Urinary Tract Infections-The Importance of Early Treatment

Urinary Tract Infections-The Importance of Early Treatment

Posted by AskNurseLinda on Nov 12, 2018 11:34 am

Readers often send questions that contain important that would benefit everyone. Recently, a very enlightened reader asked about urinary tract infections (UTI). This is a common problem that needs to be addressed periodically. It is easy to get lulled into commonplace self-care activities that thinking about catheterization and UTIs can be put to the back of your mind.

UTI is more common in individuals with spinal cord injury, paralysis or movement disorders for a variety of reasons. First, catheterization offers opportunity for bacteria to enter your urinary tract. Even with the best pre and post catheterization hand washing and urethral cleaning, bacteria can still slip in. Careful attention to hygiene is a must when catheterizing as well as general body cleanliness, especially after a bowel movement-planned or incontinent.

The location of the genitals is in a warm, dark, moist area created by natural body flora and positioning. This is a classic environment for bacteria to thrive. Adding water proof containment such as condom catheters or urine containment apparel only increases the warmth, darkness and moistness of the area. To combat this perfect storm of bacteria growth, in addition to careful hygiene, individuals might opt to ‘frog’ for 15-20 minutes a couple of times a day. To frog, you need to remove all clothing and urinary containment, part the legs even propping them open to allow air and light to circulate around the groin. This will destroy any bacteria that has found a home in this area. It also helps to clear up skin rashes.

Keeping your urine dilute will assist in moving bacteria out of the bladder before it can multiply. This can affect your catheterization program so be cautious in adding fluid. Just a swallow or two of water every hour can help move fluid through your urinary tract. Consult your healthcare professional before increasing your fluid to ensure your bladder program and your heart function can tolerate an increase in fluid. Large amounts of water taken in at one time is not recommended.

Be cautious of the quality of fluid that you are drinking. Sugary drinks will leave sugar in your urine. Bacteria love sugar. It helps them grow and survive. Caffeine and alcohol will dehydrate your body. Some sports drinks, energy drinks and electrolyte replacements contain excessive sugar and caffeine so read the label to make sure you are not ingesting substances that are harming you in the long run.

Diabetes, which is a risk for individuals with spinal cord injury, can affect your risk for UTI because sugar is expelled in the urine. Again, that sugar in the bladder is a perfect medium for growing bacteria.

Lack of movement is another risk for increasing UTIs. When you move your legs, your abdominal muscles are activated. This helps shake the bladder. It also helps the bowel function. When the bladder is shaken periodically with movement, bacteria have less opportunity to adhere to the bladder wall or to clump together. Something as simple as performing range of motion exercises, changing position, doing pressure relief, all help move your body which shakes the bladder.

Age and gender are other risks for UTI. Some people become less active as they age. They might not drink as much or feel the urge to toilet as often. Hygiene becomes more difficult especially for ladies. These issues do not happen to everyone. But healthcare professionals know that older, less active women will probably have a urinary infection.

From these factors, you can see a number of risks for getting a UTI. Even with best efforts, a UTI can be lurking in your future. This is not an indication of failure on your part but a consequence of spinal cord injury, paralysis or movement disorders. It has nothing to do with your excellent care of your body, but the risks are great.

The most classical symptoms of a UTI is pain or burning with urination or a strong urge to urinate.  If lack of sensation is an issue, you will not feel this symptom. You could have an increase in spasticity due to uncommunicated pain or burning as your body tries to tell you something is amiss. You also could have referred pain to a shoulder or jaw. Sometimes, there are no symptoms physically, but you might notice a change in your urine or output or even incontinence.

More often individuals with SCI might notice a foul odor to their urine. You might not smell an odor to your urine if you use a closed urinary collection system if you do not drain it before discarding it. Other signs of a UTI that you might notice are cloudiness, increased sediment, mucus, or even a faint tinge of blood or blood strands in your urine. You might develop a fever or just have ‘the blahs’ noting that you do not feel like your normal self.

The color of urine varies from slightly yellow to a straw like yellow. Dark or orange-ish urine is too concentrated. Water is needed to dilute it. The important thing is to look at your urine to see if it looks different. Some people might typically have sediment in their urine, but they might notice an increase. You should never see blood in your urine.

