ICD-10 , urinary infections are cataloged under the code N39.0 – Urinary tract infection of unspecified location.
The type of urinary tract infection depends on the presence or absence of symptoms and the region in which the bacteria settle.
Some of the criteria for classifying the infection are:
Manifestation : the patient has symptoms (symptomatic) or not (asymptomatic);
Occurrence : isolated (the infection is punctual), recurrent (the cases frequently affect the patient) and persistent (the condition presents difficulties in regression).
Know a little about each of the types:
People who have bacteria in their urine but have no symptoms or complaints are classified as so-called asymptomatic bacteriuria.
Among healthy women who have not yet reached
menopause , the Brazilian Medical Association estimates that up to 5% have an asymptomatic infection. Already after menopause, the numbers rise to 15%.
In addition to
Escherichia coli , the bacterium responsible for most cases, the microorganisms Pseudomonas aeruginosa , enterococci, group B streptococci and Staphylococcus saprophyticus are frequently found to cause the infection.
In general, women under 60 years old, non-pregnant and without chronic diseases are not indicated for treatment in asymptomatic cases, but each condition needs to be evaluated by a doctor.
Cystitis (bladder infection)
When bacteria infect the bladder, the condition is called
cystitis . The most associated symptoms are the urge to pee, a small amount of urine each time you go to the bathroom, burning, pain and burning in the vagina area, in addition to rarely showing fever and blood.
Cystitis can be further divided into complicated or uncomplicated, which refer to the patient’s conditions.
When there are dysfunctions in the functioning or structure of the urinary system, diseases that favor UTI or if the patient is pregnant, the infection is considered complicated.
Immunodepressed patients, with chronic diseases (such as
diabetes ), who have been using a bladder catheter or with symptoms for more than 7 days can also be considered cases of complicated cystitis.
As for uncomplicated cystitis, the patient must fulfill the requirements: be sexually active, not pregnant, without chronic or aggravating disease, symptoms manifesting in less than 7 days and without urinary tract dysfunctions.
Pyelonephritis (kidney infection)
Pyelonephritis occurs when invading bacteria affect the kidneys and ureters. Normally, microorganisms are installed primarily in the lower urinary tract, that is, in the urethra and bladder.
Without treatment or if there is any factor that favors the migration of bacteria, they can reach the upper part, made up of the ureters and kidneys.
The cases can be
acute or chronic . Usually, the acute type appears suddenly and compromises the function of the kidneys, but tends to respond well to treatment. However, without the right measures, pyelonephritis can progress to a chronic condition.
In these cases, the kidneys have a gradual loss of function, which can be caused by other diseases (such as type 2 diabetes and high blood pressure) or by untreated or recurrent cases of acute pyelonephritis.
The condition usually causes more severe pain that radiates to the lower back, in addition to fever, burning and the presence of blood in the urine.
The asymptomatic acute type can occur in up to 7% of pregnant women and the symptomatic type occurs in approximately 2%, being more common in the last trimester of pregnancy.
In addition to the common symptoms of the condition (fever,
severe low back pain , nausea and vomiting), the pregnant woman may suffer from increased uterine contractions, increasing the risks of premature birth . In some more serious cases, the condition poses risks to the baby and the mother’s life as well.
Urethritis (infection in the urethra)
When infectious agents affect the urethra is called urethral syndrome,
urethritis non – gonococcal urethritis or just.
The urethral tube is responsible for carrying urine from the bladder to the outside of the body.
Pain in the abdomen, burning when urinating, fever, discharge (discharge) and discomfort when urinating may manifest.
What causes urinary tract infection?
Urinary infections occur due to the invasion of microorganisms in the urinary tract, especially
Escherichia coli , responsible for up to 85% of cases. Factors of low immunity, poor hygiene, dysfunctions of the urinary system are some aspects that facilitate the entry of bacteria in the body.
Microorganisms can affect the urethra, bladder and even the kidneys, manifesting symptoms such as pain and burning.
Some situations, habits and conditions of the patient lead to infection, promoting the entry of bacteria into the urethra or causing them to settle more easily. Between them:
Little water intake
Water participates in several fundamental functions of the organism, helping in the functioning of the intestine, in hydrating the skin and transporting nutrients, for example.
When the liquid ingested is almost being eliminated as urine, it still plays an important role in the body, helping to clean the urethral canal and preventing bacteria from invading the body.
Therefore, the more liquids you drink, the more urine you will produce and, consequently, the greater the number of visits to the bathroom.
