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Urinary Tract Infections
Sid Cu, Gabby Decano, Bailey Gansert, Sofia Johnson, Katelynn Le, Shyanna Perez, and Iohanne Paula San Diego
School of Nursing
San Diego State University
NURS208: Pathophysiology
Professor Lisa Concilio
November 18, 2020
What is a
Urinary tract infection?
What is a Urinary Tract Infection?
A urinary tract infection, also commonly known as a UTI, is an
infection of any part of the lower or upper urinary tract
(Sorenson et al., 2019).
Introduction
This includes the:
Urethra
Bladder
Ureters
Kidneys
(Centers for Disease Control and Prevention, 2019)
The Urinary System
What is the Urinary System?
Figure 1. Urinary System
The urinary system is the body's way of filtering and removing water and wastes.
The kidney's job is to filter wastes from the blood, produce hormones, regulate blood pressure, and balance many of the chemicals in the body. Urine is produced by the kidneys and brought to the bladder by the ureters. The bladder stores the urine and the urethra allows the urine to pass to the outside of the body.
Urine should be STERILE, but this system can become infected and compromised.
(Urology Care Foundation, 2020)
Figure 2. Urinary Tract Infection
Note. From Urinary Tract Infection [Image], n.d., Health Jade Team. https://healthjade.net/urinary-tract-infection/#Urinary_tract_infection_causes
What Causes UTIs?
ETiology
UTIs are caused when bacteria enter the urinary tract through the urethra.
- E. coli causes 80% of infections.
- Staphylococcus saprophyticus causes 10-15%.
(Nunez, 2020)
Figure 3. Woman
Women!
Women are 14 times more likely to get UTIs than men.
Figure 4. Woman
Who is at Risk
Figure 5. Woman
This is due to the close proximity of the urethra to the vagina and anus.
(Mayo Clinic, 2020b)
Risk Factors
Other risk factors
Factors specific to Women
Risk Factors
- Female anatomy
- Sexual activity
- Types of birth control
- Pregnancy
- Menopause
- Catheters
- Diabetes
- Poor hygiene
- Blocked flow of urine
- Suppressed immune system
(Mayo Clinic, 2020b)
Pathophysiology
Figure 6. E. coli
Pathophysiology
Normally E. coli lives in the gut and feces. For many reasons it can reach the urethra, where it does NOT belong.
S. saprophyticus is normally found in the female genital tract. If bacteria gets into the urethra and is not completely flushed out, it can start to grow and multiply.
This provokes an immune response in the urinary tract, leading to inflammation.
(Sorenson et al., 2019)
Urethritis
Men
Women
Figure 8. Urethritis in Women
Figure 7. Urethritis in Men
Urethritis
Urethritis is an infection of the urethra, which is the small tube that allows urine to pass from the bladder to the outside of the body.
This is considered the 1st phase of a UTI (Sorenson et al., 2019).
This lower urinary tract infection can be caused by E. coli, or other bacteria, but it is also commonly caused by sexually transmitted infections such as gonorrhea or chlamydia (Mayo Clinic, 2020b).
Note. From Urethritis in Women [Image], 2020, Mount Nittany Health. https://www.mountnittany.org/articles/healthsheets/12302
Note. From Urethritis in Men [Image], 2020, Mount Nittany Health. https://www.mountnittany.org/articles/healthsheets/12300
Cystitis
Figure 9. Cystitis
Cystitis
Cystitis is an inflammation of the bladder usually caused by an infection. This happens as bacteria moves further up the urinary tract. This is commonly known as a bladder infection (Centers for Disease Control and Prevention, 2019).
Most cases are acute, but complicated cases can occur in people with poor immune systems (Sorenson et al., 2019).
Note. From Cystitis [Image], 2017, Nurseslabs. https://nurseslabs.com/cystitis/
Figure 10. Prostatitis
enlarged Prostate
Although UTIs are more common in women, they can still occur in men. The cause is usually an enlarged prostate. This sits around the bottom of the bladder and can pinch off the urethra, obstructing the flow of urine. Bacteria cannot get out and will cause an infection of the bladder. This can even lead to prostatitis which is an infection of the prostate.