Some people who have a UTI will have all these symptoms, but others will have only one or two symptoms. It is important to note that not all the symptoms have to be present when you have a UTI. Some individuals will not have any symptoms. Therefore, it is a good idea to a urinalysis at your regular checkup.

If you suspect a UTI, you will need to submit a urine sample for testing. Some facilities will let you have a sterile cup for specimen collection that can then be dropped off at a lab for testing. Keep the cup in the packaging until ready to use so the cup remains sterile. To get a specimen that is not contaminated, wash your hands and your urethra before collection.

Try to get a sample, midstream of urinating. If you use a catheter, collect the sample midstream. If you use a urine collection device such as a condom catheter, remove the catheter and collect the sample as the urine exits your body. You want a fresh sample of urine, not one that has been in your collection bag where it accumulates bacteria.

When you drop off your specimen, be sure to pick up a sterile cup to have on hand should you need it for the future.

The testing that will be performed on your urine is called a urinalysis (U/A). This will assess the quality of your urine and check for the presence of bacteria. There should be no bacteria in your urine, although sometimes there might be one or two bacteria just from contamination. A number of bacteria or white blood cells present in your urine indicates an infection. White blood cells are the bodies natural defense to kill bacteria so a large presence of white blood cells in your urine indicates they are there working to remove bacteria.

Once it is determined by the urinalysis testing that a urinary tract infection is present, a second test called a culture and sensitivity (C&S) is completed. This test will assess the bacteria to see which antibiotics will kill the bacteria present in your urine. Antibiotics are developed to kill specific bacteria. Taking an antibiotic that does not affect the specific bacteria in your urine will not rid you of the infection.

Antibiotics are developed in what is called generations. The first antibiotics developed (penicillin’s) are called first generation antibiotics. Over time, more advanced antibiotics have been developed, in different generations. We are in the fourth generation now but quickly working on fifth and sixth generations. You want to catch bacteria early so you can use the lowest level generations possible.

Bacteria are interesting organisms. They exist to multiply themselves. A few bacteria like those in your gut help you to digest food but otherwise, bacteria do nothing to help you. Their goal is to make more bacteria and quite frankly, they don’t care if you die in the process. You would think they would want you, the host, to stay alive so they can thrive, but they don’t. They multiply until they destroy the host and thereby destroy themselves.

Bacteria multiple exponentially every 4 to 20 minutes depending on the type of bacteria, and the moisture and temperature of their environment. If one bacterium is present, on average, in 10 minutes, you will have two, but in 20 minutes, you have six. In an hour you could have thousands or even millions depending on the multiplying conditions of the bacteria. Bacteria replicate themselves. It is their sole purpose.

Every time you take an antibiotic, the bacteria are learning how to live despite the antibiotic. Even if you feel better, you need to take the entire prescription of antibiotic to be sure you have eliminated all of the bacteria. Once the number of bacteria is controlled by the antibiotic, you might feel better but there are still bacteria present. These left-over bacteria become stronger, unless you take the entire prescription to ensure the death of all of the bacteria.

If you start with a high-level generation of antibiotic, you are teaching the bacteria how to survive on the top level of antibiotics. Therefore, lower generations of antibiotic are actually better. Once you get to the highest level of antibiotic, there currently is no higher level to beat the next evolution of bacteria. Researchers are working on higher level generations of antibiotics, but these are infinitely hard to find. Because of prescription of top generation antibioitcs, there are super bacteria for which there is no treatment.  

If you suspect a UTI, it is best to get treatment rapidly to avoid development of super bacteria or to keep infection from spreading to your kidneys and eventually your blood stream where the infection can spread throughout your body leading to sepsis which can be deadly.

There are some advertisements for natural treatment of UTI or treatment of bacteria without antibiotics. As an individual with spinal cord injury, you do not want to take the chance of any infection spreading or even lurking to multiply becoming stronger. The risks are too great that the infection should turn into sepsis or that you will need advanced antibiotics to treat it. Prevention of infection through hygiene and fluids is a perfect start. Nurse Linda

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