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Urinary Tract Infections – the causes, symptoms and prevention

Urinary Tract Infections – the causes, symptoms and prevention


Do you ever experience a burning sensation when urinating? Do you get the urge to urinate more frequently than usual? These could be signs of a urinary tract infection, the second most common type of infection in humans.

The urinary tract is made up of the organs of the body that produce, store and discharge urine. These organs include the kidneys, ureters, bladder and the urethra. This system can be divided into upper urinary tract comprising of the ureters and kidneys and the lower urinary tract being the bladder and the urethra.

The urinary system does several important jobs. It removes liquid waste from the blood in the form of urine. It also regulates, keeping a stable balance of salts and other substances in the blood. The system also produces a hormone that is essential in the formation of red blood cells and also an enzyme that plays a role in blood pressure. The kidneys also regulate blood pressure by adjusting the volume of blood as well as the flow in and out of them.

What causes infection? This very important system of the body, however, gets infected frequently. The lower urinary tract tends to be more prone to infections.  The most common cause of urinary tract infections is bacteria within the body. The bacteria from the bowel that is found on the skin near the rectum or vagina may spread and enter the urinary tract through the urethra causing urethritis. The infection may go up to the bladder, infecting the bladder (cystitis). When it reaches the kidneys it causes a more serious infection called pyelonephritis. Germs may be introduced into the urethra by wiping from back to front after bowel movement.

Infections may be introduced also by anything that obstructs or delays the flow of urine, for example kidney stones or holding urine longer. Weakening of the bladder muscles also allows residual urine, which promotes multiplication of the germs. Sexual activities and introduction of foreign bodies into the urethra also encourages infections. Women are more prone to urinary tract infection due to their shorter urethras and the close proximity to the anus.

For men, uncircumcised individuals are at greater risk of urinary tract infection as the foreskin of the penis makes it easier for the germs to get trapped and enter the urinary system. In an elderly man, an enlarged or infected prostate increases the risk of urinary tract infection. Unprotected sex and anal sex also increase the risk of urinary tract infection.

These are the symptoms and signs of urinary tract infection: Urinating more often or waking up from sleep to urinate; urine that smells bad; the urine may be cloudy or tinged with blood; pain or burning when you urinate; very little urine produced and the urge to urinate recurs quickly; and pain or pressure in the lower abdomen. When the infection spreads up to the kidneys (pyelonephritis) this could be more serious and can cause shaking chills with a fever.

This may be associated with side pain or lower back pain that gets worse. Vomiting may also occur.

There are simple steps that help preventing urinary tract infections: Drink plenty of fluids, drinking a lot of water (six to eight glasses of water daily) leads to passing a lot of urine which has the effect of flushing the urinary tract. Always wipe from front to back after a bowel movement to avoid introducing anal bacteria. Avoid holding urine for long periods of time; urinate as soon as you feel the need.

Good hygiene is of great importance in preventing urinary tract infections. Both men and women ought to exercise good hygiene before and after sexual intercourse. Hygiene in men is significantly improved by undergoing circumcision. Medical male circumcision is offered free in government health services and covered by medical aid, so ask your health provider.

If one suspects having urinary tract infection, take lots of fluid especially water and visit the nearest clinic or doctor. The nurse/doctor will take note of your symptoms, examine you and may take a sample of your urine for analysis. Urinary tract infection may be treated with oral antibiotics and with more severe cases hospitalisation may be necessary.

• Dr Emmanuel Tom is a general medical practitioner at Wanaheda Medical Centre in Windhoek (e-mail:


6 things your pee can tell you

6 things your pee can tell you


Centuries ago, doctors tasted their patients’ urine to diagnose diabetes. If it was sweet, it meant the body wasn’t properly clearing away glucose. Fortunately, we have more advanced — and much less gross — medical tests available today, but the ancient clinicians were on to something: Your pee is an excellent predictor of your health.

“Urine is a byproduct that includes fluids and other filtrates that come out of your body so it can tell you what’s going on inside,” says Tomas Griebling, M.D., M.P.H., vice chair of the department of urology at the University of Kansas. Take a peek at your pee before you flush, and watch out for these six signs.

The sign: Dark yellow color

What it means: You’re dehydrated—but you probably already knew that. What you may not know is that even short-term dehydration, like not guzzling enough fluids during your work day or workout, can set you up for more serious bladder conditions down the road. “When you’re dehydrated, your body tries to conserve fluid so your urine becomes more concentrated,” Dr. Griebling says. The chemicals in your urine come into contact with the lining of your bladder and can cause irritation, which may lead to incontinence or an infection. Ideally, your pee should be consistently clear or light yellow. Up your H2O intake if it’s dark to help restore hydration.

The sign: Red urine

What it means: There’s blood in your pee, a condition called hematuria. That’s never normal, “so you should get it checked out as soon as possible,” Dr. Griebling says. Causes of bloody urine include trauma, kidney disease or cancer, inflammation or an infection in the kidneys, and more. Taking blood thinners can also make your urine red, but it’s still important to see a doc, stat.

