Who is more prone to urinary tract infections (male, female, age range...)?
It could be said that urinary tract infections are more frequent in women, but more serious in men.
Dr. Patricia Ramirez.
In general, women are more prone to suffer urinary infections, and this is mainly due to the anatomy of women. After all, the urethra of women is much shorter than that of men and this means that the germs that cause urinary tract infections are in our perineal area and in the case of women have very little travel to enter the bladder.
Infections are very frequent in young women who have sexual intercourse, since in these sexual relations there is a transfer of these bacteria that are in our perineal area to the inside of the bladder.
I always tell my patients that there are two circumstances when these bacteria enter the bladder: one in which the germ is in a situation that is not prone to generate an infection, because it is a healthy bladder, with a healthy epithelium, or two, that the bacteria find a bladder where an infection can occur, as may be the case of patients who have repeated urinary tract infections, who are not treated well and who continue to have sexual relations and become reinfected. And what happens? That the protective layer generated by the epithelium becomes impermeable, that is to say, those bridges that join the cells open and favor the passage of those bacteria, they stick, and generate infection. Then we enter a vicious circle, which is what happens many times, with young girls, which I see every day.
What to do in such cases?
Regenerate this urothelium so that it is strong when it comes to defending itself against urinary tract infections.
That is why it is important to see a urologist. Having urinary tract infections can alter your quality of life. Urinary tract infections involve a lot of things: besides having to take so many antibiotics, the pain, the discomfort... you have to realize that you cannot always go to urinate every 5 minutes, and if you do it can lead to an episode of urge incontinence, with the consequent social discomfort...
Young women tend to think that the solution is to take antibiotics over and over again, but that is not the case. Normally the family doctor is consulted, who sees you as a standard, but does not have enough data to offer an adequate treatment, and what is usually done is to prescribe a monurol, which for a punctual and typical urinary tract infection may be valid, but not for the case of a patient who has repeated urinary tract infections.
The other important age peak where we find more cases of urinary tract infections are women with menopause, mainly due to hormonal alterations and vaginal trophism.
In menopause, with the drop of estrogens in the blood, there is a sclerosis of the genital area, vagina and vulvar fork, which produces an imbalance in the bacterial area, as well as an accumulation of secretions, urine...
People with urinary incontinence are also more likely to suffer from infections.
Another incidence group is men over the age of 60, which is when the prostate starts to become irritable. At about this age, the prostate begins to grow and obstruct the ducts, which can lead to urinary tract infections.
And finally, there are those people who due to cognitive impairment, either by age or neurological disease, do not control the sphincters, have different types of incontinence and all this favors infections. In the latter cases, hygienic and dietary measures are especially important.
What causes urinary tract infections in the elderly and what precautions should they take to avoid getting them?
In the elderly we must take extreme hygienic and sanitary precautions. For example, in institutionalized patients there are many urinary tract infections because all patients are given diapers, whether they need them or not, and this is a breeding ground for infections. It can also happen that they spend many hours without changing their diapers, which also generates urinary tract infections.
The vast majority of women over 70 years of age suffer from urinary incontinence, and that favors infections. Because urine has bacteria that remain in the genital area, and because of the use of pads, panty liners, or diapers.
In men, urinary tract infections are also caused by benign prostatic hyperplasia, which is very common after the age of 50.
It is also essential to follow some basic hygienic-dietary rules for prevention, which we will discuss later.
Symptoms of urinary tract infections
- Dysuria, which is the stinging when urinating.
- Increased frequencywhich is urinating many times and with the sensation of not having finished emptying the bladder.
- The hematuria which is bleeding in the urine, and which should make us go to the urologist as soon as possible, because it may be caused by more serious causes than a urinary infection and should always be treated as an alarm sign and should always be evaluated by a urologist, to rule out any other complication.
- The urgency, the irrepressible desire to go to the bathroom as soon as possible and the feeling that you are not going to make it in time.
- Urinary incontinence.
- Nocturia, getting up frequently at night to urinate.