Urinating helps to clean the walls of the urethra, eliminating agents that can cause infections and reduce toxins in the body. Therefore, it is useless to drink enough water and not respect the wishes of the bladder.
When we go a long time without going to the bathroom, this cleaning process does not go as it should and bacteria are easier to migrate to the bladder or kidneys, for example.
Lack of hygiene
Especially for women, who have the entrance of the vagina very close to the anus, the lack of correct hygiene can be decisive for the development of urinary infections.
The intestine and anal area are full of microorganisms that, in general, do not cause diseases or changes as long as they remain in the correct place. That is, away from the urethra.
When there is a proliferation of bacteria due, for example, to poor hygiene, the proximity to the urethra causes contagion to be rapid and infections can settle more easily.
Intimate feminine hygiene products
It is also important to maintain care for situations that facilitate infection. Even if the baths are regular and attention is paid to hygiene, some common situations can trigger the infection. For example, the use of panty protectors or intimate hygiene products.
It may seem that using intimate soaps improves cleanliness and protects the body more, but it is important to note that they can affect the intimate pH and cause deregulation, especially if they are used very often.
Using vaginal soaps, in itself, does not cause a urinary tract infection, but it can eliminate the good bacteria, necessary for the natural protection of the region.
Without immunity, other infectious bacteria are easier to invade the body.
In the case of intimate protectors, the logic is similar: constant use can prevent the vulva and vagina from breathing properly. With the muffling of the place, it becomes easier for infectious agents to proliferate, especially if there is humidity.
Delay in changing tampons
The ideal is to do a regular change of absorbents – whether intimate or not -, maintaining a maximum average use of 4 hours. Both common absorbents (for external use) and internal ones can be great sources of bacterial proliferation.
Menstrual collectors, although generally less irritating, reducing the risk of developing colonies of bacteria, must be washed properly with each emptying.
Predisposition to urinary tract infection
Anyone who has close relatives (mother, father or siblings) who suffer from urinary infections should be aware of the organism itself, as hereditary factors may be among the causes of UTI.
The structure of the urinary canal can also be decisive in facilitating infections. In general, patients with recurrent UTIs may present functional or structural changes, which is one of the causes.
Is urinary infection contagious?
It may be, albeit uncommon, depending on the agent causing the infection. It is worth remembering that bacterial urinary infection is not a sexually transmitted disease and is not able to infect other people (through contact or saliva, for example).
Facilitation of infection by microorganisms can occur during sex, but it will depend a lot on the immunological conditions of each person.
Some factors increase the chances of urinary infections to settle, such as:
Immunity problems : AIDS patients, being treated for chemotherapy or using drugs that reduce the defense system are more susceptible to UTIs;
Genetics : changes in the structure of the urinary canal can facilitate the invasion of microorganisms;
Urinary dysfunctions : problems that prevent the correct emptying of the bladder can cause a higher incidence of infections;
Gender : women are considerably more likely to suffer from UTI due to the anatomy of the urethral canal;
Menopause : with the reduction of estrogen, the female hormone, the vaginal flora can be affected and present changes in the tissue of the vagina and urethra. Thus, bacteria are easier to invade the region;
Some contraceptive methods : diaphragms and spermicides are options to prevent pregnancy, but they can increase the risk of urinary tract infections;
Pregnancy : hormonal changes can cause greater humidity in the vaginal region, favoring the proliferation of bacteria;
Recent urinary tract surgeries : patients undergoing surgical or invasive treatments in the urinary system may have infections;
Use of a catheter : patients who need a catheter for the elimination of urine can be more easily affected by urinary infections;
Sexual intercourse : for women, penetrative sexual intercourse can promote the entry of bacteria into the urethral canal.
Why is UTI more frequent in women?
Among women, the subject is much more common – and experienced – than among men. On average, 50% of women have suffered or will suffer from at least 1 urinary tract infection during their lifetime. Among men, the rate drops to just 10%.
The intensity or frequency of infections can vary widely between women, but there is a determining factor for bacteria to more easily affect the female body: anatomy.
The anus and the entrance of the vagina are very close regions, favoring that the bacteria migrate more easily to the vaginal region. In many cases, they are microorganisms that normally live in the intestine or skin, but that enter and improperly occupy the urinary system.
The urethra – the channel that eliminates urine – is much shorter in women than in men – about 3 times smaller -, making the bacteria have a faster way to the bladder, facilitating infections.
In addition, hormonal changes resulting from menstrual cycles and menopause, reduced immunity and changes in the pelvis region, which occur in pregnant women, help to justify the higher rates of UTI among women.
