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<div class="noeditbox">Welcome to "[http://www.physio-pedia.com/Pathophysiology_of_Complex_Patient_Problems Pathophysiology of Complex Patient Problems]" PT 635 Pathophysiology of Complex Patient Problems. &nbsp;This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div><div class="editorbox">
<div class="editorbox"> '''Original Editor '''- [[User:User Name|Elaine Lonnemann]], [[User:User Name|Kaylee Whitehead]], [[User:User Name|Melanie Anderson]]
'''Original Editors '''- [http://www.physio-pedia.com/User:Elaine_Lonnemann Dr. Elaine Lonnemann],&nbsp;[http://www.physio-pedia.com/User:Kaylee_Whitehead Kaylee Whitehead],&nbsp;[http://www.physio-pedia.com/User:Melanie_Anderson Melanie Anderson]
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>
== Introduction ==
[[File:Urinary Tract Infection (UTI).png|thumb|Symptoms UTI]]
A urinary tract [[Infectious Disease|infection]] is an infection in any part of your urinary system, which includes the bladder, urethra, ureters (urine tubes) and [[Kidney|kidneys]]. If untreated, UTIs can lead to kidney infection which can be very serious. UTIs are caused by microbes, mainly [[Bacterial Infections|bacteria]], but also [[Fungal Diseases|fungi]] and [[Viral Infections|viruses]]<ref name="Rose">Rosenblum, N. Recurrent Urinary Tract Infections. Urology. Available at: http://www.med.nyu.edu/urology/patient-care-information/conditions-we-treat/recurrent-urinary-tract-infections</ref>.


'''Top Contributors''' - [http://www.physio-pedia.com/User:Kaylee_Whitehead Kaylee Whitehead], [http://www.physio-pedia.com/User:Melanie_Anderson Melanie Anderson] &nbsp;&nbsp;
Normally, bacteria that enters the urinary tract is rapidly removed by the body before symptoms are present, but sometimes this bacteria overcomes the natural defences of the body, resulting in an infection. This infection may involve the lower urinary tract only, or both the lower and upper urinary tracts<ref name="Rowe" />. The upper urinary tract is made up of the kidneys and the ureters, while the lower urinary tract is made up of the bladder and urethra <ref name="Rowe" />.&nbsp;&nbsp;
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== Definition/Description<br>  ==
== Types of urinary tract infections (UTIs) ==
[[Image:UpperLowerUrinaryTract.jpeg|border|200x200px|Upper and Lower Urinary Tract|right]]The different types of UTI can include:


[[Image:UpperLowerUrinaryTract.jpeg|border|left|200x200px|Upper and Lower Urinary Tract]]A Urinary Tract Infection (UTI,) is defined as an infection in the lining of the urinary tract caused by microbes, mainly bacteria, but also fungi and viruses <ref name="Rose" />. <br><br>Normally, bacteria that enters the urinary tract is rapidly removed by the body before symptoms are present, but sometimes this bacteria overcomes the natural defenses of the body, resulting in an infection. This infection may involve the lower urinary tract only, or both the lower and upper urinary tracts <ref name="Rowe" />. The upper urinary tract is made up of the kidneys and the ureters, while the lower urinary tract is made up of the bladder and urethra <ref name="Rowe" />.&nbsp;&nbsp;
* Urethritis – infection of the urethra
* Cystitis – infection of the bladder
* Pyelonephritis – infection of the kidneys
* Vaginitis – infection of the vagina.<ref name=":0">Better Health UTIs Available:https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/urinary-tract-infections-uti (accessed 13.5.2022)</ref>


<br>
=== Etiology ===
 
Pathogenic bacteria ascend from the perineum, causing the UTI.   
<br>
 
<br>
 
Infections of the urinary tract can be subdivided into two classifications <ref name="Goodman">Goodman CC, Snyder TE. Differential Diagnosis for Physical Therapists, Screening for Referral. 5th ed. St. Louis, MO: Elsevier/Saunders; 2012.</ref>'''.'''
 
'''Upper Urinary Tract Infections:'''
 
*Renal infections
*Acute of chronic glomerulonephritis&nbsp;
*Renal papillary necrosis
*Renal tuberculosis
 
'''Lower Urinary Tract Infections:'''
 
*Cystitis
*Urethritis<br>
 
== Prevalence  ==
 
An estimated 150 million UTIs occur every year world-wide, adding to $6 billion in health care costs <ref name="Pontari" />.&nbsp;<br>
 
[[Image:Bladder.png|border|right|250x250px|Anatomy of Male and Female Bladder]]
 
Across all age groups, the&nbsp;incidence of UTI is higher in women than men, with the lifetime risk greater than 50% for women <ref name="Rowe" />.&nbsp; Women are&nbsp;especially prone due to anatomical reasons: the uretha is shorter allowing bacteria quicker access to the bladder and the urethral opening is near bacteria sources, such as the anus and vagina <ref name="Urinary" />.&nbsp;<br>
 
UTI is frequent in young and sexually active women with reported incidence rates ranging from 50-70% per person per year <ref name="Rowe" />.&nbsp; Pregnancy does not show an increased risk compared to typical women, but a UTI is more likely to travel to the kidneys in pregnant women due to hormonal and positional changes <ref name="Urinary" />.
 
