Urinary Tract Infections, better known as UTIs, are extremely common. Patients can experience one and be treated completely via the outpatient setting. However, if a UTI goes untreated, it can lead to other more serious health concerns. Let’s go over what a UTI is and proper patient education.
What is a UTI?
A Urinary Tract Infection is an infection anywhere in the urinary system. This can include the urethra, ureters, bladder, and even the prostate. You might even hear pyelonephritis as being an ‘upper UTI’ because it is involving the urinary system, just further up into the kidneys.
Cause
The most common cause of Urinary Tract Infections is Escherichia coli, better known as E. coli. But the introduction of other organisms can also lead to a UTI. Including klebsiella, proteus, pseudomonas, and Staphylococcus saprophyticus.
Risk Factors
There are many risk factors for developing a UTI, the most common one is being a female. Additional risk factors include sexual activity, frequent use of feminine hygiene products, pregnancy, and synthetic underwear. In the summer, wearing wet bathing suits and being in a warm bath or hot tub for many hours can also lead to a Urinary Tract Infection. Having a history of UTIs additionally adds a greater risk for developing another one later on down the road. Other risk factors include being post-menopausal, having an indwelling urinary catheter, being incontinent, and having poor personal hygiene.
Symptoms
The most common early symptoms of a Urinary Tract Infection include pain or burning with urination, frequent urination (aka polyurea), feeling the need to urinate even on an empty bladder, and blood in the urine (possibly not seen with the naked eye). As the infection gets worse, the patient may present with lower abdominal or back pain/tenderness, nausea, vomiting, fever, and chills.
It is important to note that UTIs are common in older adults and symptom presentation might be slightly different. Geriatric patients with Urinary Tract Infections might experience confusion, sudden incontinence, and be unable to sleep at night. As the infection progresses their vital signs may change as well. For example, they may experience hypotension (aka decreased blood pressure), tachycardia (aka increased heart rate), tachypnea (aka fast/shallow breathing), and a fever.
Labs
If a patient presents with any of the abovementioned symptoms, it is important to run some labs to determine if they do in fact have a UTI, the cause, as well as the appropriate treatment. So what labs do we perform?
Urine Test
First off, we are going to collect a sample of the patients’ urine and perform what we call a urinalysis. Educate the patient on how to perform a clean catch urine sample. Be sure to include proper cleaning pertinent to the gender of the patient. If the patient is unable to perform the collection on their own, see if they have an indwelling device you can collect from. If not, we can always perform a more invasive option, called a straight catheterization on the patient.
From this collection, we can run what’s called a culture and sensitivity test. Expected UTI findings include increased white blood cell (aka WBC) count, bacteria, sediment, and red blood cells which can sometimes be seen with the naked eye. The urinalysis will also likely come back positive for leukocyte esterase and nitrates.
Blood Tests
We can also collect a blood sample from our patient and send it to the lab to determine what their WBC (aka White Blood Cell) count is. If elevated, it’s indicative of infection, pair that with their UTI symptoms and you have a pretty good understanding of what’s going on.
Patient Education
Educate patient on what a UTI is using language they understand. This will look different for various patients. Inform them of the treatment plan and encourage non-pharmaceutical remedies they can try at home. In addition, we need to educate our patients on the importance of proper hygiene, risk factors, symptoms, cause, and prevention. This way we can help avoid another UTI and/or encourage the patient to seek treatment sooner if symptoms are experienced.
Treatment
There are various treatments, both pharmaceutical and non-pharmaceutical, for patients experiencing a Urinary Tract Infections. The treatment plan is going to be based on how far along the infection is, the cause, the patients age, and if they have any other comorbidities. Let’s start with the non-pharmaceutical remedies.
Non-Pharmaceutical
Non-pharmaceutical remedies are typically used in conjunction with prescribed medications or when a patient feels a UTI coming on but doesn’t yet have any symptoms or access to a provider. Increasing fluid intake and the classic cranberry juice is a well known non-pharmaceutical remedy. But did you know that urinating every 3 hours, using sitz baths, and showering daily are also encouraged?
Pharmaceutical
In addition to the non-pharmaceutical remedies, the doctor will also prescribe an antibiotic to help treat the infection. The antibiotic will be chosen based on the cause of infection. In addition to an antibiotic, the doctor may also prescribe an analgesic, such as phenazopyridine, to help with the pain of the Urinary Tract Infection.
Prevention
After a patient comes in for one UTI, it’s important to educate on the prevention of another UTI because as we know, having one increases our chances on having another. Educate patients on the importance of hydrating and hygiene. Encourage showers rather than baths. Inform on the importance of emptying the bladder every 3 to 4 hours rather than waiting till it’s completely full. Educate on urinating before and after sexual activity and on the proper way to wipe after urinating. Inform patients on the proper type of fabrics to look for in underwear and never to sit in a wet bathing suit. If the patient is prone to UTIs, have then drink cranberry juice to decrease the risk of infection.
If Left Untreated…
When a Urinary Tract Infection is left untreated it can become very dangerous to the patient. The infection will worsen and travel up the urinary tract until it reaches the entire body. Urethral obstructions, pyelonephritis (aka a kidney infection), chronic kidney disease, urosepsis (sepsis originating from the urinary tract affecting the entire body), septic shock, and even deaths have been reported from untreated UTIs. Which is why patient education, labs, access to healthcare, and proper treatment is so important.
For more information on sepsis, visit Patient Education: Identifying Sepsis and Understanding its Care and Treatment.
Do you treat patients with UTIs? Comment below!
Plus be sure to check out the rest of the Patient Education Series:
- How to Spot a Stroke and Save a Life
- A Guide to Treating and Managing Type 1 Diabetes and Type 2 Diabetes
- How to Effectively Manage Acute and Chronic Pain
- What is Hypertension? Causes, Symptoms, and Treatments
- What is Heart Failure? Risk Factors, Symptoms, and Treatments
- What is Asthma? Risk Factors, Symptoms, and Treatments
- What is COPD? Risk Factors, Symptoms, and Treatments
- What is Pneumonia? Symptoms, Labs, and Treatments
For more information on UTIs by the CDC, click here.