Urinary tract infection in pregnancy
UTIs can affect up to 20% of pregnant women, occurring at any time during pregnancy, but there is a higher incidence in the final stretch, when the woman enters the 3rd trimester.
The closer to delivery, the greater the chances of infection causing a premature delivery, as the pregnant woman usually has an increase in uterine contractions.
Pregnancy, in itself, does not result in higher risks for urinary infections, but as there are intense changes in the body – changes in hormone rates, immunity and changes in the pelvic region -, bacteria find it easier to affect pregnant women.
Therefore, care with immunity, nutrition and intimate routine, in addition to medical monitoring and attention to the body’s signals are essential to prevent and treat a urinary infection early.
The most classic and frequent symptoms of urinary tract infection are pain, burning in the intimate area and that constant urge to urinate (usually without much to be urinated).
As the patient constantly feels that he needs to pee, the trips to the bathroom increase even without any more consumption of liquids. Along with this, the pain can intensify, affecting the pelvic region (below the navel).
In general, ITU staff can present:
Burning and pain when urinating (dysuria);
Urgency to go to the bathroom;
Change in the color of urine;
Pain in the pelvic region;
Strong smell in the urine;
Urinary incontinence (dripping after peeing);
Presence of blood in the urine (hematuria);
Fever and chills;
Secretions and discharge.
It is still possible for the patient to experience
back pain , fever, severe malaise, nausea and vomiting. However, they are generally more common when UTI worsens, related to pyelonephritis (kidney infection).
Urinary tract infection in babies
Babies can also suffer from urinary tract infections and it can be more difficult to make the diagnosis, as it is not always easy to interpret the signs that manifest themselves.
Generally, the child will experience irritation, frequent crying and agitation, especially when urinating or changing a diaper.
It is important to observe whether the urine has a more pronounced odor, a change in color or, when the child is older, the amount of visits to the bathroom should be analyzed. Vomiting, fever and reduced appetite can also be indicative, and you need to see a doctor.
Urinary tract infection in men
Although the incidence is lower among men, due to the anatomy of the urinary tract, men can also suffer from UTIs.
Generally, it is men over 50 years of age who are most likely to have the infection, as in this stage of life urinary tract dysfunctions can occur (such as an enlarged prostate gland), making it difficult or blocking urine output.
With the accumulation of urine in the bladder, the bacteria find favorable conditions to proliferate.
Symptoms are characteristic of UTI: pain and burning when urinating, pressure in the pelvic area, change in the color and smell of urine and low fever.
As it is less frequent in men, it is possible that the doctor makes a more in-depth assessment of the patient, seeking to rule out possible STDs or changes in the prostate.
How is the diagnosis made?
The most suitable professionals to diagnose and monitor urinary tract infections are the
general practitioner, gynecologist, urologist and nephrologist .
The doctor usually makes a clinical survey of the patient, in which the habits, the frequency of symptoms, the presence of cases in the family are evaluated, in addition to other information that may be pertinent, such as:
Presence of urinary incontinence;
I use antibiotics or medications that can reduce immunity.
After suspicions are raised, urinary tract infection must be confirmed by performing urine and radiological tests.
Examinations for the diagnosis of urinary tract infection help to confirm the diagnosis and identify which bacteria cause it, facilitating the referral of treatment.
Among the most common requests are:
The test is quick and identifies if there are bacteria in the urine, in addition to measuring the number of leukocytes, which are the body’s defense cells (if elevated, it may indicate the presence of infections).
For the test, a urine sample is collected, which should be the first urine of the day. In general, the recommendation is that the first jet be discarded and the rest to be harvested. You should store the material in a refrigerator or take it to the laboratory within 1 hour.
The test is indicated to identify the type of bacteria causing the infection and, thus, to conduct the treatment more adequately.
The procedure is very similar to the urine test, it is recommended to take a urine sample in the morning, discarding the first jet and storing the rest in a container provided by the laboratory or purchased at pharmacies.
In general, the bacteria are grown for a few days (about 3 to 5) in the laboratory, this means that the urine sample is placed in an environment that favors the proliferation of bacteria.
If there is one present in the urine, it will reproduce, being possible to identify it. As it takes more time for the analysis to be completed, the result tends to be a little longer.
Imaging exams are indicated for patients who may have developed some complication due to urinary infection or frequent infections. Among the requested procedures are ultrasound, tomography and radiography with contrast.
Each exam may have different recommendations and different analysis criteria, so it is always necessary to consult the medical recommendations for each procedure.
Is there a cure?
