Urinary tract infection: know the types, symptoms, treatments and prevention

Usually reported as “that discomfort and burning sensation when urinating”, a urinary tract infection can be summarized as the infection caused by bacteria in the urinary tract.

Many people use the term to describe cystitis (bladder infection), which is very common in women. However, it is important to know that cystitis is an infection only of the bladder (or lower part of the urinary tract), that is, it is a type of urinary infection. The term urinary infection, on the other hand, expresses an infectious condition that can occur in any part of the urinary system (such as kidneys, bladder, urethra and ureters).

Maria Letícia de Azevedo, a nephrologist at Hospital Santa Lúcia and director of the Clinic for Renal Diseases in Brasília (CDRB), explains that urinary tract infection is the presence of pain and burning sensation when urinating, caused by the body’s reaction to the presence of bacteria, viruses or even fungi in the bladder and urinary tract, which are normally sterile”.

Women of reproductive age, according to the nephrologist, are the group with the highest incidence by age group.

The problem deserves a lot of attention. Patrícia de Rossi, a gynecologist and obstetrician at the Conjunto Hospitalar do Mandaqui, in São Paulo (SP), points out that more than half of women will have cystitis throughout their lives, mainly from the beginning of their sexual life.

Types of urinary tract infection and their symptoms

Basically, there are three types of urinary tract infection:

cystitis

This is the most common type. Maria Letícia explains that it happens when the germs are in the bladder and urethra. “The symptoms are burning when urinating, increased urinary frequency. In most cases of cystitis, the infection would be cured even without the use of antibiotics. However, these are indicated as they shorten the duration of symptoms.”

pyelonephritis

According to Maria Letícia, this is when the germs are found in the ureters and kidneys. “In addition to the symptoms of cystitis, there may be fever, body tremors, a feeling of malaise and pain in the back region (where the kidneys are). All cases of pyelonephritis deserve treatment to prevent the infection from spreading through the bloodstream.”

asymptomatic bacteriuria

Patricia highlights this type of urinary infection that happens when there are bacteria in the urine without causing symptoms. “It is relevant in pregnancy as it increases the chance of premature birth and low birth weight babies,” she says.

Causes of urinary infections

Patricia says that the bacteria come from the woman’s own intestinal flora.

A urinary tract infection happens when a bacteria enters the urinary system (through the urethra) and begins to multiply. Normally, the urinary tract is able to expel such foreign organisms, but sometimes this defense fails and bacteria then grow inside the urinary tract, starting an infection.

The causes vary greatly depending on where the infection occurs, but it is possible to cite some factors that show why urinary infections (especially cystitis) are more common in women:

1. Anatomical particularities of women: women have a shorter urethra and are closer to the anus, thus, the anatomical particularities of the female urinary tract already allow them to have more urinary infections.

2. Sexual intercourse: during intercourse, naturally, the vaginal flora changes; and when the body cannot expel foreign organisms, they can travel up the urethra to the bladder and cause infection.

3. Pregnancy: at this stage, bacteria naturally increase. It is worth noting that, in the case of pregnant women, the infection is usually asymptomatic (without symptoms), therefore, it requires a lot of attention from the professional.

4. Menopause: in this phase there is a hormonal drop, in addition, immunity is also low – factors that, together, make the woman more prone to this type of infection.

5. Holding the urine: common in the case of people who do not go to the bathroom for a long time at work or on a trip, for example. The “stopped pee” in the bladder creates the perfect environment for bacteria to thrive.

6. Low consumption of liquids: drinking little water daily is an aggravating factor. The person thus pees less and the “stagnant urine” allows the proliferation of bacteria.

7. Other factors: existence of any calculus in the urinary tract; existence of a vaginal discharge; presence of genital warts that alter the vaginal flora; low immunity (which can occur due to various health problems) are other factors that can favor urinary tract infection.

problem diagnosis

Patricia highlights that the symptoms of cystitis are very characteristic:

• Pain when urinating (dysuria);
• Frequent urge to urinate (pollakiuria);
• Urgent desire to urinate (urinary urgency);
• Pain in the lower abdomen;
• Blood in the urine (hematuria) is seen in some cases;
• As well as foul-smelling urine.

On the other hand, pyelonephritis, according to the gynecologist and obstetrician, has signs of systemic infection, such as:

• Fever;
• malaise;
• Nausea and vomiting.

“This condition is serious and needs medical attention as soon as possible”, recalls Patricia.

The gynecologist explains that, taking into account the symptoms, the tests are auxiliary in the diagnosis and, depending on the case, they can even be dispensed with. “The most commonly used are simple urinalysis and urine culture. In selected cases and in pyelonephritis blood tests are also required,” she says.