Not always when you have urinary tract infections you have to have all these symptoms, there are people who have mild dysuria and with a high degree of frequency, for example. What is clear is that when a person notices that something is not normal is the time to go to the doctor. It is not necessary to wait to have hematuria to make an appointment with the urologist.
Treatment and advice for urinary tract infections
There is something important to know, because many times we get off to a bad start. My opinion as a urologist is that, except in specific cases, it is essential to perform a culture.
When to cultivate and when not to cultivate?
Not all urinary tract infections require a urine culture. Is it recommended? - Yes, but it is not always necessary.
For example, a healthy patient who has a sporadic urinary tract infection for the first time, or after many years, does not require a urine culture. In that case the urologist may prescribe a monurol (antibiotic), and that patient may not have another infection for another 10 years.
But those patients who have either predisposing risk factors or repeated urinary tract infections, those people must have a culture, because that culture will provide us with a lot of information, we will know how to deal with it, how to control it, whether it will be susceptible in the future to a vaccine or not, what type of germs are present? because having a fungus is not the same as having a bacterium, and a very atypical bacterium is not the same as having a bacterium such as ecoli, which is responsible for more than 90% of urinary tract infections.
Then it is also important to make a good anamnesis. For example, an immunosuppressed patient who suffers a simple cystitis can become complicated and develop into an infection with urinary sepsis, which can be very serious.
In cases of prostatitis, for example, it is advisable to take a culture, since in many cases these patients suffer urinary tract infections, which can also lead to urinary sepsis.
When urinary sepsis occurs, treatment may require hospitalization and intravenous antibiotics.
The fundamental advice and the first recommendation is always to see a specialist. The urologist will be able to tell you if you have a urinary tract infection, what is the bacteria causing the infection and what is the most appropriate treatment.
The most common way to treat a urinary tract infection is the use of antibiotics, but be careful, not all antibiotics work. The first thing the urologist will do is take a culture to determine which bacteria has caused the urinary tract infection and will send you an antibiotic "ad hoc" for your case.
Vaccines are useful, but only in selected cases. Right now vaccines are made personalized, with your culture, that's why they are called autovaccines. Because they are tailored to the bacterium that the patient has. The vaccine is only used when you have already had multiple repeat infections and multiple treatments. It is one more step in the treatment.
It is true that there are people who are phenomenal after the vaccine, and there are people who do not do well with this type of treatment.
It usually works well for people who have repeated urinary tract infections caused by the same bacteria, for example, e-coli. But the person who has an e-coli today, tomorrow a candida, the next day an elicobacter... These people do not do well, because the vaccine is prepared on the basis of a culture with a result.
In short, if the treatment is carried out according to the urologist's recommendations, the cure rate is 99% of the cases.
Preventive measures to avoid urinary tract infections:
Prevention is based mainly on hygienic-dietary measures.
Hygiene:
- Avoid urine retention.
- Drink plenty of fluids.
- Avoid cold and humidity.
- Apply local heat.
- Ensure careful perineal hygiene, especially prior to sexual intercourse and during the menstrual period.
- Avoid constipation.
- Consumption of drugs that hinder bacterial adherence to the bladder wall.
How to detect urinary tract infections in seniors with other diseases such as Alzheimer's disease
The problem of people suffering from Alzheimer's disease and any other neurodegenerative disease is that they often have episodes of urinary incontinence, which as we already know favors the appearance of infections, and also, in most cases they do not warn that they have suffered these losses and can spend many hours with the genital area dirty and wet, which is a breeding ground for urinary infections.
In these cases, my recommendation for caregivers is to take extreme hygienic measures. It is essential that the patient showers every day, even if it is complicated, and change the diaper or underwear when urinary or fecal leakage occurs. In these cases, they can be given food supplements that favor prevention in a chronic way.
To detect possible infections we will have to be aware of how many times they urinate, if they urinate very frequently, if they have pain or stinging when urinating, if they have blood in the urine, and above all if all these symptoms are associated with fever.
There are other diseases in which there is a greater propensity to suffer urinary tract infections, for example in the case of diabetic patients, where diabetes must be strictly controlled to avoid the appearance of infections.
