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Urinary Tract Infection

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of urinary infections.

Other Treatments

The following are hygiene tips, although it should be noted that there is no evidence that good hygiene makes any difference in preventing UTIs. It is always a wise practice, but women should not rely on it for protection from infection.

  • Cleanse the genital and urinary areas from front to back with soap and water after each bowel movement.
  • Keep the genital and anal areas clean before and after sex. Urinate before and after intercourse to empty the bladder and cleanse the urethra of bacteria.
  • Avoid tight-fitting pants.
  • Wear cotton-crotch underwear and panty hose, changing both at least once a day. (Mild detergents are best for washing underwear.)
  • Take showers rather than baths.
  • Avoid bath oils, feminine hygiene sprays, douches, and powders. In fact, as a general rule, any product containing perfumes or other possible allergens should not be used near the genital area. Note: Douching in any case is never recommended. It may destroy the natural antiviral agents normally present in the vagina, making women more susceptible to human papillomavirus (HVP), a risk factor for cervical cancer.
  • Choose sanitary napkins instead of tampons (which some physicians believe encourage infection). Napkins and tampons, in any case, should be changed after each urination.
  • Urinate frequently.
Prevention of cystitis
Appropriate hygiene and cleanliness of the genital area may help reduce the chances of introducing bacteria through the urethra. Females are especially vulnerable to this, because the urethra is in close proximity to the rectum. The genitals should be cleaned and wiped from front to back to reduce the chance of dragging E. coli bacteria from the rectal area to the urethra.

Sexual Precautions

The following recommendations may reduce the risks from sexual activity:

  • In women using contraceptives, consider alternatives, particularly if exposed to spermicides from condoms or diaphragms. Discuss the best contraceptive choice with a physician.
  • Avoid sex with multiple partners. This can cause many psychological and health problems, including sexually transmitted diseases and UTIs.

Estrogen Cream or Estrogen-Releasing Vaginal Devices

Postmenopausal women with recurrent UTIs may consider the use of an estrogen vaginal cream or estrogen-releasing vaginal ring (Estring). Estrogen may resist infection by increasing the number of lactobacilli, the microorganism that fights infection by lowering the vaginal pH levels and preventing E. coli from adhering to vaginal cells. Estrogen creams and estrogen-releasing rings have been associated with a lower incidence of recurring urinary tract infections than women not using such topical estrogens. A 2003 study indicated however, that the estrogen ring had no effect on lactobacilli and less effective than the standard preventive antibiotic regimen. Oral hormone replacement therapies, which contain estrogen, do not seem to provide the same benefit as the topical forms, and in any case are proving to have health risks, including an increased risk for breast cancer and heart disease. Evidence is lacking about whether vaginal forms of estrogen have not been associated with these risks.

Fluids

Many physicians believe that emptying the bladder frequently will help prevent bladder irritation and therefore recommend drinking plenty of water daily and urinating often.

Cranberries, Blueberries, and Lignonberries

Cranberries, blueberries, and lignonberry, a European relative of the cranberry, are three fruits that may have protective properties. Researchers are finding that red pigments in these closely related fruits called tannins (or proanthocyanadins) prevent E. coli bacteria from adhering to cells in the urinary tract, thereby inhibiting infection. Fructose, which is commonly used to sweeten fruit juices, may also interfere with bacterial adhesion.

Cranberry juice offers well-known protection against urinary tract infections. In one study, only 15% of elderly women who drank cranberry juice daily for six months experienced UTIs, compared with 28% of women who did not drink the juice. Its effects were stronger in helping the body rid itself of infections than in preventing them in the first place, but it showed benefits in both situations.

Studies have suggested that for protection, it is necessary to drink at least one to two cups of 30% cranberry or lignonberry juice daily, or to take at least 300 mg to 400 mg in tablet form twice daily.

Probiotics, Lactobacilli, and Fermented Milk Products

Important research has targeted probiotics (essentially friendly organisms), which may protect against infections in the genital and urinary tracts. They may have other health benefits as well, including important ones in children. The most well-known probiotics are the lactobacilli strains, such as acidophilus, which is found in yogurt and other fermented milk products (e.g., kefir). The probiotics bifidobacteria and GG lactobacilli may prove to be even more important. Other probiotics include the lactobacilli rhamnosus, casel, plantarium, bulgaricus, and salivarius, and also Enterococcus faecium and Streptococcus thermophilus.

Lactobacilli have the potential to help protect women from UTIs in a number of ways:

  • Maintain a low pH environment.
  • Hinder E. coli growth.
  • Produce hydrogen peroxide, which produces an environment hostile for bacteria.

In one 2003 study drinking fermented milk reduced the risk for UTIs. Not all studies show benefits from drinks containing lactobacilli, but more research is warranted.

Investigative Protective Measures

Escherichia Coli 83972. A strain of E. coli called 83972 is being investigated because it can grow in the urinary tract without causing infection, crowding out other potentially harmful bacteria. Some research suggests that it may be protective in certain individuals, including those with spinal cord injuries or urinary catheters.

Vaccines. Vaccines are being developed against urinary tract infections. There is some urgency in the need for such vaccines, as bacterial strains resistant to many common antibiotics are becoming increasingly prevalent. The Urovac vaccine, for example, is an immune-boosting vaginal suppository made from 10 heat-killed strains of common UTI-causing bacteria. In early trials, 55% of the women who received the vaccine plus booster doses remained free of recurrences at six months, compared to 22% who got a dummy vaccine or the vaccine without boosters. None had serious side effects. Investigators are also testing a vaccine that prevents E. coli from attaching to the lining of the bladder.

Circumcision in Infant Males

Although there is some controversy over whether circumcision helps prevent UTIs in boys, a 2000 analysis of nearly 15,000 male infants born in 1996 reported that the uncircumcised boys under one years old had nine times the risk for UTIs as circumcised boys. (The risk is still very low, in any case.)

Circumcised vs. uncircumcised Click the icon to see an image of a circumcised penis in comparison to an uncircumcised penis.

Biofeedback in Children

Some research indicates that in children who are prone to UTIs because of problems related to urine voiding, teaching them to relax and control their pelvic muscles using biofeedback, a technique that provides visual and auditory clues in response to specific exercises, results in fewer recurrences of infection.

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