cm.   Bacteria have very little distance to travel in women, before contaminating the bladder which under normal circumstances, houses urine which is sterile.  In either sex, a bladder infection can progress into the ureters above, and then on to the kidneys, so most of the time, physicians and nurses call it a UTI or urinary tract infection rather than simply a cystitis or bladder infection.
      The symptoms of urinary tract infection include burning on urination, stinging, and may progress to fever, chills, back pain or pain in the genital region.  When it progresses to pyelonephritis, there will be fever, chills, nausea and often severe vomiting.  It is very important that pyelonephritis be correctly treated because it can progress to sepsis, shock and death very quickly. (It's pyelonephritis which kills so many paraplegics and quadriplegics who are not able to sense the pain of such an infection.)       The urine in UTIs can look normal, or in can be bloody, smoky, or have mucus shreds.

Note that in both men and women, the patient's right kidney is lower than the other. In pyelonephritis, the right kidney is therefore usually infected first.  Kidney pain is often felt just below in our backs just below the scapula.

                  Sometimes normally healthy people get a urinary tract infection for no discernible cause, but certain groups are more prone to them.   The people who are most likely to be afflicted are those who are run down for some reason, have a chronic illness of some kind, are elderly or diabetic, pregnant,  have some type of an anomaly of the urethra,  bladder, ureters, or kidneys,  have chronic diarrhea or have had recent diarrhea.  Drinking lots of water can help flush the urinary tract and may prevent a very early UTI from becoming something more.  Powders, creams, and synthetic underwear can also irritate the urethra, and some people with chronic irritation, move on to an infection.
                   Once the patient has burning on urination sufficient that she is reluctant to to urinate, or have bloody urine,  then there is nothing more you can do at home. You need to see your primary care physician/nurse practitioner who may take a sample of the urine, for a dipstick and a culture.  They will prescribe an antibiotic, and perhaps another drug also for the spasms and discomfort of an active urinary tract infection.  Most urinary tract infections are caused by one organism, E-coli, the bacteria which is a normal colonist in our stool.  However, sometimes other organisms have infected the bladder, and this is why a culture of the urine should ideally be taken in order to be certain about which organism has caused the infection, and been certain that the antibiotic chosen by your physician will indeed eradicate it..  The newest thinking is that they assume this is an uncomplicated E-Coli infection and treat you with an appropriate antibiotic for three days.  Yes, earlier thinking was that 10-14 days would eradicate more infections, but it was found that we were producing more resistant strains of E-coli in your colon, which would wind up as resistant bacteria in your bladder sometime in the future.  If your UTI returns after treatment, then you must return to your physician to get treatment with an antibiotic which will be effective for more resistant strains of E-coli or for other bacteria entirely.  Usually a longer course of antibiotic is required for a resistant case. and we see 7-10 days being prescribed then.  UTIs comprise a lot of the visits to physicians, and over 100,000 hospitalizations per year in the US,  when if untreated, they become pyelonephritis (a kidney infection)  They need to be taken seriously.     I have specifically not mentioned kidney stones in this post, but I do wish you to know that kidney stones would certainly complicate any UTI and certainly would complicate pyelonephritis.

             As people with an interest in preparedness, we don't much like being told that this is something we should not manage alone. We can handle prevention, but with something as crucial as your urinary tract and your kidneys, your safest course is to develop a good working relationship with a physician, who even after a collapse or during a real emergency, can still provide this level of medication. A child with a urinary tract infection must ALWAYS see a physician or  nurse practitioner.  Stocking medication that may never be used may not be wise for us.
            We can however, focus on prevention, and there is much we can do to prevent urinary tract infections.  Some of it is likely known to you, and some of it, isn't discussed very much much.  First of all, both men and women need to get rid of synthetic underwear for daily use.  Cotton underwear is for sale at Wal-Mart and this is the safest for most people.  These should be changed daily.  Women who use panty liners should pay attention if a particular brand stays damp or is irritating to them. Irritation can lead to later infection.  Find a panty liner you like, if you use them, and remain with a brand you know. Don't apply talcum or similar powders between your legs. We know that this practice results in talcum crystals being located in ovaries, so it's a much shorter trip to have them wind up in the urinary tract where they can cause irritation. Dribbling or urine from the urethra, whether the patient is a man or a woman, should necessitate a visit to the doctor.  Women should urinate after intercourse in order to help flush bacteria which inadvertently enters her urethra.     Make water your primary drink with any other drink a treat.  Both tea and coffee can irritate the bladder in some people.  Water helps everything function at its best.  Cranberry juice, the juice and not the cocktail drinks do help to acidify urine and can make the replication of bacteria in the bladder more difficult, but there is a fair amount of sugar in it, and many times, the diabetics you seek to have avoid a UTI ,cannot handle the added sugar.

Cranberry juice cocktails are less likely to acidify urine making the environment for organisms less hospitable in urine.  However, cranberry juice is marketed, and if you look carefully, this can usually be found.

              Recently, an astute reader, asked me  to point out that there is a 100% cranberry juice available also, but the labels need to be read closely to be sure that no other juices are added.

The pure 100% cranberry will have 7 grams of sugar per 8 oz serving, where when other juices are added will have closer to 17 grams of sugar, and the juice cocktail will be even higher.  Our astute reader also adds that the pure cranberry juice flavor takes some getting used to, but that it's worth such adjustments.

 There are cranberry juice capsules which are available OTC **   in the US and Canada, that will help to acidify urine, but they also can interrupt blood clotting, and so your physician needs to approve your use of these.  Children and adults should be taught to wipe after defecation from the back and from front to back.  The goal is to keep stool away from the urethra.   In emergencies, or during water outages, a squirt bottle can be fashioned to facilitate cleaning after defecation for those who can't shower as frequently as they might normally.  Men and boys should be instructed to void standing, and to take great care that their penis not touch the toilet seat or the toilet water, particularly in public bathrooms if they must sit to have a bowel movement.  We are seeing an increase in young male urinary tract infections unrelated to STDs.  Both sexes should avoid holding urine. We should void as reasonably soon as possible when we feel the urge to go.


**  OTC means over-the-counter or available without prescription, if you are reading from another nation.

This is helpful to acidify urine when we experience the irritation we may notice prior to developing an overt infection.  However, if you take any medications or have any chronic medical issues whatsoever, you must run this past your primary physician.  It does interrupt clotting time.

               Adequate plain water intake,  using the bathroom to empty the bladder when we need to, avoiding urine stagnation in the bladder, getting enough sleep, buying cotton underwear, showering or using a peri bottle during emergencies when showering is not possible, wiping correctly, and using great care in public bathrooms will go a long way in terms of avoiding a lot of urinary tract infections. 

Lots of water is our best defense during an uncomplicated urinary tract infection, although patients with nausea often prefer to drink their water without ice.



Please also see our next post on this subject at:

http://rationalpreparedness.blogspot.com/2012/04/clear-tract-is-available-over-internet.html