UTI is one of the most commonly diagnosed infections in older adults and the most frequently diagnosed infection in long-term care residents, with over 10% of women over 65 years old reported having a UTI within the past 12 months <ref name="Rowe" />.<br><br>
 
== Characteristics/Clinical Presentation  ==
 
When a patient presents with both clinical features and laboratory evidence of a urinary infection, a symptomatic UTI diagnosis can be made. Patients presenting with '''two''' of the following meet the diagnostic criteria for a symptomatic UTI <ref name="Mody" />:<br>
 
*Worsened urinary urgency or frequency
*Acute dysuria
*Suprapubic tenderness
*Costovertebral angle pain or tenderness
*Fever<br>
 
<br>
 
Additional signs and symptoms include the following <ref name="Rose" /> <ref name="Goodman" />:&nbsp;
 
[[Image:FlankPain.jpeg|border|right|200x200px|Flank Pain]]
 
*Nausea and vomiting
*Urinary frequency<br>
*Urinary urgency<br>
*Flank pain<br>
 
*Malaise<br>
*Muscle aches
*Pelvic/lower abdominal pain<br>
*Ipsilateral shoulder pain
*Pyuria
*Bacteriuria
*Low back pain<br>
 
== Associated Co-morbidities ==
 
Conditions or diseases that can be associated with UTIs include the following <ref name="Urinary" />:<br>
 
*Diabetes Mellitus<br>
*Hypertension<br>
*Kidney stones<br>
*Bowel incotinence<br>
*Prostratic obstruction<br>
*Immunological disorders
*Spinal cord injuries
*Congenitial urinary tract anomalies<br>&nbsp;&nbsp;&nbsp;


Other risk factors include <ref name="Goodman" />:<br>  
* Women have shorter urethras than men and therefore are far more susceptible to UTI.
* A major risk factor for UTI is catheter use. Sexual intercourse and the use of spermicides and diaphragms are also risk factors for UTI. Frequent [[Pelvic Floor Dysfunction - A patient guide.|pelvic]] exams and the presence of anatomical abnormalities of the urinary tract can also predispose one to a UTI.
* UTIs are very common after a kidney transplant.  The two triggers include the use of [[Immunotherapy|immunosuppressive]] drugs and vesicoureteral reflux. Other risk factors include the use of [[antibiotics]] and [[Diabetes|diabetes mellitus]]<ref name=":1">Bono MJ, Reygaert WC. Urinary tract infection. InStatPearls [Internet] 2021 Jun 23. StatPearls Publishing. Available:https://www.ncbi.nlm.nih.gov/books/NBK470195/ (accessed 13.5.2022)</ref>.


*Urinary catheterization<br>
=== Epidemiology ===
*Residency in a nursing home or hospitalization<br>
[[Image:Bladder.png|border|right|250x250px|Anatomy of Male and Female Bladder]]An estimated 150 million UTIs occur every year world-wide, adding to $6 billion in health care costs <ref name="Pontari">M, Pontari. Adult UTI. Advancing Urology. Available at: www.auanet.org/education/adult-uti.cfm</ref>.&nbsp;
*Immobility<br>
*Previous urologic surgery<br>
*Obstructive urinary tract problems<br>  
*Gout<br>
*Hypertension<br>
*Sexual Activity<br>


<br>Urinary catheterization interferes with the body's ability to clear microbes from the urinary tract, therefore, increasing the risk for bacteria; to reduce the risk of a UTI, the Infectious Diseases Society of America recommends using catheters for the shortest time possible <ref name="Urinary" />.<br><br>
* Urinary tract infections are very frequent bacterial infections in women.
* Usually occur between the ages of 16 and 35 years, with 10% of women getting an infection yearly and more than 40% to 60% having an infection at least once in their lives.
* Recurrences are common, with nearly half getting a second infection within a year.
* Urinary tract infections occur at least four times more frequently in females than males<ref name=":1" /><br>


== Medications  ==
== Characteristics/Clinical Presentation ==
Some of the symptoms of UTIs include:


&nbsp;&nbsp;&nbsp;&nbsp; The type of bacteria and the patient's history play a role in the choice of medication and length of treatment determined by the health care provider.&nbsp; As these infections are usually caused by bacteria, antibiotics are used to treat UTIs. Removing predisposing factors are also considered if possible- draining urine collections, removing or changing catheters <ref name="Pontari" />.&nbsp; Health care providers will sometimes perform a sensitivity test and analyze the results to select the most effective antibiotic specific to the patient based on the the site of infection and severity of illness <ref name="Pontari" />.<br>
* Wanting to urinate more often and urgently, if only a few drops
* Burning pain or a ‘scalding’ sensation when urinating
* Feeling that the bladder is still full after urinating
* Pain above the pubic bone
* Cloudy, bloody or very smelly [[urine]].&nbsp;


== Diagnostic Tests/Lab Tests/Lab Values  ==
[[Image:FlankPain.jpeg|border|right|200x200px|Flank Pain]]If infection reaches the kidneys, prompt medical attention is needed. In addition to the general symptoms of UTIs, a person with a kidney infection can also experience:


