In this month’s Your Questions Answered series we take a look at some of the common urological conditions that people experience.
Mr Leye Ajayi is a Consultant Urological Surgeon at St John & St Elizabeth Hospital, specialising in minimally invasive surgery for urinary tract stone disease, prostate cancer and other conditions of the urinary tract. Here, he describes the causes and symptoms of urinary tract infections, and the various treatments available to both men and women.
A urinary tract infection is a bacterial contamination of the urinary tract, and it’s very common predominantly in females of sexually active age, and also often in women who are postmenopausal. It’s rare for men to get an infection, and if they do it needs investigation. Often the patients present with symptoms of frequently and desperately needing urinate, and occasionally discomfort when they pass urine. In very rare circumstances, if it’s a bad infection, the patient can have quite severe cystitis where they have blood in their urine. In really severe bacterial infections, bacteria can climb up into the kidney causing severe pain and fever.
How do you get a urinary tract infection?
Sexual activity is a predisposing factor in younger women. You also have a different cohort of patients, the postmenopausal women, where, as a result of the lack of oestrogen, the defence mechanism is slightly reduced thereby predisposing them to infection.
There are also causes of infection where the anatomy – or the drainage of the urinary tract – is affected, and that can happen in men as well as women. The kidneys can be formed with a pelviureteric junction obstruction, where the patient is born with a congenital obstruction which can predispose them to an infection because there’s inadequate drainage of that kidney. We often see it in men when there’s poor drainage of the bladder.
Patients who have a large prostate, or an issue with bladder outflow where they have an obstructed prostate, or an obstruction within their urinary tract such as a stricture where the bladder is not empty, can develop stagnant urine in the bladder and that can predispose them to recurrent infection. Stones in the kidney and in the bladder can also be a factor, as often the stones are full of bacteria which can cause a recurrent urinary tract infection.
What is the treatment for UTIs?
The key thing is to find the cause of the infection, because in the vast majority of cases if you can identify and treat the cause you can hopefully prevent it from becoming a recurrent theme.
For women who have been sexually active, often all they require is a therapeutic course of antibiotics for a week. We also encourage them to remain well hydrated at all times and to take a probiotic to help improve their defence mechanism. With the vast majority of patients that is all that is required.
For patients with a congenital obstruction, the patient will likely require a robotic-assisted operation to relieve the obstruction and allow adequate drainage. For patients with stones, you treat them by removing the stones.
With regards to postmenopausal women who have hormone-related issues, some patients go into hormone replacement therapy. Occasionally we offer vaginal oestrogen in the form of a pessary, which is administered into the vaginal area. We often put them on a low dose antibiotic for about three months in combination with a probiotic. We also sometimes provide cranberry tablets because they’ve been proven to be beneficial by affecting the acidity of the urine. We also put them on a low dose of vaginal oestrogen for a short duration of time.
Are there any home remedies for UTIs?
There is a common misconception that cranberry juice is helpful. But the cranberry fruit is very bitter, so imagine the amount of additives and sugar that they put in it to make it sweet. The bacteria in your blood loves the sugars, so it’s best avoided. We recommend pure cranberry extract, which can come in a powder form or in a tablet form.
There are also a number of formulations that are available over the counter from pharmacies that can help alter the acidity of urine to treat infections.
Then there are the things you can do generally to prevent getting a UTI: maintain good hygiene and keep well hydrated at all times. We also know that stress and excessive consumption of alcohol can be a factor in the risk of infections: the acidity of the urine is affected by alcohol while stress affects one’s immune system and can predispose you to infections.
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