Diabetic patients do not process glucose, therefore those sugars are expelled in the urine, so the urine of diabetic patients is sugary, it is sweet. A sugary urine is a breeding ground for bacteria, which feed on glucose, so the worse the diabetes is controlled, the more likely you are to suffer urinary tract infections.
We see many patients who come with glycosylated hemoglobin, which is the marker of diabetes control in altered values. Glycosylated hemoglobin is a parameter that is extracted with a blood test and determines the glycemic control in recent months, it is a long-term pattern. Therefore, it gives us many clues as to whether the patient is truly controlling his disease, because it cannot be tricked by "behaving well" in the last few days.
For this reason, the first treatment for a diabetic person is to better treat his or her disease.
How to know if it is just another urinary tract infection or if it could be something more serious: repetition, duration...
There are two types of infections: complicated and uncomplicated. The uncomplicated infection can be summarized as: young, healthy girl, without pathologies, without structural or anatomical defects, not pregnant...
Anything beyond that is a complicated urinary tract infection. For example, a prostatitis is a complicated urinary tract infection, a pyelonephritis is a complicated urinary tract infection, an infection in a pregnant woman is considered a complicated urinary tract infection....
The fact that it is complicated does not mean that it requires hospitalization, but it is advisable not to delay treatment and to go to the urologist or gynecologist as soon as possible if you are a pregnant woman.
In the case of pregnant women it is important because an untreated urinary tract infection can lead to pre-term deliveries, infections that pass to the fetus... it has many complications.
All infections of the parenchyma, which is the tissue surrounding the organs, are considered serious. Pyelonephritis in the kidney parenchyma, and prostatitis in the case of the prostate parenchyma, for example, can cause the infection to pass into the blood, because they are vascularized organs. When the bacteria pass into the blood it is known as bacteremia, and bacteremia already causes fever. Therefore, whenever we have a urinary tract infection associated with fever, it is mandatory to go to the emergency room or be evaluated by a urologist because there is a risk of urinary sepsis.
Another symptom to take into account is hematuria. Blood in the urine means an advanced infection, and in addition, it may also be due to other more serious diseases, so it is necessary to see a urologist. Blood in the urine should always be taken as a warning sign.
In the case of Benign Prostatic Hyperplasia, what causes it and can it be treated?
Benign Prostatic Hyperplasia is the non-malignant growth of the prostate; and it is quite frequent after the age of 50.
The prostate has several parts, the one that causes Benign Prostatic Hyperplasia is the prostate adenoma, which is inside the prostate.
For example, in a tangerine, the skin would be the prostate capsule, and the segments would be the adenoma. As the adenoma grows, it obstructs the center, the urine outflow channel, and this means that the narrower it is, the more effort the bladder has to make to empty itself.
When an obstruction is evolved, it normally presents with straining bladders. With time it reaches a point where it begins to give way in that effort, and that is when postvoid urine begins to be generated, which is urine retained inside the bladder. And that waste is a breeding ground for urinary tract infections.
The cause of Benign Prostatic Hyperplasia? - Age and testosterone.
The prostate is an organ that has a natural tendency to grow, but it is true that not all prostate growth generates obstruction. There are very large prostates, which are not obstructive at all, and very small prostates that are obstructive. It depends on the anatomy and how they grow towards the center of the urethra. There are prostates that grow outwards and these do not obstruct anything, the ones that generate the obstruction are the ones that grow inwards.
Benign prostatic hyperplasia can be treated. Initially, the first therapeutic step is always pharmacological treatment. In cases where pharmacological treatment is refractory, we would move on to surgical treatment, which would always be adapted to the patient and his prostate.
IMPORTANT FACTS ABOUT URINARY TRACT INFECTIONS
- 90% of infections are caused by E-COLI.
- For an infection to be considered recurrent, it must occur two or more times in 6 months or three times in a year.
- 50% of women will experience cystitis in their lifetime.
- According to a report by the Cystitis Information Center, one in four women suffers an episode of cystitis each year.
Remember the most important thing. If you are suffering from a urinary tract infection, get in the hands of your urologist. We are here to provide the best treatment and improve your quality of life.