&nbsp;&nbsp;&nbsp;&nbsp; Due to bacteria possibly being found in urine of healthy individuals, a UTI is diagnosed based on symptoms of the individual and a laboratory test. The health care provider will request a "midstream" urine sample and then send it to a laboratory <ref name="Urinary" />. In the case of recurring infections or in a hospital environment, the urine sample may be cultured to identify the bacteria growing. Sensitivity tests may also be ordered by the health care provider to interpret the most efficient medication for treatment <ref name="Urinary" />.  
* Chills
* Fever
* Loin (lower abdominal) pain
* Pain in the back
* Vomiting.<ref name=":0" />
Urinary Tract infections that are left untreated may lead to many complications, including urosepsis, systemic inflammatory response syndrome ([[SIRS / Sepsis / Septic Shock|SIRS]]), and chronic kidney infections. Sepsis associated with UTIs often requires hospitalization<ref name="Mody" />.  


[[Image:UrineSample.jpg|border|right|125x150px|Pyuria]]
'''Variation in Symptom Presentation'''


[[Image:UTIurine.jpg|border|left|150x150px|Microscopic]]Confirmation of a diagnosis of UTI includes a positive urine&nbsp;culture (≥ 105 CFU/mL) with no more than 2 uropathogens and pyuria <ref name="Mody" />. Dipstick tests are easy to perform in a clinic and used often when testing for UTI <ref name="Mody" />.<br>
* Post-[[Menopause|menopausal]] women&nbsp;present with constitutional symptoms, such as abdominal pain, back pain, chills, and constipation <ref name="Rowe" />.
* Nursing home patients present with nonspecific symptoms, such as confusion and a decline in functional status.&nbsp;
* A urinary infection in a child needs to be investigated as it may indicate a more serious condition. The most common urinary system condition is urinary reflux. With this condition, the bladder valve isn’t working properly and allows urine to flow back to the kidneys, increasing the risk of a kidney infection<ref name=":0" />.


Typically, symptoms of a UTI will conclude within 24-48 hours after treatment. A UTI is considered recurrent if the condition presents more than twice in a 6 months <ref name="Rose" />.&nbsp; Additional tests include the following: kidney and bladder ultrasound, voiding cystourethrogram, computerized tomography (CT) scan, MRI, radionuclide scan, urodynamics, and cystoscopy <ref name="Urinary" />.<br><br>
== Diagnosis ==


== Etiology/Causes  ==
[[Image:UrineSample.jpg|125x150px|Urine sample|alt=|thumb]]Tests and procedures used to diagnose urinary tract infections include:


&nbsp;&nbsp;&nbsp; Urinary tract infections are a result from bacteria invading the urinary tract <ref name="Rose" />.&nbsp; Research confirms that most UTIs are caused by bacteria that live in the bowel, specifically the bacterium Escherichia coli (E. coli) <ref name="Urinary" />.&nbsp; The routes that bacteria take to enter the urinary tract include ascending through the urethra, bloodborne, and through the lymphatic system <ref name="Goodman" />.  
* Analyzing a urine sample.
* Growing urinary tract bacteria in a lab. This test finds what bacteria is causing infection and which medications will be most effective.


'''Common Causative Pathogens in Adult UTIs''' <ref name="Pontari" />''': '''
Typically, symptoms of a UTI will conclude within 24-48 hours after treatment. A UTI is considered recurrent if the condition presents more than twice in 6 months <ref name="Rose" />.&nbsp; Additional tests include the following: kidney and bladder ultrasound, voiding cystourethrogram, computerized tomography (CT) scan, MRI, radionuclide scan, urodynamics, and cystoscopy <ref name="Urinary" />


*Escherichia coli (80% of outpatient UTIs)
== Prognosis ==
*Klebsiella; Enterobacter
Even with proper  antibiotic treatment, most UTI symptoms can last several days. In women with recurrent UTIs, the [[Quality of Life|quality of life]] is poor,  25% of women experience such recurrences. Factors indicating a poor outlook include: Catheterization; Poor overall health; Advanced age; Presence of renal calculi; Diabetes (especially if poorly controlled); Presence of malignancy; [[Urinary Incontinence]]; Chronic diarrhea.<ref name=":1" />
*Proteus
*Pseudomonas
*Staphylococcus saprophyticus (5 - 15%)  
*Enterococcus
*Candida
*Adenovirus type 11 <br>
 
The urinary tract encompasses several systems to prevent infection such as preventing urine from backing up toward the kidneys and urination washing removing microbes from the body.&nbsp; Unfortunately, infections can still occur due to some bacteria having a strong ability to attach to the urinary tract lining <ref name="Urinary" />.<br>&nbsp;<br>


