Urinary tract infection

A urinary tract infection (UTI) can be the cause of urinary incontinence. Find out more about the causes and symptoms.

At the onset of the continence problem test the urine to identify if there is an infection as if this is the cause and it is effectively treated the problem could be resolved.

Confirm diagnosis by sending a mid stream specimen of urine (MSU) to the laboratory for culture and sensitivity. The culture will identify the organism causing the infection. The sensitivity will identify which antibiotics are sensitive to the infection.

Did you know? UTIs can affect men and women but the incidence is higher in women because the urethra is short and its opening is close to the back passage/anus.

In women intestinal bacteria are the most common sources of urinary tract infections. Bacteria from the faeces contaminates the vagina and perineum and ascend into the bladder via the short urethra. The most common organism is Escherichia coli. Other organisms include Proteus mirabilis, Klebsiella pneumoniea, Aerobacter aerogenes and Gram-positive cocci.

A UTI can affect any part of the urinary tract. It is the adherence of the bacteria which is the important factor in the development of the infection.

The ‘flushing effect’ of voiding helps to eliminate bacteria and the acidity, osmolality and concentration of urea are mechanisms which work to inhibit bacterial growth and adherence. The bladder mucosa (urothelium) itself has antibacterial properties and destroys bacteria which remain on it’s surface.

Increasing fluids and emptying the bladder effectively also prevent adherence of bacteria.

Causes of urinary tract infection

UTI occurs when bacteria enter the urinary tract through the urethra and begin to multiply in the bladder but why this happens is not fully understood. There are many risk factors:

  • Low fluid intake - concentrated urine which irritates the urothelium
  • Intestinal bacteria coming in contact with the urethra. This can happen as a result of:
    • incorrect wiping after bowel movement
    • soiling/smearing from back passage
    • incorrect removal of continence pads transferring stool to the urethra
  • Incomplete bladder emptying eg from enlarged prostate, constipation/faecal impaction or kidney stones, resulting in residual urine left in bladder after voiding
  • Related to sexual intercourse – vigorous sex, some spermicidal lubricants, some contraceptive diaphragms
  • Following menopause, when oestrogen levels are low, which can cause atrophic vaginitis. This cause is often mis-diagnosed
  • Over-washing the urethral area and damage to delicate mucosa allowing bacteria to breach the surface
  • Using perfumed products around urethral area (talc, shower gel, creams, shampoo) which can destroy the body’s natural healthy bacteria (normal flora)
  • Immunosuppression from a conditions such as diabetes, irritable bowel syndrome or from medical treatments such as cytotoxic drugs and steroids. These can affect the body’s defence against bacteria.
  • Use of urethral catheters (indwelling or intermittent)

Clinical practice note. Only treat symptomatic infections[1].

Symptoms of a lower urinary tract Infection

These include:

  • Frequency and nocturia
  • Sharp pain or discomfort, burning, stinging when voiding
  • Cloudy urine
  • Urgency
  • Unpleasant odour - fishy, ammonia, very strong
  • Haematuria
  • Discomfort/pain in lower abdominal pain or back
  • High temperature, pyrexia
  • Uncontrolled shivering
  • General feeling of being unwell
  • Sometimes nausea and vomiting
  • Confusion and disorientation (especially in older adults)

Repeated UTIs can be difficult to treat and if the infection develops in the upper tract this is more serious and there is a risk of kidney damage.

Clinical practice notes - proactive care:.

Discuss with the individual ‘what are the symptoms of a UTI?’

Discuss with the individual ‘what are the causes of a UTI?’

Support the individual to identify ‘what could have been the causes of their infection’

Support the individual to identify ‘actions they can take to reduce incidence of further UTI’s’


Reference

1. NICE Quality Standard [QS90] Urinary tract infections in adults. June 2015. [Cited 13 August 2018] Available from: https://www.nice.org.uk/guidance/qs90

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Understanding Continence Promotion: Effective Management of Bladder and Bowel Dysfunction in Adults

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