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Bladder Infection


OVERVIEW OF Bladder Infection :

The bladder infection which is termed as urinary tract infection. The bladder infection might occur anywhere in the kidney tract such as urinary tract,urethra and renal,ureters


STRUCTURE of Bladder Infection :

the structure of the kidney includes ureter,renal component which constitutes glomeruli,bowmen’s capsule,proximal convoluted tubule,distal convulted tubule,collecting duct.The main function of the kidney is to collect and filtrate the  blood and blood products.


EPIDEMIOLOGY :

It is more among the female and accounts for 20-30% of the cases worldwide


CAUSES :

Dehydration

Non hygienic practices

Bacteria

Foods such as milk,caffeiene , citrus,ginger.

Risk factors:

  • Age below one year
  • Female – UTI is more common among the females since the urethra is shorter in females  and it is close to the anus in females.
  • Previous UTI
  • Voiding dysfunction
  • Vesicoureteral reflex (VUR) – this is the reflux of urine from the bladder into the ureter (can be unilateral or bilateral), Around 33% of infants and children who have a urinary tract infection have VUR.
  • Sexual practices – can cause urinary symptoms but infection is uncommon
  • Spinal abnormalities
  • Constipation


PATHOPHYSIOLOGY :

 

The urinary tract, from the kidneys to the urethral meatus, is normally sterile and resistant to bacterial colonization despite frequent contamination of the distal urethra with colonic bacteria. The major defense against urinary tract infection (UTI) is complete emptying of the bladder during urination. Other mechanisms that maintain the tract’s sterility include urine acidity, the vesicoureteral valve, and various immunologic and mucosal barriers.

About 95% of UTIs occur when bacteria ascend the urethra to the bladder and, in the case of pyelonephritis, ascend the ureter to the kidney. The remainder of UTIs are hematogenous. Systemic infection can result from UTI, particularly in older patients. About 6.5% of cases of hospital-acquired bacterimia are attributable to UTI.

Uncomplicated UTI is usually considered to be cystetitis  or polynephritis that occurs in premenopausal adult women with no structural or functional abnormality of the urinary tract and who are not pregnant and have no significant comorbidity that could lead to more serious outcomes. Also, some experts consider UTIs to be uncomplicated even if they affect postmenopausal women or patients with well-controlled diabetes. In men, most UTIs occur in children or older patients, are due to anatomic abnormalities or instrumentation, and are considered complicated.

The rare UTIs that occur in men aged 15 to 50 years are usually in men who have unprotected anal intercourse or in those who have an uncircumcised penis, and they are generally considered uncomplicated. UTIs in men this age who do not have unprotected anal intercourse or an uncircumcised penis are very rare and, although also considered uncomplicated, warrant evaluation for urologic abnormalities.

Complicated UTI can involve either sex at any age. It is usually considered to be pyelonephritis or cystitis that does not fulfill criteria to be considered uncomplicated. A UTI is considered complicated if the patient is a child, is pregnant, or has any of the following:

  • A structural or functional urinary tract abnormality and obstruction of urine.
  • A comorbidity that increases risk of acquiring infection or resistance to treatment, +


COMMON CLINICAL SIGNS AND SYMPTOMS :

  • burning with urination
  • increased frequency of urination without passing much urine
  • increased urgency of urination
  • lethargy
  • bloody urine
  • cloudy urine
  • urine that looks like cola or tea
  • urine that has a strong odour
  • pelvic pain in women
  • rectal pain in men


DIAGNOSTIC :

 Urine culture: The urine culture of the bacteria reveals the type of bacteria and the number of bacterial count.

Urinanalysis: The urine analysis includes the red blood cell count,white blood cell count.T

Ultrasound: The ultrasound which reveals the inflammation the ureter,renal,urethra. And provides the information about the renal calculi,hydronephrosis and obstruction.

Temperature: an increase in temperature increase greater than 38 degree indicates the infection

Urine dipstick:

     Leukocyte esterase and nitrites if tends to be positive then go for the urinary culture.

Micturating cystography:

During cystography, contrast dye is injected into the bladder. Contrat dyes are placed in the  body that causes the particular organ or tissue under study to be seen more clearly. X-rays are taken of the bladder, and fluoroscopy may be used to study the bladder emptying while a person urinates (voiding cystography). Cystography may indicate how well the bladder emties the urine and whether any urine backs correctly (vesicoureteral reflux).

DMSA scintigraphy(dimercaptosuccinic acid):

It is a radionucleoside  scanning that reveals the morphology of renal morphology,structure and function.

Radioactive technetium-99m is combined with DMSA and injected into a patient, followed by imaging with a gamma camera after 2-3 hours.

CT scan:

The CT scan involves the slicing of the kidney and detecting the abnormalities.


TREATMENT AND PROGNOSIS :

Hydration: taking lots of water reduces the infection.Taking lots of water that is 3-4 liters per day

Medications:

  • Nitrofurantoin
  • Sulfonamides
  • Amoxicillin
  • Cephalosporins
  • Trimethoprim/sulfamethoxazole
  • Doxycycline


PROGNOSIS :

The prgnosis is based on the antibiotic course and its effects.

1 week course of antibiotic is needed and it should be follow up


PREVENTION :

  • Practicing good hygiene: You can often prevent UTIs by practicing good personal hygiene. This is especially important for women. Because the urethra in women is much shorter than it is in men, it’s easier for E. coli bacteria to move from the rectum back into the body. To avoid this, it’s recommended that you always wipe from front to back after a bowel movement. Women should also use good hygiene practices during their menstrual cycle avoid infections. Changing pads and tampons frequently, as well as not using feminine deodorants can also help prevent UTIs.
  • Drinking plenty of fluids: Adding extra fluids, especially water, to your daily routine can help remove extra bacteria from your urinary tract. Drinking six to eight glasses of water per day is recommended.
  • Changing your urination habits: Urination can play a big role in getting rid of bacteria from the body. Your urine is a waste product and each time you empty your bladder, you’re removing that waste from your body. Urinating frequently can reduce your risk of developing an infection, especially if you have a history of frequent UTIs. Drinking plenty of fluids will encourage this, but makes sure to avoid fluids and foods that could irritate your bladder. These can include alcohol, citrus juices, caffeinated drinks and spicy foods. You should also try to urinate immediately before and after sex. This could help flush out any bacteria that may have been introduced during intercourse. You can also wash the genital area with warm water before having sex. Don’t douche. This practice isn’t recommended by healthcare providers.
  • Changing your birth control: Some women have an increased risk of developing a UTI if they use a diaphragm for birth control. Talk to your healthcare provider about other options for birth control.
  • Using a water-based lubricant during sex: If you experience vaginal dryness and use a lubricant during sex, use one that is water-based. You may also need to avoid spermicide if you have frequent UTIs.
  • Changing your clothing: Avoiding tight-fitting clothing can actually help keep you dry, preventing bacteria from growing in the urinary tract. You can also switch to cotton underwear. This will prevent extra moisture from getting trapped around your urethra.


Recovery Period :

Bladder infection subside as soon as the treatment is started.

Atleast it might take 2-3 weeks for completet recovery.


Medicines used in the Treatment :

  • Nitrofurantoin
  • Sulfonamides
  • Amoxicillin
  • Cephalosporins
  • Trimethoprim/sulfamethoxazole
  • Doxycycline


REFERENCE :

http://cdc.in

http://sciencedirect.com

http://medicinenet.in

http://who.gov.in

http://medlineplus.org

http://seniorliving.org