== Systemic Involvement  ==
== Systemic Involvement  ==


&nbsp; &nbsp; &nbsp;Urinary Tract infections that are left untreated may lead to many complications, including urosepsis, systemic inflammatory response syndrome (SIRS), and chronic kidney infections. Sepsis associated with UTIs often requires hospitalization<ref name="Mody">Mody, L, Juhani-Mehtta, M. Urinary Tract Infections in Older Women: A Clinical Review. JAMA. 2014;311:844–854.</ref>. Urosepsis spreads into the bloodstream from its origin in the urinary tract. Kidney infections also progress to the blood stream, referred to as septicemia<ref name="Urinary">Urinary Tract Infections in Adults. Urologic Diseases. 2013. Available at: http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/urinary-tract-infections-in-adults/pages/ez.aspx.</ref>. This complication can be life threatening. Systemic inflammatory response syndrome can also become life threatening if treatment fails. SIRS is usually the first incidence of multi-organ failure<ref name="Grabe">Grabe, M. Guidelines on Urological Infections. Urological Infections. Available at: http://uroweb.org/wp-content/uploads/19-urological-infections_lr2.pdf.</ref>. <br>
&nbsp;Urinary Tract infections that are left untreated may lead to many complications, including urosepsis, systemic inflammatory response syndrome (SIRS), and chronic kidney infections. Sepsis associated with UTIs often requires hospitalization<ref name="Mody">Mody, L, Juhani-Mehtta, M. Urinary Tract Infections in Older Women: A Clinical Review. JAMA. 2014;311:844–854.</ref>. Urosepsis spreads into the bloodstream from its origin in the urinary tract. Kidney infections also progress to the blood stream, referred to as septicemia<ref name="Urinary">Urinary Tract Infections in Adults. Urologic Diseases. 2013. Available at: http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/urinary-tract-infections-in-adults/pages/ez.aspx.</ref>. This complication can be life threatening. Systemic inflammatory response syndrome can also become life threatening if treatment fails. SIRS is usually the first incidence of multi-[[Vital Organs|organ]] failure<ref name="Grabe">Grabe, M. Guidelines on Urological Infections. Urological Infections. Available at: http://uroweb.org/wp-content/uploads/19-urological-infections_lr2.pdf.</ref>.


== Medical Management (current best evidence)  ==
== Treatment ==
[[Image:Amoxicillin.jpg|200x200px|alt=|thumb|Amoxicillin]]Antibiotics usually are the first line treatment for urinary tract infections. Which drugs are prescribed and for how long depend on persons health condition and the type of bacteria found in your urine.


&nbsp; &nbsp; Urinary tract infections are most commonly treated by antibiotic prescription. Frequently prescribed antibiotics include<ref name="Rose">Rosenblum, N. Recurrent Urinary Tract Infections. Urology. Available at: http://www.med.nyu.edu/urology/patient-care-information/conditions-we-treat/recurrent-urinary-tract-infections</ref>:
The group of antibiotic medicines known as fluoroquinolones are not commonly recommended for simple UTIs, as the risks of these medicines generally outweigh the benefits for treating uncomplicated UTIs. In some cases, such as a complicated UTI or kidney infection, they may be prescribed, if there are no other treatment options.


*Nitrofurantoin[[Image:Amoxicillin.jpg|border|right|200x200px]]
Pain medications may be prescribed (numbs your bladder and urethra to relieve burning while urinating), but pain usually is relieved soon after starting an antibiotic<ref>Moyo clinic UTI Available;https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/diagnosis-treatment/drc-20353453 (accessed 13.5.2022)</ref>.
*Amoxicillin
*Trimethoprim
*Fluoroquinolones


Antibiotics are usually taken anywhere from 3 days to 10 days, depending on severity of symptoms, comorbidities, complications of infection, and dosage <ref name="Rowe">Rowe, TA, Juthani-Mehta, M. Urinary tract infection in older adults. Aging Health. 2013;9(5).</ref>&nbsp;<ref name="Rose" />. Overutilization of antibiotics is a common issue, particularly in hospitals and long term facilities, which may cause patients to develop resistance to the medication over time <ref name="Rowe" />. <br>&nbsp; &nbsp; &nbsp;Alternative treatment includes the use of probiotics, ensuring proper hydration, drinking cranberry juice, and urinating frequently <ref name="Beck">Becknell, B, Schober, M, Korbel, L, Spencer, JD. The Diagnosis, Evaluation and Treatment of Acute and Recurrent Pediatric Urinary Tract Infections. Expert Review of Anti-infective Therapy. 2015;13(1):81–90.</ref>&nbsp;<ref name="Mody" /><ref name="Urinary" />. Using a heating pad on the patient’s lower back or abdomen may also help the symptoms of the UTI<ref>Urinary Tract Infections in Adults. Urologic Diseases. 2013. Available at: http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/urinary-tract-infections-in-adults/pages/ez.aspx.</ref>. Surgery may be required in the presence of an anatomical abnormality <ref name="Rose" />. <br><br>
Antibiotics are usually taken anywhere from 3 days to 10 days, depending on severity of symptoms, comorbidities, complications of infection, and dosage <ref name="Rowe">Rowe, TA, Juthani-Mehta, M. Urinary tract infection in older adults. Aging Health. 2013;9(5).</ref><ref name="Rose" />. Overutilization of antibiotics is a common issue, particularly in hospitals and long term facilities, which may cause patients to develop resistance to the medication over time <ref name="Rowe" />.  


