The Tribune

By DR GREGGORY PINTO

Far too many Bahamians live their lives in misery and utter frustration as they deal with recurrent urinary tract infections (UTIs). Bahamian women in particular are prone to suffer from urinary tract infections due to the female anatomy and menopause.

A urinary tract infection may present with burning on urination, possible bladder or kidney pain, increased urinary urgency and frequency.

Some 30 to 44 percent of women who get a urinary tract infection will have a recurrence within six months, according to the American Academy of Physicians (AAFP), and most of these women have normal anatomy and are generally healthy. The vast majority of urinary tract infections are not due to poor hygiene.

Women have a shorter urethra than in men and it is located near to the anus and rectum. Bacteria that is normally present in rectum, such as escherichia coli, can be transferred a short distance into the short female urethra and into the bladder and urinary tract system. Bacteria in the rectum can enter the urethra in women and girls if they wipe from back to front instead of the required front to back.

Sexual intercourse is a relatively common cause of UTIs in women, because sex introduces bacteria into a woman’s urinary tract when the urethra comes into contact with bacteria present in a woman’s anus and genital area. A diaphragm used for birth control and the use of spermicides increases the risk of UTIs from sex.

The National Institute of Diabetes and Digestive and Kidney Diseases in the US has published that one out of every four women are plagued with recurrent urinary tract infections.

Diabetic women, men and children can also suffer from diabetic cystopathy whereby the bladder filling sensation and the ability for the bladder to fully contract and empty is impaired. Diabetic cystopathy leads to incomplete bladder emptying and increased urinary frequency, urgency and incontinence as well multiple UTIs.

Recurrent urinary tract infections may result from anatomical and functional abnormalities such as a neurogenic bladder that may occur in cases of lower back spinal canal and nerve compressions, bladder outlet obstruction from urethral strictures or an obstructive prostate in men or prolapsed bladder or uterus in women or large uterine fibroids compressing the bladder.

Women as they enter menopause are more likely to have urinary tract infections as a result of lower estrogen levels and vaginal atrophy and weakening of the pelvic muscles.

For women with increasing age coupled with lower estrogen levels associated with menopause, the bladder loses its elasticity and volume and there is a weakening of the vaginal walls leading to frequent urination. Menopausal women also have a thinning of their urethra which allows bacteria to more easily enter the bladder. Bacteria in the bladder can enter the kidneys in both women and men and enter to prostate and testicles in men, which can lead to more complex and serious infections.

Men as they enter middle age are prone to incomplete bladder emptying secondary to obstruction of their bladders as a result of an enlarged obstructive prostate. Incomplete bladder emptying can lead to urinary stasis and greater UTI risk.

Men, women and children with bladder or kidney stones are susceptible to UTIs as bacteria clings to the stones. Infections related to kidney stones are twice as common in females.

Urinary tract infections worldwide are becoming increasingly resistant to commonly prescribed antibiotics such as ciprofloxacin and augmentin.

Management of urinary tract infections should involve analysis of a midstream urine culture specimen, particularly with recurrent UTIs.

A urine culture can determine which bacteria are present in the urine and which antibiotics are susceptible or resistant to the antibiotics.

Unfortunately, according to a scientific study published in Clinical Microbiology and Infection, nearly 20 percent of urine cultures that were found to be negative, had bacteria present in the urine when the urine was tested for the DNA of common bacteria. A clear or negative urine culture therefore does not mean that there is not a urinary tract infection. Many women are wrongly told that they do not have a urinary tract infection and unfortunately are not treated.

Recurrent urinary tract infections, are defined as two or more UTIs in six months or three or more UTIs in one year. Recurrent UTIs can negatively impact every aspect of a sufferer’s life and lead to a poor quality of life. Many Bahamian men, women and children live their life in fear of the pain endured during urination and frequent urination with UTIs has made them learn where every bathroom is located in the daily path of their lives.

The uncommon condition of interstitial cystitis/painful bladder syndrome has symptoms similar to a bladder infection but the cause is not related to bacteria.

Recurrent or chronic urinary tract infections need a thorough workup to determine the root cause and ensure appropriate treatment is given. Antibiotic chronic or recurrent use without investigation into recurrent urinary tract infections is not proper management.

Seek comprehensive, confidential and compassionate urological care. Regain control of your bladder and your happiness. Stop the misery in your life of recurrent urinary tract infections.

• Dr Greggory Pinto is a Bahamian urologist who has trained in South Africa, Germany, France and India. He is a member of the European Association of Urologists. Dr Pinto can be reached at Urology Care Bahamas at the Surgical Suite, Centreville Medical Centre, Collins Avenue and Sixth Terrace. Call 326 1929, e-mail welcome@urologycarebahamas.com, or visit www.urologycarebahamas.com.