Urinary tract infections (UTIs) occur when microorganisms enter the urinary system through the urethra. UTI symptoms vary depending on the infected area. Risk factors include anatomical abnormalities, kidney stones, and sexual activity. Treatment involves antibiotics and completing the full course to avoid complications.
The pathophysiology of urinary tract infection involves infection of urinary tract organs such as the urethra, bladder, ureters, and kidneys. Although different organisms can cause UTI, the pathophysiology of UTI is similar for each organism. Normal urine is sterile, but when a bacterial UTI occurs, the microorganisms enter through the urethra and can travel up or back up to other parts of the urinary system. It is important to treat the UTI to avoid complications.
In all cases, the pathophysiology of UTI begins with the entry of organisms through the outermost part of the urinary system called the urethra. Normal urine is acidic and resistant to bacterial growth, and urine flow is always to the external environment. Other protective mechanisms against bacterial urinary tract infection include bladder emptying, the presence of contracted muscles called sphincters, and the availability of immune cells and antibodies in the urinary mucosa. In men, secretions from the prostate gland minimize bacterial growth.
Bacterial agents, such as Escherichia coli (E. coli), can be transferred from the anus to the urethral opening, causing a urethral infection. E. coli is an organism that lives in the colon and is passed out in the stool during defecation. The relationship between the anus and the urethra explains why UTIs occur more frequently in women than in men. In women, the anal and urethral openings are closer to each other and the length of the urethra is shorter. This leads to easier bacterial translocation and ascension to the upper portions of the urinary tract.
UTI symptoms differ depending on which part of the urinary tract is infected. Symptoms of urethra infection or urethritis may be limited to increased frequency of urination and burning pain when urinating, called dysuria. With bladder infection or cystitis, there may be additional symptoms of pain in the abdominal and pubic regions as well as a low-grade fever. Kidney infection, or systemic pyelonephritis, symptoms include high fever, chills, nausea, and vomiting. In some cases, blood in the urine and loss of appetite may occur.
Several risk factors contribute to the pathophysiology of urinary tract infection. Congenital anatomical abnormalities and acquired diseases, such as kidney stones, can predispose a person to getting a urinary tract infection. Among sexually active people, the frequency of intercourse and the pattern of intercourse increase the risk of urinary tract infections. In older men, the enlarged prostate gland impedes the flow of urine, leading to an increased risk of infection. Immunocompromised states, such as diabetes, contribute to an increased risk of urinary tract infections because the body’s immune cells are unable to fight off the infection.
Treatment of urinary tract infections usually involves antibiotics, such as co-trimoxazole. It is important to follow the full course of antibiotics recommended by your doctor. This is necessary to avoid complications such as scarring of the urethra, strictures and destruction of the renal parenchyma.
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