== Physical Therapy Management (current best evidence)  ==
Alternative treatment includes the use of probiotics, ensuring proper hydration, drinking cranberry juice, and urinating frequently <ref name="Beck">Becknell, B, Schober, M, Korbel, L, Spencer, JD. The Diagnosis, Evaluation and Treatment of Acute and Recurrent Pediatric Urinary Tract Infections. Expert Review of Anti-infective Therapy. 2015;13(1):81–90.</ref><ref name="Mody" /><ref name="Urinary" />. Using a heating pad on the patient’s lower back or abdomen may also help the symptoms of the UTI<ref>Urinary Tract Infections in Adults. Urologic Diseases. 2013. Available at: http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/urinary-tract-infections-in-adults/pages/ez.aspx.</ref>. Surgery may be required in the presence of an anatomical abnormality <ref name="Rose" />.&nbsp;
 
&nbsp; &nbsp; &nbsp;Physical therapists that are trained in pelvic floor dysfunction can greatly improve a UTI patient’s quality of life. A typical approach includes training pelvic floor musculature, manipulative techniques, local heat, breathing and relaxation techniques, postural education, muscle coordination reeducation, and behavioral therapy<ref name="Souza">Souza, EL, Figueiredo, EM, Velloso, FB, Geo, MS. Physiotherapy For Women with Recurrent Urinary Tract Infection: A Promising Approach. International Continence Society. 2013:223.</ref>. Therapists are also encouraged to educate the patient on drinking and voiding schedules to ensure consistency<ref name="De">De Paepe, H, Hoebeke, P, Renson, C, et al. Pelvic-floor therapy in girls with recurrent urinary tract infections and dysfunctional voiding. British Journal of Urology. 1998;3:10–9113.</ref>. Treatments and patient education have been found to improve efficiency of emptying the bladder, create better bowel habits, and promote full relaxation of the pelvic-floor when voiding <ref name="Souza" />. All of these factors may lead to a decreased incidence and reoccurrence of UTIs. <br>&nbsp; &nbsp; &nbsp;For those patients in the hospital, recent studies have shown that mobilization of patients with a catheter is safe and is not associated with urinary-related adverse effects, including urinary tract infections<ref name="Lima">Lima, NP, Cardim da Silva, GM, Park, M, Pires-Neto, RC. Mobility therapy and central or peripheral catheter-related adverse events on an ICU in Brazil. J bras pneumol. 2015;41(3):225–230.</ref>.<br>
 
<br>[[Image:Pelvic Floor Muscles.jpg|border|center|500x400px]]<br>
 
== Differential Diagnosis  ==
 
The American Urological Association has identified conditions that can cause symptoms similar to UTI, including<ref name="Pontari">M, Pontari. Adult UTI. Advancing Urology. Available at: www.auanet.org/education/adult-uti.cfm</ref>:
 
*STDs: Genital Herpes, Gonorrhea, Chlamydia, Trichomonas
*Inflammatory disorders: Vaginitis, Prostatitis, Urethritis
*Nephrolithiasis (Kidney Stones)
*Trauma
*Genitourinary Tuberculosis
*Genitourinary Neoplasm
*Intra-abdominal Abscess
*Yeast Infection
 
<br>  
 
[[Image:JaundiceKid.jpg|border|right|150x200px]] '''Variation in symptom presentation:'''
<div>
Post-menopausal women&nbsp;present with constitutional symptoms, such as abdominal pain, back pain, chills, and constipation <ref name="Rowe" />.  
 
Nursing home patients present with nonspecific symptoms, such as confusion and a decline in functional status.&nbsp;
</div><div>
Children are usually the hardest to diagnose due to the their vagueness of symptoms.&nbsp;The typical adult symptoms of frequency, urgency, and dysuria are usually absent in children. Young children sometimes present with irritability, poor feeding, vomiting, or jaundice.&nbsp;&nbsp;UTI should be considered in any child between two months and two years of age with fever that doesn't have an identifiable source of infection '''<ref name="Beck" />'''.Young children with incontinence and abdominal pain should also be checked '''<ref name="Beck" />.'''<br>
</div>
 
== Case Reports/ Case Studies  ==
 
&nbsp;1. Physiotherapy For Women With Recurrent Urinary Tract Infection: A Promising Approach
 
*http://www.ics.org/Abstracts/Publish/218/000223_poster.pdf
 
2. Pelvic floor therapy in girls with recurrent UTIs<br>
 
*http://www.ncbi.nlm.nih.gov/pubmed/9634033
 
== Resources <br>  ==
 
American Urological Association<br>http://www.auanet.org/education/adult-uti.cfm
 
NYU School of Medicine Department of Urology<br>http://www.med.nyu.edu/urology/patient-care-information/conditions-we-treat/recurrent-urinary-tract-infections#diagnosis
 
European Association of Neurology<br>http://uroweb.org/wp-content/uploads/19-Urological-infections_LR2.pdf
 
Choices in Health<br>http://choicespc.net/physical-therapy-for-urinary-problems-and-pelvic-floor-dysfunction/<br><br>
 
