Urinary Tract Infection

Urinary Tract Infection (UTI) Symptoms, Diagnosis & Treatment

A urinary tract infection (UTI) is when an infection affects the urinary tract. This includes the kidney (pyelonephritis), bladder (cystitis), urethra (urethritis), and prostate (prostatitis) in males.

The urinary tract consists of the upper urinary tract (kidneys, ureter) and the lower urinary tract (bladder, urethra, and prostate in males).

UTIs are a common phenomenon and a frequent complaint seen in many urological clinics worldwide. Urinary tract infections in Singapore are one of the most commonly treated infections in primary care, with around 40% of women developing a UTI at some point in their life. Other susceptible populations include the elderly and patients who require urethral catheterisation.

What causes urinary stones?

There are four broad types of UTIs:

1. Cystitis — infection of the bladder (the most common lower urinary tract infection)
2. Urethritis — infection of the urethra
3. Pyelonephritis — infection of the kidneys
4. Prostatitis — infection of the prostate in men

What are the symptoms of a Urinary Tract Infection?

Typical symptoms of a UTI include:

• Painful urination (also known as dysuria)
• Feeling the urge to urinate more often
• Having a sensation of incomplete bladder emptying after urinating
• Blood in urine
• Cloudy urine
• Foul-smelling urine
• Abdominal pain over the lower half of the abdomen, right above the pelvis, with or without back pain over the areas of the kidneys, just under the ribs
• Fever

If you are experiencing any such symptoms, do seek medical attention. Prompt treatment of UTIs is also important to help prevent the upward spread of the infection to areas such as the kidneys, which can result in more complications.

Medical attention must be sought for the following:

• Children with UTIs
• Patients who are pregnant (even for mild symptoms)
• Individuals with multiple episodes of previous UTIs
• A man with UTI symptoms
• An elderly patient with UTI symptoms

This is essential because UTIs may run a more complicated course in these patients, and further evaluation and treatment are crucial.

How do you know if a UTI has spread to your kidneys?

Signs that indicate the UTI has spread to your kidneys include pain in your back around the areas of your kidneys (to the right or left of the spine), as well as chills, high fever, nausea, vomiting, and exhaustion.

What causes Urinary Tract Infections?

Bacteria do not normally live within the urinary tract! However, if bacteria get into the urinary tract, UTIs can occur. While there are many bacteria that can cause UTIs, the most common type is Escherichia Coli or E. coli, which spreads to the urinary tract readily and easily.

Some factors that increase the risk of bacteria getting into the urinary tract include:

• Not drinking enough water, being dehydrated
• Holding your bladder for prolonged periods of time
• Not keeping the genital area clean and dry (e.g., unhygienic toileting habits such as wiping from back to front – this may transfer bacteria from the anal to vaginal region)
• Having difficulty passing urine (e.g., due to pelvic organ prolapse in postmenopausal women, due to enlarged prostates in men, weakened bladder due to old age, having recently undergone surgery, post vaginal delivery, constipation)
• Conditions that obstruct the normal flow of urine, such as kidney stones, strictures (narrowing/scarring of the ureter or urethra), and cancer
• Indwelling urinary catheters
• Having a weak immune system (e.g., in diabetes)

### Can UTI go away on its own?

Yes, a UTI can go away on its own. However, some infections may linger longer or spread to other parts of the urinary system, such as the kidneys and ureters. Hence, we treat them as early as possible to reduce severe complications.

Can UTIs spread from person to person?

As UTIs are not sexually transmitted infections (STIs), they are not contagious and so one cannot contract them from another individual. Similarly, bacteria that can cause bladder infections are not transmitted from one sexual partner to another. However, as mentioned earlier, it can spread to other organs and cause serious consequences.

How are Urinary Tract Infections diagnosed in Singapore?

UTIs are a clinical diagnosis and, more often than not, can be diagnosed within the same clinic setting. Having a fever or experiencing pain, particularly in the lower abdomen or back in the kidney region or when passing urine or blood in the urine, may hint towards a diagnosis of a UTI.

Some tests may also be done to help confirm a diagnosis and rule out other conditions. This includes urine tests to look out for bacteria in the urine, bladder scans to look out for any issues with passing urine, and a kidney and bladder scan to look out for any growths or stones within the urinary tract which may be obstructing the flow of urine.

What can I expect during my first consultation?

When you meet the doctor, a detailed medical history and physical examination will be carried out to help diagnose a UTI. Some investigations will also be carried out during the consultation to help confirm the diagnosis of a UTI and rule out any abnormalities of the urinary tract. If a UTI is suspected, the doctor will then go through treatment options with you in the same setting and arrange a follow-up appointment with you a few weeks later to review your progress.

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How are Urinary Tract Infections treated in Singapore?

The treatment of a urinary tract infection (UTI) is often broad and aims to address the underlying causes. These include:

• Medical treatment with antibiotics
• Probiotics, which may be helpful in restoring vaginal flora and reducing recurrent UTIs
• Lifestyle measures such as:
  • Drinking at least 1.5-2.5 litres of water a day
  • Passing urine regularly, every 3-4 hours
  • Practising good genital hygiene, including wiping or cleaning from front to back andwashing the genitals thoroughly every day
  • Using lubrication to avoid micro-tears in the vagina during sexual activity
  • Urinating after sexual activity
  • Wearing comfortable undergarments made of cotton
• Treating underlying medical conditions which may lead to UTI, such as:
  • Diabetes – optimal control of blood sugar levels
  • Surgery for pelvic organ prolapse in postmenopausal women
  • Treating vaginal dryness with topical vaginal oestrogen in postmenopausal women
  • Treatment of bladder and kidney stones
• Vaccination against certain bacteria e.g., E. Coli.

What should you not do with a UTI?

It would be best to avoid foods and beverages that may further aggravate your symptoms, such as caffeinated drinks, alcohol, spicy and acidic foods, and artificial sweeteners. It is also not advisable to hold your urine for a prolonged period of time when you are having a UTI.

My doctor told me I have bacteria in my urine – do I need treatment?

Having bacteria in your urine (bacteriuria) may not require treatment, especially if you do not have symptoms of urinary tract infections (asymptomatic). Generally, treatment of asymptomatic bacteriuria is not recommended in the following cases:

• Women without risk factors or post-menopausal
• Elderly individuals who are hospitalised
• Patients with renal transplants
• Patients with a history of recurrent urinary tract infections
• Prior to non-urological surgeries
• Patients with evaluated urinary issues or with indwelling urinary catheters

Summary

UTIs in Singapore are common conditions seen in clinical practice. Here at Assure Urology & Robotic Centre, we offer comprehensive and thorough treatment plans to help deal with a wide range of urological conditions, including UTIs, urinary incontinence, kidney stones, benign prostatic hyperplasia, and more.

To reduce the risk of getting UTIs, make sure that you drink plenty of fluids, keep the genital area clean and dry, promptly change soiled undergarments, and have good control over your medical comorbidities, such as diabetes.

Get the help you need now.

Don’t let uncomfortable symptoms rob you of your peace and leave you in physical discomfort. Early treatment can reduce further risk of complicated disease progression.

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