(Pendick, 2019).
Note. From Prostatitis [Image], 2019, AAUrology. https://www.urologyhealth.org/urology-a-z/u/urinary-tract-infections-in-adults
Bladder Cancer
The more chronic cases of cystitis, the more the cells of the bladder are damaged.
Over time this can lead to bladder cancer.
The further the bacteria travel up the urinary tract, the more DANGEROUS the infection becomes.
(Mayo Clinic, 2020a)
Pyelonephritis
An infection that affects the upper urinary tract which includes the following...
- ureters
- kidneys
Pyelonephritis
Figure 11. Urinary tract infection
Note. Urinary Tract Infection, n.d., Health Jade https://healthjade.net/urinary-tract-infection/#Urinary_tract_infection_causes
(Sorenson et al., 2019)
Acute pyelonephritis
Acute
This occurs a day or two after the urethra becomes infected by E. coli. E. coli will then travel and infect in an upwards direction from the bladder, through the ureter, and to the kidney.
The body tries to fight off the bacteria. This immune response scars the kidneys. This scarring can damage the structure and function of the kidney.
(Sommers, 2019a)
Chronic pyelonephritis
Chronic
Figure 12. Kidney stone
Figure 13. Catheter
Obstructions, like kidney stones and medical instruments, can block normal urine flow. As a result, urine flow can abnormally backflow from the bladder and upwards to the kidneys.
If the infection from this abnormal urine flow fails to go away, this results in even more inflammation and kidney scarring. Ultimately, the kidney may fail in producing enough urine, resulting in chronic renal failure.
(Sorenson et al., 2019)
Check out this video
UTIS Explained
Lee Health (Producer). (2016, July 24). Urinary tract infection causes [Video]. Youtube. https://youtu.be/IHEYX5LxkA8
General signs and symptoms
CLINICAL
MANIFESTATIONS
Most common symptoms include:
- frequent urination
- pain or burning when urinating
- feelings of urgency to urinate
- blood present in the urine
Figure 14. Urinary Tract
(Sommers, 2019b)
Upper UTI - Kidneys (pyelonephritis)
Upper UTI
Patients may experience chills, fever, nausea, vomiting, or pain and tenderness in the upper back and sides. This may be indicative of an upper UTI, an infection in the kidneys.
Figure 15. UTI Symptoms
(Lights, 2020)
Lower UTI - bladder and Urethra (cystitis and urethritis)
Lower UTI
signs and symptoms found in urine of lower uti
signs and symptoms in urine
With lower UTIs, the patient will notice the signs especially in their urine. If the urine is discolored, like a dark brown color (similar to cola or tea) or a red color (due to blood), an infection in the bladder may be present. Another sign of infection includes cloudy and smelly urine.
Figure 16. Urine
(Lights, 2020)
physical signs and symptoms of lower uti
Physical signs and symptoms
Besides the symptoms evident in the appearance of urine, the patient may also notice an increased urge to urinate more often despite urinating little amounts, feel a burning sensation when urinating, and may even feel pain. Men may experience pain in the rectal area while women feel pain in the pelvic area.
Figure 18. Rectal Pain
Figure 17. Pelvic Pain
Rectal pain
Pelvic pain
(Lights, 2020)
Treatments
Treatments
ANTIBIOTICS
Antibiotics are used to kill the bacteria or prevent recurrent UTIs and UTIs caused by sex. Antibiotic therapy ranges from 3 days to 1 year.