<br>


== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
== Prevention ==
Measures include:


see tutorial on [[Adding PubMed Feed|Adding PubMed Feed]]
* Although, not evaluated in a controlled trails, women should urinate after sexual intercourse<ref>Pietrucha‐Dilanchian1 P, Hooton TM. [https://journals.asm.org/doi/10.1128/microbiolspec.UTI-0021-2015?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed Diagnosis, treatment, and prevention of urinary tract infection. Urinary Tract Infections:] Molecular Pathogenesis and Clinical Management. 2017 Feb 15:41-68.</ref> because bacteria in the bladder can increase by ten-fold after intercourse.
<div class="researchbox"><rss>http://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1tyP_Q3NRDkzDQxin-HwKllPB1C1QKC1_WMLDNRnc1ehG1ysm7|charset=UTF-8|short|max=10</rss></div>  
* After urination, women should wipe from front to back, not from the anal area forward, which seems to drag pathogenic organisms nearer to the urethra.  
<br> http://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1L77UU-fM1--NXiSTHLqK2KgWUoTe7GVIsj-1tFm0bQoVs_5Sd
* Vigorous urine flow is helpful to prevention.  
* Baths should be avoided in favor of showers.  
* A gentle, liquid soap should be used in bathing or a liquid baby soap, which is very acceptable for the vagina.  The soap should be applied using a clean, soft cotton or microfiber washcloth and the vaginal area should be cleaned first to avoid unnecessary contamination of the area with germs<ref name=":1" />


http://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1twh4oYFmCRxDnF-K12oI-0b51xUbejqtqL6fa9t8hKbLt8sKl
== Physical Therapy Management ==
Pelvic floor dysfunctions has been linked to the development of  urinary [[Urinary Incontinence|incontinence]] as well as urinary tract infections<ref name=":2">Divine K, McVey L. [https://www.ingentaconnect.com/content/wk/jwh/2021/00000045/00000001/art00006 Physical Therapy Management in Recurrent Urinary Tract Infections: A Case Report.] Journal of Women's Health Physical Therapy. 2021 Jan 1;45(1):27-33.</ref>. A study concluded that improved [[Pelvic Floor Anatomy|pelvic]] floor muscle strength and coordination  could  contribute to decease in UTI  re occurrence<ref name=":2" /> Physical therapists that are trained in [[Pelvic Floor Dysfunction|pelvic]] floor dysfunction can greatly improve a UTI patient’s quality of life. A typical approach includes training [[Pelvic Floor Disorders|pelvic floor]] musculature, manipulative techniques, local heat, [[Breathing Exercises|breathing]] and relaxation techniques, postural education, muscle coordination reeducation, and behavioral therapy<ref name="Souza">Souza, EL, Figueiredo, EM, Velloso, FB, Geo, MS. [https://www.ics.org/Abstracts/Publish/218/000223.pdf Physiotherapy For Women with Recurrent Urinary Tract Infection: A Promising Approach]. International Continence Society. 2013:223.</ref>.  


http://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1tyP_Q3NRDkzDQxin-HwKllPB1C1QKC1_WMLDNRnc1ehG1ysm7
Therapists are also encouraged to educate the patient on drinking and voiding schedules to ensure consistency<ref name="De">De Paepe, H, Hoebeke, P, Renson, C, et al. [https://www.physio-pedia.com/index.php?title=Urinary_Tract_Infection&veaction=edit Pelvic-floor therapy in girls with recurrent urinary tract infections and dysfunctional voiding.] British Journal of Urology. 1998;3:10–9113.</ref>. Treatments and patient education have been found to improve efficiency of emptying the bladder, create better bowel habits, and promote full relaxation of the pelvic-floor when voiding<ref name="Souza" />. All of these factors may lead to a decreased incidence and reoccurrence of UTIs. &nbsp; &nbsp;


For those patients in the hospital, recent studies have shown that mobilization of patients with a catheter is safe and is not associated with urinary-related adverse effects, including urinary tract infections<ref name="Lima">Lima, NP, Cardim da Silva, GM, Park, M, Pires-Neto, RC. [https://observatorio.fm.usp.br/bitstream/OPI/10684/1/art_LIMA_Mobility_therapy_and_central_or_peripheral_catheterrelated_adverse_2015.PDF Mobility therapy and central or peripheral catheter-related adverse events on an ICU in Brazil.] J bras pneumol. 2015;41(3):225–230.</ref>.
== References  ==
== References  ==


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[[Category:Womens_Health]]
[[Category:Mens_Health]]

Latest revision as of 13:24, 29 December 2022

Original Editor - Elaine Lonnemann, Kaylee Whitehead, Melanie Anderson Top Contributors - Kaylee Whitehead, Melanie Anderson, Cate Hurst, Kim Jackson, Lucinda hampton, Vidya Acharya, Temitope Olowoyeye, Elaine Lonnemann, Krista Polanin, WikiSysop and Nicole Hills

Introduction[edit | edit source]

Symptoms UTI

A urinary tract infection is an infection in any part of your urinary system, which includes the bladder, urethra, ureters (urine tubes) and kidneys. If untreated, UTIs can lead to kidney infection which can be very serious. UTIs are caused by microbes, mainly bacteria, but also fungi and viruses[1].

Normally, bacteria that enters the urinary tract is rapidly removed by the body before symptoms are present, but sometimes this bacteria overcomes the natural defences of the body, resulting in an infection. This infection may involve the lower urinary tract only, or both the lower and upper urinary tracts[2]. The upper urinary tract is made up of the kidneys and the ureters, while the lower urinary tract is made up of the bladder and urethra [2].  

