Correction appended
It is only five minutes into the lecture, but you realize you
already made two mistakes ““ coming to the class and sitting
in the front row. You really have to go to the bathroom. Again.
Eventually, your urge to pee overcomes your fear of social
inadequacy. But on your fourth trip to the bathroom this early in
the morning, you feel like a victim of a bad joke.
Difficulty emptying your bladder is one thing, but there are
strange burning sensations “down there” with urination
that makes you more nervous.
The names of a few well-known sexually transmitted diseases run
through your mind on your way to the Ashe Center.
Relieved, you are diagnosed with a simple urinary tract
infection, a common infection that can occur anywhere along the
urinary tract ““ the kidneys, ureters, bladder and
urethra.
Ureters are tubes that take urine from each kidney to the
bladder. The urethra is the tube that empties urine from the
bladder to the outside.
The number one risk factor for getting a UTI is being
female.
About 20 percent of women at some time during their lifetime
will be affected, which translates into 6 million plus
doctors’ visits annually.
Unfortunately, females are more at risk naturally because of
their anatomy.
They have a shorter urethra and a shorter distance between the
opening of the urethra and the anus.
The bacteria do not have to travel far to enter the bladder.
Being sexually active is another major risk factor. During
sexual intercourse, bacteria from the gastrointestinal tract can be
introduced into the bladder through the urethra from the anal
region.
Other risk factors include pregnancy, diabetes, HIV, congenital
malformation of urinary tract and previous instrumentation, such as
catherization.
Believe it or not, foreign objects like batteries, light bulbs
and, yes, vibrators in the bladder are also occasionally picked up
in the ER. In such cases, they are no doubt the prime suspects for
causing a UTI.
Common symptoms of UTIs include lower abdominal discomfort,
painful urination, increased need to urinate and abnormal urine
color or odor.
UTIs become serious when the infections migrate upward to
involve the kidneys. Although it is rare, this could evolve into
kidney failure.
When this occurs, you may often experience flank pain, fatigue,
fever, chills, nausea and vomiting. That is, a lot sicker than just
having problems with urination.
Your doctor generally is able to make the diagnosis based on
your story and your urine sample in a single visit.
For clinicians at the Ashe Center, the challenge in diagnosis
lies in differentiating STDs from UTIs.
STDs often cause UTI-like symptoms, but they are different
beasts, and treating them is an entirely different game.
UTIs, on the other hand, will resolve without any complication
after taking a 7- to 14-day course of antibiotics.
You can never go wrong drinking extra fluids and cranberry
juice. You may also get medicine to ease your urinary discomfort
““ and turn your urine bright orange.
If the symptoms of the infection do not subside two to three
days after you start taking the antibiotics, contact your doctor
right away.
A few unfortunate people could end up having chronic or
recurrent UTIs.
While it is critical to treat their UTIs with antibiotics to
prevent kidney infections, it is often more important to detect and
treat the underlying conditions that predispose them to UTIs.
But prevention is the best medicine. Knowing the risk factors,
we can start with safe sex, drinking plenty of water to flush out
the bacteria, and drinking cranberry juice to keep bacteria from
sticking to the walls of the bladder.
Other preventive measures include wiping from front to back
after each bowel movement, avoiding the diaphragm as a method of
birth control, and no urine holding. Most professors whom I
encountered allow bathroom privileges, even during final exams.
Finally, as always, know that your doctor is there for you; so
get rid of the UTI before it becomes big and ugly.
Chen is a first-year medical student at the UCLA David
Geffen School of Medicine and a writer for The Diagnosis, an
organization comprised of UCLA medical students. The Diagnosis is
coordinated by Daniel Zaghi, a second-year medical student. Send
questions to dzaghi@media.ucla.edu.
Correction: April 28, 2004,
Wednesday
Hui Jie Jenny Chen is a third-year medical student (“To
prevent infection, just go with the flow,” Science and
Health, April 27).