Treatments for urinary infections

Patricia explains that the urinary infection should be treated with antibiotics. “There are several drugs and regimens, depending on the characteristics of the patient and the severity of the case. For cystitis, there are from single-dose treatments to seven-day regimens,” she says.

“Analgesics and/or anti-inflammatories are used to control bladder pain and discomfort”, adds the gynecologist.

“A very important guideline is to take the antibiotic for the time prescribed by the doctor, because the improvement of symptoms does not mean that the infection is completely overcome. The interruption can lead to a relapse”, emphasizes Patricia.

Generally speaking, it is generally recommended that a person avoid sexual intercourse for about a week (as the urethra is still injured). And, in addition, to drink plenty of fluids (as soon as she can urinate normally, without pain).

It is worth noting that an acute infection can be treated by any trained professional. In cases of recurrent chronic infections (when they happen 4 or 5 or more times a year), the patient must turn to a specialist doctor who, in turn, will investigate the cause of the problem.

Prognosis

According to Patricia, the chances of a cure are good. “If there is no improvement, you should assess whether the treatment was done correctly. Other possibilities are bacterial resistance to the antibiotic used or some complication,” she says.

It is worth reinforcing the importance of treating the problem, so that complications do not occur. “In the case of cystitis, the risk of not treating it is basically discomfort. But there is a possibility that the infection could spread to the kidneys. In pyelonephritis, the infection can become widespread, cause kidney failure, or severe lung complications. In severe cases, it can even lead to death”, explains the gynecologist.

How to prevent infection and take care of yourself?

The basic guidelines, according to Patrícia, are: drink enough fluids so that the urine comes out clear; urinating after sexual intercourse; perform correct genital hygiene. “If the woman has many episodes of cystitis, the doctor can guide additional measures to prevent infection,” she says.

The main preventive measures can be summarized as follows:

1. Drink enough fluids to make your urine clear;
2. Urinating after sexual intercourse;
3. Perform correct genital hygiene (but not douche);
4. Do not hold the pee for a long time;
5. Avoid underwear that is too tight or that retain heat and moisture;
6. Change pads or diapers (for older women) frequently;
7. Keep immunity high (through physical exercise, good nutrition);
8. See the gynecologist in cases of discharge to treat the problem;
9. In case the urinary infection has already occurred, take the antibiotic correctly as prescribed by the doctor;
10. In the case of repeated infections, look for a specialist doctor to investigate the cause and treat the problem in the best way.

Urinary tract infection in pregnancy

During pregnancy, women are more susceptible to urinary tract infections, especially due to a low immune system and an increase in protein in the urine (which causes greater growth and development of bacteria).

Asymptomatic bacteriuria (when bacteria are detected in the urine test, but the pregnant woman has no symptoms), for example, occurs in 2 to 7% of pregnant women. Acute cystitis occurs in approximately 1 to 2% of pregnant women; and the occurrence of pyelonephritis is 0.5 to 2%.

As in the case of pregnant women, urinary infection is usually asymptomatic, it is essential that the professional who accompanies her is attentive, as a more serious infection can lead to miscarriage or premature birth.

Patrícia reinforces the importance of treating all cases of urinary infection, even without symptoms, using antibiotics that are safe for use in pregnancy.

9 questions about urinary infections clarified

Check out the answers to some common questions related to urinary tract infections:

1. Does sex without a condom cause a urinary tract infection?

“Sex without a condom does not increase the risk of infection. However, sexual intercourse with or without a condom and the use of spermicides increase the risk”, explains Maria Letícia.

2. Is it true that the incidence is higher in pregnant women? Because?

“The incidence is higher in pregnant women, yes. Hormonal and anatomical changes provide a more favorable environment for bacterial multiplication”, explains the nephrologist.

3. Does any burning to urinate mean infection or should I investigate further the causes of the problem?

“Burning when urinating is an important symptom, it can be caused by other diseases such as STDs (urethritis, genital herpes) or candidiasis. But most of the time (90%) it is due to cystitis”, explains Maria Letícia.

In any case, in the case of this symptom, the doctor should always be consulted so that, if necessary, he can better investigate the causes of the problem.

4. Is there any way to relieve the burning to urinate?

The use of antibiotics, anti-inflammatories and some analgesics for the urinary tract (such as “Pyridium”) relieve the burning, according to Maria Letícia.

Any of these medications must be prescribed by the doctor.

5. Is a urinary tract infection contagious?

Maria Letícia highlights that urinary tract infection is not contagious. It is worth remembering that the bacteria is from the person’s own body and is not passed on.

6. Is it normal not to menstruate when you have a urinary tract infection?

According to Maria Letícia, urinary tract infection does not change the cycle…