Yes , as long as it is properly treated. It is worth mentioning that each infection is treated, but it is not always possible to prevent new occurrences.
Patients with recurrent or persistent infection should investigate the possible triggers or factors that cause the symptoms and, therefore, treat the cause of the problem, facilitating the process of recovery from the infection.
What is the treatment?
Treatment is done with
that depend on the type of UTI, and can be combined with analgesics to relieve pain and discomfort. The choice of the antibiotic depends on the patient’s specificities (allergies, for example) and the symptoms of the condition. antibiotics
The treatment, in general, lasts between 3 and 7 days, and auxiliary measures can be suggested, for example, patients with chronic diseases may need better control of the pathology to reduce the incidence of urinary infection.
In cases of
uncomplicated cystitis (non-pregnant women, people without chronic diseases or immune weakness), the Guidelines for the Treatment of Urological Infections recommend:
Nitrofurantoin : 500mg per day;
Macrocrystalline nitrofurantoin: 100mg per day;
Trimethoprim + Sulfamethoxazole : up to 200 mg daily or 3 times a week;
Ciprofloxacino : 500mg per day;
Fosfomycin trometamol : 3g for 10 days.
complicated infections , where there is a risk factor for the disease, the Guidelines for the Treatment of Urological Infections recommend:
Ciprofloxacino : 125mg per day;
Norfloxacin : between 200mg and 400mg per day;
Pefloxacin: 800mg per week.
pregnant women , the use of:
Cephalexin : 125mg per day;
Cefaclor : 250mg per day.
To relieve burning and pain, the use of phenazopyridine drugs (which do not act as antibiotics and do not cure urinary tract infection) may be included in the treatment .
That is, the isolated use of analgesics can mask the symptoms and hinder the effective monitoring of the condition. Therefore, they should only be used under medical advice, as soon as UTIs should be treated with the elimination of the bacteria through antibiotics.
Among the medications are: Uropac, Pyrisept , Urovit and Pyridium .
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
During treatment, care and attention to actions that can aggravate the infection must be increased. Even people who have already improved their symptoms should maintain some precautions to avoid recurrence of the infection.
Maintaining a good fluid intake is critical. During the period of infection, the feeling of wanting to go to the bathroom often can be quite uncomfortable, and as a result, many patients further reduce fluid consumption.
However, it is important to maintain adequate consumption so that urine is produced and eliminated from the body, helping to clean the urinary canal.
Go to the bathroom
Make habits of going to the bathroom every 3 hours or less. Often, day-to-day activities disperse attention and can cause that urge to go to the bathroom to be left for later.
As holding the pee for a long time can favor the entry of bacteria into the urethra, creating a routine can greatly ease the condition.
For women, urinating after penetrative sex is a valuable tip. Although simple, the measure helps to greatly reduce cases of urinary tract infection, because the penis facilitates the entry of bacteria into the intimate canal.
Avoid irritating drinks
Drinking plenty of fluids is essential, but not all types of drinks are recommended, as some substances can irritate the bladder, especially those with a lot of caffeine or alcohol. Avoid soft drinks, coffee, black and green or energy teas.
Relieve the pain
The pain can be constant and, in some cases, quite severe. Using hot water bags in the abdominal area, making thermal compresses can help to minimize discomfort.
Respect the schedule of medications
As the treatment is carried out with antibiotics, one of the fundamental points to have effective improvements is to respect the medication schedule.
Antibiotics are generally quite effective for UTIs and show rapid improvement in symptoms, but if treatment is abandoned, the body can become more resistant and hinder the improvement of future infections. Therefore, follow the doctor’s recommendations correctly.
The prognosis of urinary tract infection is generally good, as long as the treatment is carried out correctly.
Patients who present risk factors and, therefore, suffer more frequently from UTIs, generally respond well to treatments and present a decrease in the intensity of symptoms when they identify triggering factors.
Urinary infections, especially when left untreated, can present complications such as recurrent infections, in which even when the treatment is carried out, the bacteria constantly invade the body and show lesser responses to treatment.
Patients with low immunity, chronic diseases, undergoing chemotherapy or with a weakened organism are the most vulnerable to complications.
In general, cystitis that does not receive treatment can worsen for pyelonephritis, affecting the kidneys and progressively worsening. As the infection tends to spread throughout the body, lung dysfunction can also occur.
Studies by the Latin American Institute of
Sepsis indicate that generalized infections (sepsis) resulting from UTIs are less frequent compared to other types, but are still possible.
Even if uncommon, without treatment, urinary tract infection can evolve and reach the bloodstream, causing sepsis, which is a generalized infection.
