Urinary tract infections are disorders that can affect different parts of the urinary system: kidneys, ureters, bladder or urethra. They can affect both sexes and in any age group, although they are more frequent in women for several reasons, which we will discuss later. Cystitis and urethritis are the most common urinary infections and, in general, have a benign course, provided they are treated properly. Sometimes, however, these disorders can be very annoying and become chronic, that is, they recur frequently in the same person. Furthermore, if neglected, they can lead to very serious complications, such as kidney infection, called pyelonephritis, kidney failure or even septicemia. For this reason, urinary tract infections should never be underestimated.
Before proceeding, I remind you that the urinary system is made up primarily of two kidneys, which filter the blood, cleaning it from waste substances and giving rise to urine. This is conveyed into the bladder through two thin tubes, one for each kidney, called ureters. The urinary bladder is a kind of pouch that receives urine before emptying itself through urination, which is the act of expelling urine outside. Urination is made possible by the urethra, a thin tube which connects the bladder to the outside. Kidneys, ureters, bladder and urethra are therefore all part of the urinary tract. This brief reminder allows us to divide urinary tract infections into two broad categories: those of the lower urinary tract and those of the upper urinary tract.Lower tract infections occur more frequently in the bladder, and in this case we will speak of cystitis, or they can affect the urethra, resulting in the so-called urethritis. Less frequent but associated with a more critical clinical picture are cases of pyelonephritis, which are upper urinary tract infections that arise when the infectious process affects the kidneys. Compared to men, women are more susceptible to urinary tract infections due to several predisposing factors. To explain this phenomenon, let's start from an anatomical consideration. The urethra, or the small channel that allows the outflow of urine from the bladder during urination, has different lengths in the two sexes. Men have a longer urethra, since it extends from the bladder to the apex of the penis, passing through the prostate. If the male urethra measures about 15-20 cm, the female one is just 3-5 cm long. In women, therefore, infectious agents can easily go up and reach the bladder due to the shortness of the urethra. Furthermore, still in women, the infection is favored by the proximity of the urinary meatus, that is the external opening of the urethra, with the vaginal and anal orifices. This translates into a greater possibility of contamination by germs of intestinal origin. Pregnancy and urethral trauma during sexual intercourse can also promote urinary tract infections. On the other hand, it must be said that the "man, having a longer" urethra, is more exposed to the risk of urethritis, since the greater the tract is. disposition of pathogens to take root.
But why do urinary infections occur? We mentioned that some infectious agents coming from the intestine, therefore present in the anogenital area, can reach the urinary tract by going up the urethra. In addition to this path, called ascending due to the upwelling of pathogens from the outside, germs, albeit more rarely, can also reach the urinary tract via the blood and lymphatics. Responsible for urinary tract infections are mainly bacteria that normally colonize the genitals external or are part of the normal intestinal flora, such asEscherichia coli. Under certain conditions, these normally harmless microorganisms can reproduce in the urinary tract causing infection. Less frequently, they are referred to as viruses or fungi, such as Candida albicans. Chronic, and therefore recurrent, urinary infections may instead represent the sign of anatomical-functional anomalies, which facilitate the entry of infectious agents into the bladder, or cause the reflux of urine from the bladder towards the ureter. In general, regardless of the causes that cause it, urinary stasis in the bladder, in addition to promoting the survival and proliferation of bacteria, can facilitate the spread of infection to the upper urinary tract, or to the renal parenchyma. Among the possible structural anomalies that predispose to urinary infections, we also remember congenital malformations, tumors, the presence of stones in the urinary tract or kidneys, and strictures, ie narrowings, of the urethra. In humans, infections of the urethra. urinary tract can be linked to problems affecting the prostate, such as benign prostatic hypertrophy, that is the enlargement of the gland, which can cause problems with urinary obstruction. Other causes of urinary tract infections include catheterization and predisposing diseases of various kinds , such as diabetes, immune deficiencies, vaginal infections and some neurological disorders.
Urinary tract infections generally manifest themselves with characteristic symptoms, such as discomfort and burning when urinating, an urgent need to urinate, pain in the lower abdomen and in the lumbar region. It is also common to feel the need to urinate more frequently, although the expulsion of urine is often painful, difficult, weak in intensity and associated with the sensation of incomplete emptying of the bladder. The urine can also be cloudy, dark in color and with a pungent odor. Sometimes, it can have traces of blood. Other symptoms associated with urinary infections can be fever, vomiting and diarrhea. Fever and lower back pain, in particular, are warning signs of a possible kidney infection, called pyelonephritis, which deserves immediate medical attention.
Often, the symptoms listed above are sufficient to make a diagnosis of urinary infection. To confirm the presence of an infection, urinalysis and urine culture are still required. The urine test will show the presence of white blood cells, bacteria and, in some cases, red blood cells. Urine culture with an antibiogram, on the other hand, allows to isolate the specific responsible microorganism and verify its response to specific antibiotics, in order to select the most effective drug. In relapsing forms or in the case of pyelonephritis, it may be useful to undergo a more in-depth examination, with a renal ultrasound or a cystoscopy, to check for the possible presence of an anatomical-functional problem of the urinary system.
Treatment of urinary infections involves drug treatment, often with antibiotics or urinary antiseptics that must be prescribed by the doctor. Therapy should be followed for the entire indicated period, even when symptoms tend to disappear quickly. The risk of prematurely discontinuing treatment is to develop relapses and promote bacterial resistance to antibiotics. In the presence of a more serious infection, hospitalization and intravenous antibiotic treatment may be necessary. Pyelonephritis, in particular, if not recognized and treated quickly, can cause permanent damage and compromise kidney function, even leading to the need for dialysis. Finally, if the infection is sustained by anatomical defects of the urinary system, surgical correction of the anomaly itself can be resorted to.
Often, prevention is an effective weapon against urinary tract infections. First of all, it is good practice to take care of intimate hygiene daily, especially during the menstrual period and before and after sexual intercourse. Women must pay particular attention to washing and cleaning themselves with direct movements from the vulva to the anus, never vice versa. Otherwise, you risk transferring the fecal bacteria to the vaginal and urinary orifices. In addition, harsh intimate cleansers, synthetic fiber underwear and clothing that is too tight should be avoided. For the prevention of urinary infections, it is important to avoid holding urine for a long time if you feel the need to empty the bladder, and to promote intestinal transit, avoiding constipation. To promote the flow of urine and maintain proper daily hydration, it is also recommended to drink at least a couple of liters of water a day. An excellent natural remedy for preventing further urinary infections and fighting those in progress is the American cranberry, also called cranberry. Also useful in this sense are mannose and bearberry. On the other hand, refined sugars, which favor the proliferation of bacteria, should be avoided or limited. Even spicy and very spicy acid foods, alcoholic beverages and coffee can irritate the urinary tract, further intensifying the burning and pain associated with these infections.
