DYSURIA and PAINFUL URINATION

Urinary Tract Infections and Cystitis

Urinary tract infections are also known as cystitis. Urinary tract infections are caused by the following bacteria, which mainly live in the intestines; E.coli mainly (80%), KLEBSIELLA, ENTEROBACTER, PROTEUS MIRABILIS / PSEUDOMONAS and STAPHYLOCOCCUS SAPROPHYTICUS.

Pyelonephritis

Urinary tract infections can become complicated .These urinary tract infections that are complicated require more intensive care and treatments. These include; PYELONEPHRITIS, which means infection of the kidneys with a bacterium.

Pregnancy and Urinary Tract Infections

Urinary tract infections during pregnancy, as these can cause labor to insue or infect the amniotic fluid of the baby, recurrent or persistent urinary tract infections and urinary tract infections with renal stones.

Urethritis

Urehtritis means infection of the urethra, which is the last tube that urine passes through.

Most common pathogens/bacteria that cause this are: Chlamydia trachomatis - which is spread through sexually intercourse, as it is a sexually transmitted disease, Neisseria gonorrhea and Herpes Simplex virus.

 

VAGINOSIS, VAGINITIS

Vaginitis is caused by numerous organisms, including CANDIDA yeast infections, GARDNERELLA and ATROPHIC VAGINITIS, which are changes and deterioration of the vagina through age, mainly seen in post-menopausal females.

SIGNS and SYMPTOMS of URINARY TRACT INFECTIONS

Symptoms vary depending on where the infections is, worse with early versus late urination. If early, this is an infection of the urethra. If late, this is an infection of the bladder, trigonal region of the bladder.

ASSOCIATED SYMPTOMS

IRRITATIVE SYMPTOMS

Irritative symptoms include FREQUENCY, going to the washroom many times, URGENCY, DYSURIA which is burning pain with urination and NOCTURIA, going to the washroom at night.

OBSTRUCTIVE SYMPTOMS

Obstructive symptoms include HESITANCY, which is taking longer than usually to begin urination, INTERMITTENCY, breaking of your urination into fragments, INCOMPLETE EMPTYING and POST-VOID DRIBBLING, which is the continous dripping of urine after going to the washroom.

URINE COLOUR

Urine colour can point ot an infection or something more serious. Be suspicious is your urine is cloudy and/or dark, there is blood or pus in the urine.

SYSTEMIC SYMPTOMS

Symptoms of involvement of your blood or other organs is a serious event. Systemoc symptoms are fever, chills, night sweats, nausea and vomitting. If any of these symptoms are present, there is concern of progression of the urinary tract infection, such as in pyelonephritis, pelvic inflammatory disease caused by sexually transmitted diseases (PID), and septicemia (infection in the blood).

RED FLAGS

Signs of more serious condition or situation include ABDOMINAL PAIN (pelvic infection), FLANK PAIN (Pyelonephritis? Renal Stone?) and ABNORMAL VAGINAL DISCHARGE (Vaginitis or STD).

COMMON RISK FACTORS FOR URINARY TRACT INFECTIONS

Risk Factors include: BEING SEXUALLY ACTIVE, # OF PARTNERS, SAFE SEX PRACTICES (CONTRACEPTION), POST-INTERCOURSE URINATION/WASHROOM USE, PREVIOUS URINARY TRACT INFECTIONS, RENAL STONES, IMMUNOSUPPRESSED (HIV POSITIVE), DIABETES, HOSPITAL ADMISSION AND CATHETERIZATION, ALCOHOL/SMOKING - both increase risk of UTI's

LABS/INVESTIGATIONS:

URINALYSIS

Urinalysis is basically an analysis of all components in the urine and whether any are elevated, as well as detecting the presence of bacteria, immune cells and blood cells.

A Dipstick can show: Spec. Gravity, pH, Glucose, Protein, Hg, Nitrites (bacteria) , WBCs (immune cells).  A microscope analysis of the urine will show RBCs, WBCs, CASTS, CRYSTALS, BACTERIA. The urine can also be cultured (put on a plate that may grow anything living in the urine like bacteria). Defined as > 100,000 CFU/mL from a mid-stream urine. 80% of the time it grows E.coli.

INFECTION OF THE KIDNEYS

If an infection of the kidneys is suspected, pyelonephritis, the following tests are usually done; an ULTRASOUND to find any obstruction, CYSTOSCOPY, SPIRAL CT scane and a VOIDING CYSTOURETHROGRAM.

MANAGEMENT AND TREATMENT OF URINARY TRACT INFECTIONS

These include EDUCATION AROUND RISK FACTORS, POST-INTERCOURSE URINATION, INCREASE FLUID INTAKE, advice the patient to GO TO EMERGENCY IF THEY HAVE A FEVER, ABDOMINAL PAIN OR RENAL STONE.

ANTIBIOTIC THERAPY

BEGIN ANTIBIOTIC THERAPY IF a) SYMPTOMATIC or b) CONFIRMED ON CULTURE THAT THERE IS AN INFETION. Treatment consists of TMP/SMX for 3days or NITROFURANTOIN for 3days (especially if patient may be pregnant), AMOXICILLIN for 3days or CIPROFLOXACIN or ANOTHER QUINOLONE (e.g. such as NORFLOXACCIN) for 3days. Do NOT need to treat asymptomatic bacteriuria if less than 100,000 CFU/mL on MSU.