Types of urinary tract infections (UTIs)[edit | edit source]

Upper and Lower Urinary Tract

The different types of UTI can include:

  • Urethritis – infection of the urethra
  • Cystitis – infection of the bladder
  • Pyelonephritis – infection of the kidneys
  • Vaginitis – infection of the vagina.[3]

Etiology[edit | edit source]

Pathogenic bacteria ascend from the perineum, causing the UTI.

  • Women have shorter urethras than men and therefore are far more susceptible to UTI.
  • A major risk factor for UTI is catheter use. Sexual intercourse and the use of spermicides and diaphragms are also risk factors for UTI. Frequent pelvic exams and the presence of anatomical abnormalities of the urinary tract can also predispose one to a UTI.
  • UTIs are very common after a kidney transplant. The two triggers include the use of immunosuppressive drugs and vesicoureteral reflux. Other risk factors include the use of antibiotics and diabetes mellitus[4].

Epidemiology[edit | edit source]

Anatomy of Male and Female Bladder

An estimated 150 million UTIs occur every year world-wide, adding to $6 billion in health care costs [5]. 

  • Urinary tract infections are very frequent bacterial infections in women.
  • Usually occur between the ages of 16 and 35 years, with 10% of women getting an infection yearly and more than 40% to 60% having an infection at least once in their lives.
  • Recurrences are common, with nearly half getting a second infection within a year.
  • Urinary tract infections occur at least four times more frequently in females than males[4]

Characteristics/Clinical Presentation[edit | edit source]

Some of the symptoms of UTIs include:

  • Wanting to urinate more often and urgently, if only a few drops
  • Burning pain or a ‘scalding’ sensation when urinating
  • Feeling that the bladder is still full after urinating
  • Pain above the pubic bone
  • Cloudy, bloody or very smelly urine. 
Flank Pain

If infection reaches the kidneys, prompt medical attention is needed. In addition to the general symptoms of UTIs, a person with a kidney infection can also experience:

  • Chills
  • Fever
  • Loin (lower abdominal) pain
  • Pain in the back
  • Vomiting.[3]

Urinary Tract infections that are left untreated may lead to many complications, including urosepsis, systemic inflammatory response syndrome (SIRS), and chronic kidney infections. Sepsis associated with UTIs often requires hospitalization[6].

Variation in Symptom Presentation

  • Post-menopausal women present with constitutional symptoms, such as abdominal pain, back pain, chills, and constipation [2].
  • Nursing home patients present with nonspecific symptoms, such as confusion and a decline in functional status. 
  • A urinary infection in a child needs to be investigated as it may indicate a more serious condition. The most common urinary system condition is urinary reflux. With this condition, the bladder valve isn’t working properly and allows urine to flow back to the kidneys, increasing the risk of a kidney infection[3].

Diagnosis[edit | edit source]

Urine sample

Tests and procedures used to diagnose urinary tract infections include:

  • Analyzing a urine sample.
  • Growing urinary tract bacteria in a lab. This test finds what bacteria is causing infection and which medications will be most effective.

Typically, symptoms of a UTI will conclude within 24-48 hours after treatment. A UTI is considered recurrent if the condition presents more than twice in 6 months [1].  Additional tests include the following: kidney and bladder ultrasound, voiding cystourethrogram, computerized tomography (CT) scan, MRI, radionuclide scan, urodynamics, and cystoscopy [7]

Prognosis[edit | edit source]

Even with proper  antibiotic treatment, most UTI symptoms can last several days. In women with recurrent UTIs, the quality of life is poor, 25% of women experience such recurrences. Factors indicating a poor outlook include: Catheterization; Poor overall health; Advanced age; Presence of renal calculi; Diabetes (especially if poorly controlled); Presence of malignancy; Urinary Incontinence; Chronic diarrhea.[4]

Systemic Involvement[edit | edit source]

 Urinary Tract infections that are left untreated may lead to many complications, including urosepsis, systemic inflammatory response syndrome (SIRS), and chronic kidney infections. Sepsis associated with UTIs often requires hospitalization[6]. Urosepsis spreads into the bloodstream from its origin in the urinary tract. Kidney infections also progress to the blood stream, referred to as septicemia[7]. This complication can be life threatening. Systemic inflammatory response syndrome can also become life threatening if treatment fails. SIRS is usually the first incidence of multi-organ failure[8].

Treatment[edit | edit source]

Amoxicillin

Antibiotics usually are the first line treatment for urinary tract infections. Which drugs are prescribed and for how long depend on persons health condition and the type of bacteria found in your urine.

The group of antibiotic medicines known as fluoroquinolones are not commonly recommended for simple UTIs, as the risks of these medicines generally outweigh the benefits for treating uncomplicated UTIs. In some cases, such as a complicated UTI or kidney infection, they may be prescribed, if there are no other treatment options.

Pain medications may be prescribed (numbs your bladder and urethra to relieve burning while urinating), but pain usually is relieved soon after starting an antibiotic[9].

Antibiotics are usually taken anywhere from 3 days to 10 days, depending on severity of symptoms, comorbidities, complications of infection, and dosage [2][1]. Overutilization of antibiotics is a common issue, particularly in hospitals and long term facilities, which may cause patients to develop resistance to the medication over time [2].