Monurol
Macrobid
Bactrim
Rocephin
(fosfomycin)
(nitrofurantoin)
(trimethoprim/sulfamethoxazole)
Antibiotics
(ceftriaxone)
Figure 20. Monurol
Figure 22. Ceftriaxone
Figure 21. Macrobid
Figure 19. Bactrim
Note. From Bactrim DS 800mg-160 mg tablet, n.d., WebMD https://www.webmd.com/drugs/2/drug-5530/bactrim-ds-oral/details
Note. Monurol 3 gram oral packet, n.d., WebMD https://www.webmd.com/drugs/2/drug-419/monurol-oral/details
Note. Macrobid 100 mg capsule, n.d., WebMD https://www.webmd.com/drugs/2/drug-14376/macrobid-oral/details
Note. Ceftriaxone 500 mg solution for injection, n.d., WebMD https://www.webmd.com/drugs/2/drug-7013/ceftriaxone-injection/details
- for acute cystitis
- for UTI prevention
- can be given orally or by IV (by vein)
- for acute cystitis
- for UTI prevention
- given orally
- for acute cystitis
- for UTI prevention
- Given orally
- for most types of UTIs
- injected into a muscle or given by IV
(Quiring et al., 2020c)
(Quiring et al., 2020e)
(Quiring et al., 2020a)
(Quiring et al., 2020b)
The antibiotic prescribed is mainly based on the type of bacteria collected from a urine sample and the type of UTI.
(Mayo Clinic, 2020b; Wagenlehner & Naber, n.d.)
Pain Medications or Analgesics
These are prescribed with antibiotics to manage discomfort in the abdomen and lower back area and relieve burning sensations during urination.
Pain Medications
Examples: Tylenol and Pyridium
(phenazopyridine)
This drug directly alleviates pain in the urinary system
(Quiring et al., 2020d)
Heating pads can also be used to reduce pain.
(Mayo Clinic, 2020b)
Figure 23. Heating Pad
Increasing Water Intake
Figure 24. Water Bottle
Fluids
Drinking more water will increase urination, which helps to flush out the infectious bacteria. However, this alone will not treat the UTI.
(Sommers, 2019)
Estrogen Replacement
Postmenopausal women are at a higher risk for UTIs, which may be due to having lower levels of estrogen (a regulatory sex hormone or chemical).
Figure 25. Estrogen Cream
Estrogen
Vaginal creams containing estrogen may help to prevent harmful bacterial growth in the vagina and urethra.
(Jhang & Kuo, 2017)
How Can UTIs be Prevented?
Preventions
Drink Plenty of Water!
Figure 26. Water
Water!
- It is important to drink lots of water and liquids to dilute your urine.
- It also helps to urinate more to flush bacteria out of your urinary tract before a UTI begins.
- Although not proven, cranberry juice with no sugar and cranberry supplements may prevent UTIs.
(Mayo Clinic, 2020b)
Bathroom Methods
Figure 27. Toilet Paper
Bathroom
Methods
- Wipe front to back! It is important to do so after urination or pooping to prevent bacteria from entering the urethra.
- Urinate before and after sex! It's recommended to urinate after sex to help flush bacteria out.
(Mayo Clinic, 2020b)
Avoid Irritating Feminine Products
Feminine
Products
- Avoid scented feminine products such as douches, scented pads/tampons, powders, deodorant sprays, bath oils, soaps, etc.
- Irritating feminine products disrupt the pH balance of the vagina and allow expanded growth of harmful bacteria.
(Nunez, 2020)
Explore Different Birth Control Options
Figure 28. Doctor
Birth Control Methods
- Some birth control methods such as diaphragms and non-lubricated condoms can promote growth of harmful bacteria (Nunez, 2020).
- If you think your birth control is causing UTIs, talk to your provider as they can discuss different birth control methods with you.
Knowing which signs and symptoms to look out for and when to call your primary healthcare provider are important in preventing and managing UTIs.
Figure 29: Doctor's Appointment
If you experience any of the following please talk to your primary physician immediately:
Conclusion
- Burning sensation when peeing
- Dark brown, pink, or red color in urine
- Feeling like you have to pee more despite peeing little
If diagnosed with a UTI, adhere to the treatment plan and preventative measures.