Urinary Tract Infection

 

Welcome to PT 635 Pathophysiology of Complex Patient Problems 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!!

Original Editors - Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.

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

 

Prevalence

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Characteristics/Clinical Presentation

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Associated Co-morbidities

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Medications

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Diagnostic Tests/Lab Tests/Lab Values

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Etiology/Causes

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Systemic Involvement

     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 [5]. Urosepsis spreads into the bloodstream from its origin in the urinary tract. Kidney infections also progress to the blood stream, referred to as septicemia [9]. 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 [10].

Medical Management (current best evidence)

    Urinary tract infections are most commonly treated by antibiotic prescription. Frequently prescribed antibiotics include [8]:

• Nitrofurantoin
• 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 [1] [8]. 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 [1].
     Alternative treatment includes the use of probiotics, ensuring proper hydration, drinking cranberry juice, and urinating frequently [2] [5] [9]. Using a heating pad on the patient’s lower back or abdomen may also help the symptoms of the UTI [9]. Surgery may be required in the presence of an anatomical abnormality [8].

Physical Therapy Management (current best evidence)

     Physical therapists that are trained in pelvic floor dysfunction can greatly improve a UTI patient’s quality of life. A typical approach includes manipulative techniques, local heat, breathing and relaxation techniques, postural education, muscle coordination reeducation, and behavioral therapy [3]. Therapists are also encouraged to educate the patient on drinking and voiding schedules to ensure consistency [6]. 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 [3]. 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 [4].

Differential Diagnosis

Other conditions that can cause symptoms similar to UTI include:

• Herpes genitalis (HSV)
• Urethritis
• N. Gonorrhoeae
• Chlamydia
• Trichomonas
• Vaginitis
• Prostatitis
• Nephrolithiasis
• Trauma
• GU tuberculosis
• GU neoplasm
• Intra-abdominal abscess
• Sepsis [7]

In post-menopausal women

In children

Case Reports/ Case Studies

add links to case studies here (case studies should be added on new pages using the case study template)

 Physiotherapy For Women With Recurrent Urinary Tract Infection: A Promising Approach

• http://www.ics.org/Abstracts/Publish/218/000223_poster.pdf

Pelvic floor therapy in girls with recurrent UTIs

• http://www.ncbi.nlm.nih.gov/pubmed/9634033

Resources

American Urological Association
http://www.auanet.org/education/adult-uti.cfm

NYU School of Medicine Department of Urology
http://www.med.nyu.edu/urology/patient-care-information/conditions-we-treat/recurrent-urinary-tract-infections#diagnosis

European Association of Neurology
http://uroweb.org/wp-content/uploads/19-Urological-infections_LR2.pdf

Choices in Health
http://choicespc.net/physical-therapy-for-urinary-problems-and-pelvic-floor-dysfunction/

Recent Related Research (from Pubmed)

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References

see adding references tutorial.