The sign: Strong-smelling urine

What it means: First, rule out any foods or drinks you recently had. “The classic example is asparagus,” says Dr. Griebling. Some people have an enzyme that breaks down asparagus to a compound with a strong odor that you’ll notice within 20 to 30 minutes of eating the vegetable. That’s nothing to worry about. Coffee can also make urine smell, especially if you’re dehydrated. Bacteria that causes a urinary tract infection (UTI) can also produce a foul smell. If you have any other signs of a UTI, such as burning when you pee, a fever, or cloudy urine, let your doc know. You may need an antibiotic to fight off the infection.

The sign: Foamy or bubbly urine

What it means: You could have kidney disease. When your kidney’s filtering units aren’t working properly, that can lead to a build-up of protein in your urine. The protein then creates a foamy appearance when it hits the water in the toilet. You may be at risk for kidney disease if you have high blood pressure, diabetes, or a family member with the condition.

The sign: Increased urgency or frequency

What it means: You might have an enlarged prostate, also known as benign prostatic hyperplasia (BPH). The prostate gland surrounds the urethra through which urine leaves the body. As the gland grows bigger, it can press on the urethra and cause a variety of changes in urination. Urgency means you need to go right away and you may have difficulty holding it in. With increased frequency, you feel the need to go more often and may wake up several times at night to use the bathroom.

“Many people think that drinking less water will help with urgency and frequency, but dehydration can cause urinary issues, too,” Dr. Griebling says. BPH can also cause incomplete emptying of your bladder, so you still feel like you have to go even after taking a leak. Talk to your doctor if you notice any changes in urination. There are many treatments available for BPH including kegel exercises, medications, and surgery, if needed—but also lifestyle changes, like physical activity and limiting alcohol and caffeine. In addition, your doctor may evaluate your current medication regimen, since certain decongestants and antihistamines may increase BPH symptoms.

The sign: Air or gas coming out

What it means: Bacteria in your bladder may produce gas that releases when you pee. If you have any signs of a UTI, schedule face time with your physician. Although less likely, you could have a fistula, an abnormal opening within the bladder or between the bladder and colon. You could be at risk for developing a fistula if you have a history of Crohn’s disease or irritable bowel disease—and you may need surgery to correct the condition.


Bladder cells regurgitate bacteria to prevent urinary tract infections

Bladder cells regurgitate bacteria to prevent urinary tract infections


Duke Medicine researchers have found that bladder cells have a highly effective way to combat E. coli bacteria that cause urinary tract infections (UTIs).

In a study published online May 28, 2015, in the journal Cell, Duke researchers and their colleagues describe how bladder cells can physically eject the UTI-causing bacteria that manage to invade the host cell.
This response is analogous to having indigestion and vomiting to rid the stomach of harmful substances.
The finding suggests there may be a potential way to capitalize on this natural tendency in bladder cells to help treat recurring UTIs.

UTIs are the second most common type of infection in the body, accounting for about 8.1 million doctor visits annually, the majority of which occur in women, according to the National Institutes of Health. Bacterial infections are the most common cause of UTIs, with 70 percent of infections arising from a particular type of E. coli bacteria.

“The cost for managing UTIs in the U.S. is close to $3 billion annually,” said senior author Soman Abraham, Ph.D., professor in the departments of Pathology, Immunology, and Microbiology and Molecular Genetics at Duke University School of Medicine, and professor in the Program in Emerging Infectious Diseases, Duke-National University of Singapore.

“Because E. coli are able to hide inside of the bladder cells, it’s especially difficult to treat UTIs with regular antibiotics,” Abraham said. “So there is increased need to find new strategies for treatment, including co-opting any preexisting cellular tactics to combating infection.”

When E. coli first attack bladder cells, the cell’s surveillance machinery—known as autophagy—is the first line of defense against pathogens. The autophagy machinery encases the bacteria in a host membrane and shuttles them to the lysosome, a “capsular cauldron,” that destroys harmful pathogens in its acidic environment. But upon entering the lysosome, some pathogens have the capacity to neutralize the acidic environment and avoid being degraded.

Using mouse models of UTIs and cultured human bladder cells, the authors found that the host cells can sense when lysosomes have been rendered neutral and are malfunctioning. The host cells then respond by triggering the lysosome to eject its contents, including the bacteria.

“When the cells have trouble digesting the materials in the lysosomes, a logical way to get rid of this potential hazard is to throw it up,” said first author Yuxuan Miao, a Ph.D. candidate in Duke’s department of Molecular Genetics and Microbiology.
The bacteria that are expelled out of the bladder cells appear to be encased in a cell membrane, presumably ensuring their elimination in urine and avoiding any bacterial reattachment to the bladder wall.

“It was thought that lysosomes always degrade their contents,” Miao said. “Here we are showing for the first time that when the contents cannot be degraded, the lysosome appears to have a back-up plan which is to expel the contents in capsules.”
The researchers hope these findings will aid in finding chemical targets that can accelerate and amplify the bladder cell’s ability to expel the bacteria.

“A lot of women tend to experience recurrent infections once they have an initial bout of UTI,” Abraham said. “The reason for this is that there is bacterial persistence within the cells of the bladder. If we can eliminate these reservoirs using agents that promote expulsion, then we can potentially eradicate recurrent UTIs.”