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“НАШЕ ЖИТТЯ”, ЧЕРВЕНЬ 2016 WWW.UNWLA.ORG 33 Female Urinary Tract Infections by Ihor Magun , M.D., F.A.C.P. The most common bacterial infection in women of all ages is a urinary tract infection (UTI). Eleven percent of women develop such an infection in any given year, and more than fifty percent of women have it at least once in their lifetime. One in four women have recurrent infections. The exact definition of a UTI is the pres- ence of a pathogenic organism in the urinary tract with related symptoms. These symptoms include one or any one of the following: a need to urinate often, urgency, burning during urination, pain during urination, blood in the urine, a sensation of inadequate emptying of the bladder, offensive odor despite adequate hydration, sudden onset of uri- nary incontinence, cramping pain, and pain during sexual intercourse. Uncomplicated UTIs most commonly af- fect young, sexually active women or women who have a normal urinary tract. Complicated UTIs af- fect women with an anatomic abnormality. The term recurrent UTI refers to three or more infec- tions within twelve months or two or more in six months. The pathophysiology for this infection is simple. Bacteria follow an ascending path and make their way to the bladder. The distance that bacteria travel is short, hence it does not take long for the bacteria to infect the bladder. Most UTIs are caused by bacteria originating from the bowel flora with the most common pathogen being E. coli . Typical diagnostic methods can include urinalysis coupled with a urine culture. The pre- senting symptoms listed above frequently permit the clinician to be confident that the problem is in- deed an infection. One caveat is that at least one symptomatic episode should be verified by urine culture to guide treatment and confirm the diagno- sis. Individuals who present with multiple symptoms as well as systemic symptoms such as fever, back pain, vaginal discharge, or exposure to sexually transmitted diseases, warrant cultures and other investigational modalities. In certain sit- uations, pregnancy testing is warranted as this may exclude a UTI diagnosis. Most infections are treated with a short three day antibiotic course. Because the antibiotic is excreted in the urine, the bactericidal antimicro- bial agents are at sufficient levels to eliminate the offending organism. Some patients with UTI may need urinary tract analgesics such as phena- zopyridine. The precise mode of action of this agent is unknown but when excreted in the urine, it promotes topical analgesia on the mucosa of the urinary tract, thus relieving pain, urgency, burn- ing, as well as urination frequency. Topical analge- sics can give urine a characteristic orange color. This medication is sometimes prescribed with an antibiotic but only if necessary. In postmenopausal women, atrophic vagi- nitis is fairly common because the cells in the vag- inal area change and are predisposed to infections. Topical application of estrogen may be prescribed for those individuals who do get infections. This should obviously be done under the care of a phy- sician and requires monitoring. One popularly recommended antidote to UTI is cranberry treatments, and there may be a good reason for this because cranberries contain proanthocyanidins that actually prevent bacteria from adhering to the cells lining the urinary sys- tem. Ongoing studies are being conducted, but so far all existing research has not prompted any spe- cific recommendations to use cranberry juice or other cranberry products as a prophylactic agent. Nor has such research suggested that cranberry treatment should be used when an infection is ac- tually present. Use of cranberry tablets or juice is certainly a low-risk intervention, so this is an indi- vidual decision. But adequate hydration is always helpful and if you enjoy cranberry juice, this doctor says go for it! Tested helpful suggestions for preventing UTI and its symptoms include maintaining good hygiene, increasing fluid intake, urinating when the urge is present rather than "holding" it for longer time periods, voiding after sexual inter- course (if you know you may be at risk). Management and treatment of UTIs are straightforward. Follow the recommended advice and seek treatment sooner than later because un- complicated, simple infections can ascend the uri- nary system and invade the kidneys, transforming an annoying but simple condition into something far more serious: a complicated UTI that may re- quire hospitalization.
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