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Urinary tract infections are one of the most common afflictions of the urinary tract. These can be caused by a variety of conditions and are more in women than men. Recurrent urinary infections can cause damage to the upper urinary tracts, and scarring of the kidneys, which has long-term consequences like high blood pressure and kidney failure.
The most important reason for UTIs being more common in women than men is the relatively shorter urethra in women. A female urethra is 4 cm in length, while a male urethra is about 20 – 25 cm in length. Any urinary pathogen (usually bacteria from stool) which contaminates the urethra can travel relatively easily to the bladder in a female while it usually gets washed out by the urinary stream, before it can reach the bladder in a male.
One of the common causes of UTI in women is personal hygiene. The advent of western-style toilets and hand showers has been the cause of contamination of fecal material around the urethral meatus in women. This would also be the case when cleaning up after passing stools Indian style with water, when the direction of cleaning is back to front. It is best if the direction of the water and hand is always kept front to back to avoid any inadvertent contamination.
Constipation is also a common cause of UTI in women. A high fibre diet and plenty of water throughout the day aids in reducing this incidence. Educating girls while growing up about the correct mode of cleaning the anogenital areas is essential to reduce incidence of UTIs.
UTI with lower urinary tract symptoms and no fever is an uncomplicated UTI usually involving only the bladder called cystitis. When a fever is associated with a UTI, it is usually a complicated UTI involving the kidneys. This condition may be caused by pyelonephritis which is an infection of the kidneys and urinary collecting system. This can have serious implications especially in diabetics, and usually requires higher antibiotics and hospitalization.
A cystitis can usually be treated by oral antibiotics. But always get a urine culture done before starting any antibiotics to ensure we know the particular bug causing the UTI and that it is treated appropriately. A follow up urine culture to ensure complete cure is essential a few days after completion of the course of antibiotics. If this is not ensured, a persistent bug can appear to be causing recurrent UTI.
Repeated attacks of febrile UTI can affect the kidneys by scarring them. Scars in the kidneys can cause high blood pressure, which if left untreated can further reduce kidney function and cause kidney failure. Most diabetics are immunocompromised and already have reduced renal reserve and can be affected severely by complicated UTI and are prone to them as well.
In extreme cases, recurrent UTI can lead to chronic kidney disease, which can end up in end stage renal disease (ESRD), and can only be treated with dialysis or kidney transplantation.
Prevention is the best cure where UTIs are concerned. Adequate care about personal hygiene and building awareness of these issues in the society is essential in reducing the incidence of this extremely common yet preventable disease!