Recurrent urinary tract infection
Recurrent urinary tract infection is characterized when the patient has 2 or more clinical manifestations of UTI every 6 months or 3 times in a year.
The condition may be the result of a new invasion of bacteria (that is, there has been treatment and cure, but again the body has been invaded) or it may be the result of a poorly treated episode, which has persisted.
Abandoning treatment when symptoms subside is one of the main reasons involved in the return of symptoms, but taking medication at irregular times, consuming alcohol or forgetting certain dosages also interferes with therapy.
According to studies published in the International Journal of Urogynecology, in 2014, on average, 44% of women who have an episode of urinary tract infection will suffer from the return of the condition, that is, a recurrent infection. Of these, about 25% will occur in the first 6 months after the initial diagnosis.
The treatment and maintenance of the routine consists of reducing the agents that facilitate the infection (maintaining hygiene, taking care of immunity, improving the urinary routine, for example) and assessing the need for long-term medications, according to medical advice.
How to prevent?
To prevent the appearance of urinary infections, it is worth maintaining health care in general. It is important to maintain a good fluid intake, as increasing the volume of urine helps to clean the urinary canal and reduces the presence of invading bacteria.
In addition, it is important not to hold the pee and respect the urge to go to the bathroom.
People who have a chronic illness, such as diabetes, or use medications that reduce immunity should undergo medical monitoring and keep their attention on treatment, avoiding risks to the whole organism.
For women, peeing after intercourse with penetration is an easy way to prevent an episode of urinary tract infection, as it helps to clean the canal and prevent the attack of bacteria that have easier entry due to penetration.
Other measures that can be adopted are:
Care for intimate hygiene
Very strong products, frequent use of intimate soaps or intimate showers are facilitators of urinary infections as they can affect the body’s natural defenses.
Spermicides (products to inhibit the movement of sperm) and feminine intimate hygiene (such as intimate soaps) can deregulate vaginal pH and reduce the region’s natural defenses.
Wearing very tight pants, tight fabrics that do not allow the intimate region to breathe, in addition to synthetic fabric panties can favor the onset of infections, as they leave the vagina area very hot and stuffy, creating favorable conditions for bacteria.
In addition, synthetic fabrics – such as polyester, silk and lycra – can irritate the mucosa of the vulva (outside of the vagina), causing itching and discomfort.
The ideal is to opt for light, comfortable fabrics that let the intimate region “breathe”, such as cotton. In addition, it is important to take care with the use of fabric softener, washing powder or other products, as they may contain perfumes or components that irritate the skin.
Beware of misuse of antibiotics
The incorrect use of antibiotics can have very opposite effects to the desired one: instead of fighting bacteria, they can strengthen them, making the next treatment less efficient.
The body is also susceptible to more intense infections, causing complications to occur.
Take care of the food
Probiotic foods (such as plain yogurt and kefir) can be combined with urinary tract health, as they promote the balance of good bacteria in the body, increasing resistance and immunity.
Talk to your doctor
When infections are frequent, medical monitoring and, in some cases, assessing the need to use preventive antibiotic medications is necessary.
Drug intervention before the infection occurs can be indicated when the cases are clearly associated with sexual intercourse (post-coitus infection) or when it is recurrent due to different causes.
In these cases, the doctor may indicate antibiotics for continuous use or that should be taken after sexual intercourse, always according to the professional’s assessment and indication.
Cranberry and urinary tract infection
The small reddish fruit has gained a lot of space in health food stores due to its nutritional characteristics. Rich in vitamin A, C and E, in addition to antioxidants,
cranberry can have positive effects on immunity and skin.
The fruit has long been known for its promises to help fight urinary infections, acting as a bacterium fighter. However, more recent research has not shown significant differences between patients who consumed the food.
The National Institute of Health and Excellence in Care, a British body that evaluated the consumption of cranberry and its effects, pointed out that it can be quite beneficial to the body, due to its nutritional composition, but should not be used as a treatment or preventive of UTIs.
Therefore, it is worth including the fruit in the diet to obtain the benefits of it. As a result, the body is more strengthened against infections, but medical care and recommendations must be maintained.
Read more: Cranberry: indications of consumption
Urinary tract infections are quite uncomfortable conditions, causing pain and discomfort that are often severe to the patient.
Simple day-to-day measures can be adopted to help reduce their incidence, but several factors can still trigger an episode.
Taking care of health and maintaining regular medical appointments is essential to monitor the conditions of the organism.
And to learn more tips on health and well-being, follow the Healthy Minute!