Alternative treatment includes the use of probiotics, ensuring proper hydration, drinking cranberry juice, and urinating frequently [10][6][7]. Using a heating pad on the patient’s lower back or abdomen may also help the symptoms of the UTI[11]. Surgery may be required in the presence of an anatomical abnormality [1]. 

Prevention[edit | edit source]

Measures include:

  • Although, not evaluated in a controlled trails, women should urinate after sexual intercourse[12] because bacteria in the bladder can increase by ten-fold after intercourse.
  • After urination, women should wipe from front to back, not from the anal area forward, which seems to drag pathogenic organisms nearer to the urethra.
  • Vigorous urine flow is helpful to prevention.
  • Baths should be avoided in favor of showers.
  • A gentle, liquid soap should be used in bathing or a liquid baby soap, which is very acceptable for the vagina.  The soap should be applied using a clean, soft cotton or microfiber washcloth and the vaginal area should be cleaned first to avoid unnecessary contamination of the area with germs[4]

Physical Therapy Management[edit | edit source]

Pelvic floor dysfunctions has been linked to the development of urinary incontinence as well as urinary tract infections[13]. A study concluded that improved pelvic floor muscle strength and coordination could contribute to decease in UTI re occurrence[13] Physical therapists that are trained in pelvic floor dysfunction can greatly improve a UTI patient’s quality of life. A typical approach includes training pelvic floor musculature, manipulative techniques, local heat, breathing and relaxation techniques, postural education, muscle coordination reeducation, and behavioral therapy[14].

Therapists are also encouraged to educate the patient on drinking and voiding schedules to ensure consistency[15]. Treatments and patient education have been found to improve efficiency of emptying the bladder, create better bowel habits, and promote full relaxation of the pelvic-floor when voiding[14]. All of these factors may lead to a decreased incidence and reoccurrence of UTIs.    

For those patients in the hospital, recent studies have shown that mobilization of patients with a catheter is safe and is not associated with urinary-related adverse effects, including urinary tract infections[16].

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 Rosenblum, N. Recurrent Urinary Tract Infections. Urology. Available at: http://www.med.nyu.edu/urology/patient-care-information/conditions-we-treat/recurrent-urinary-tract-infections
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Rowe, TA, Juthani-Mehta, M. Urinary tract infection in older adults. Aging Health. 2013;9(5).
  3. ↑ 3.0 3.1 3.2 Better Health UTIs Available:https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/urinary-tract-infections-uti (accessed 13.5.2022)
  4. ↑ 4.0 4.1 4.2 4.3 Bono MJ, Reygaert WC. Urinary tract infection. InStatPearls [Internet] 2021 Jun 23. StatPearls Publishing. Available:https://www.ncbi.nlm.nih.gov/books/NBK470195/ (accessed 13.5.2022)
  5. ↑ M, Pontari. Adult UTI. Advancing Urology. Available at: www.auanet.org/education/adult-uti.cfm
  6. ↑ 6.0 6.1 6.2 Mody, L, Juhani-Mehtta, M. Urinary Tract Infections in Older Women: A Clinical Review. JAMA. 2014;311:844–854.
  7. ↑ 7.0 7.1 7.2 Urinary Tract Infections in Adults. Urologic Diseases. 2013. Available at: http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/urinary-tract-infections-in-adults/pages/ez.aspx.
  8. ↑ Grabe, M. Guidelines on Urological Infections. Urological Infections. Available at: http://uroweb.org/wp-content/uploads/19-urological-infections_lr2.pdf.
  9. ↑ Moyo clinic UTI Available;https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/diagnosis-treatment/drc-20353453 (accessed 13.5.2022)
  10. ↑ Becknell, B, Schober, M, Korbel, L, Spencer, JD. The Diagnosis, Evaluation and Treatment of Acute and Recurrent Pediatric Urinary Tract Infections. Expert Review of Anti-infective Therapy. 2015;13(1):81–90.
  11. ↑ Urinary Tract Infections in Adults. Urologic Diseases. 2013. Available at: http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/urinary-tract-infections-in-adults/pages/ez.aspx.
  12. ↑ Pietrucha‐Dilanchian1 P, Hooton TM. Diagnosis, treatment, and prevention of urinary tract infection. Urinary Tract Infections: Molecular Pathogenesis and Clinical Management. 2017 Feb 15:41-68.
  13. ↑ 13.0 13.1 Divine K, McVey L. Physical Therapy Management in Recurrent Urinary Tract Infections: A Case Report. Journal of Women's Health Physical Therapy. 2021 Jan 1;45(1):27-33.
  14. ↑ 14.0 14.1 Souza, EL, Figueiredo, EM, Velloso, FB, Geo, MS. Physiotherapy For Women with Recurrent Urinary Tract Infection: A Promising Approach. International Continence Society. 2013:223.
  15. ↑ De Paepe, H, Hoebeke, P, Renson, C, et al. Pelvic-floor therapy in girls with recurrent urinary tract infections and dysfunctional voiding. British Journal of Urology. 1998;3:10–9113.
  16. ↑ Lima, NP, Cardim da Silva, GM, Park, M, Pires-Neto, RC. Mobility therapy and central or peripheral catheter-related adverse events on an ICU in Brazil. J bras pneumol. 2015;41(3):225–230.


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