By Vicky Wandawa
It is bad enough, even just once, to feel a burning sensation as you pass urine. It is even worse, weeks after you just completed medication to ease the discomfort, only for it to strike again. A short call just might become a nightmare and so is the case with recurrent urinary tract infections (UTI).
Charles Simuya, a specialist at the Skin and Sexually Transmitted Infections Clinic, Mulago Hospital, defines a UTI as an infection of the urinary tract; the kidney, ureter, bladder or urethra.
When the infection occurs often, for example, twice in four months, six months or even four infections in one year, this is defined as a recurrent UTI, Henry Bukenya, a gynaecologist with Mulago Referral Hospital, says.
The subsequent UTI is usually caused by a bacteria that is different from the one which caused the previous infection — meaning that the new infection differs from the last one.
Women prone to recurrent UTIs
Both adults and children can suffer from recurrent UTIs, although women are more susceptible because of their anatomy. Women have a much shorter urethra than men, which allows bacteria to ascend more easily into the bladder.
Furthermore, Catherine Nyangabyaki, a paediatrician at Nsambya Hospital, notes that even when it comes to children, UTIs occur more in girls than boys — for the same reasons.
Signs and symptoms
Dysuria: This is a burning sensation one feels when passing urine.
False full bladder feeling: When the bacteria keep tickling the sphincter muscles (which are meant to act as ‘locks’ that control the bladder), they create a tickling sensation that makes one feel like one has a full bladder, though on going to the toilet, there is little or no urine to pass. The full bladder feeling, even as you are sleeping may prompt you to go to the toilet.
Bed wetting in children: The false full bladder feeling could onset bed wetting even if the child had outgrown the habit. Children are more likely to wet the bed because unlike adults, they may not easily wake up at night when they feel the urge to pass urine because they are not alert enough.
Painful sexual intercourse: Pain during sex, especially for women, may be a symptom of UTI. Furthermore, pain in the lower abdomen, especially in women, itching around the private parts and an odourless discharge from the vagina could be point to a UTI.
Irregular periods: When a woman misses her period and she is not pregnant, she just might be suffering from a UTI.
UTIs in children
In children, the signs and symptoms vary, depending on the age. In infants, about six months old, the signs may be general, ranging from vomiting, low appetite and fever, which Simuya says often, parents could mistake for malaria.
In older children, the symptoms are similar to those of adults, for example, pain while passing urine and an increased urge to urinate.
Diagnosis of recurrent UTIs
Bukenya explains that for a clear diagnosis of recurrent UTIs, a vaginal swab is done. Here a spatula is swiped inside the vagina to pick up the bacteria and a culture or assessment test done. In males, a culture test is done on the discharge from the penis.
A culture test is the evaluation of fluid, tissue or other products of the body to look for abnormal cells, indicating the presence of viruses, bacteria or fungi.
“The test is done to access the particular kind of bacteria, so that the right prescription made,” Bukenya explains.
What causes chronic UTIs?
Causes of recurrent UTIs
Underlying causes: Bukenya says if the underlying cause has not been identified, a UTI can reoccur. For example, if a woman continuously contracts the infection from using a dirty bathroom or toilet, despite treatment, she will still get re-infected unless she uses a cleaner toilet or bathroom.
Poor adherence to treatment: Often, the reason people with UTIs seek treatment is due to the resultant pain. However, the pain may ease when an antibiotic, or painkiller is taken. “But that does not mean the infection has cleared,” Bukenya warns. It is, therefore, important to take the full dose.
Treatment of both partners:
When one partner in a sexual relationship is treated, there is a chance the UTI may strike again, as the chances of re-infecting one’s partner are higher. It is, therefore, important that both sexual partners are treated.
Diet: Bukenya says if someone does not drink enough water, this predisposes one to recurrent UTIs. “Drink at least three litres of water to cleanse your body. If you consume a lot of junk and alcohol and do not drink enough water, you are likely to suffer from recurrent UTIs,” he says.
Tight clothes: That tight stylish pair of jeans may be in vogue, but it could be the reason you are suffering from recurrent UTIs. Women have normal flora or bacteria within their private parts. When suffocated, these bacteria die and develop into infections, such as UTIs.
Also, when a female does not wipe herself after a short call, some urine may drip onto the pants, so if they are tight, this leaves no room for aeration, killing the normal flora, hence increasing chances of infection.
Furthermore, Simuya adds that when children, especially girls, sit on a dirty floor without underwear, they can easily contract infections, sparking off a UTI.
Poor hygiene: Simuya warns about poor cleaning techniques, such as wiping the anus after passing stool. “One should wipe from the front to the back to prevent bacteria around the anus from entering the vagina or urethra. When the faeces are carried to the vaginal area, this predisposes one to UTIs,” Simuya explains. “Females should be taught how to clean the vaginal area, right from childhood.”
Uncircumcised men: Bukenya explains that when passing urine, a man’s penis is erect and thereafter, it becomes flaccid. With a circumcised penis, the last drops of urine are likely to end up on the underwear or trousers and ultimately dry.
However, when an uncircumcised man’s penis becomes flaccid after passing urine, the foreskin covers the glans or penis and the last drops of urine may collect in the foreskin. Eventually, this forms a porridge-like substance (smegma), which can result in a UTI infection.
Furthermore, a man can pass on the UTI to his sexual partner if he does not wash his penis before sexual intercourse.
Wearing dirty underwear: This predisposes one to UTIs, Nyangabyaki says. Simuya adds that in children, especially those above six months, care should be taken to change the underwear at least every hour, or the child may contract a UTI.
Furthermore, Nyangabyaki notes that when a child wears a diaper, the urine is able to get soaked and may not affect the baby. “However, if the child passes stool and he is not cleaned promptly, this may result in a UTI.”
Vesicoureteral reflux: This is a rare condition that involves an abnormal backward flow of urine from the bladder to the ureter and towards the kidneys. It can result in a UTI. The condition may be present at birth, but can be treated by a surgical procedure.
An ounce of prevention is worth a pound of cure
It is important to identify the underlying cause before embarking on treatment of recurrent UTIs. Secondly, keep the private parts dry to keep bacteria away. Women, especially, should wipe from the vagina to the anus with soft tissue every time they use the toilet, Bukenya says.
He recommends that women use water to clean their private parts because unlike wiping, it removes the bacteria. “Muslim women rarely contract UTIs because they use water to clean up after using the toilet.”
Furthermore, do not resist the urge to urinate because you are holding a waste product with bacteria that may cause a bladder infection.
Cleans the genitals before and after sex.
Avoid using feminine hygiene sprays and scented tissue on the private parts as they can kill the good bacteria.
Avoid nylon underwear as this material hinders aeration, creating an environment that is conducive for bacteria to multiply.
Avoid tight pants.
Drink plenty of water every day.
Urinate when you feel the urge to.
Take a shower instead of a bath, as this helps prevent bacteria from entering the urethra.
School-going children, especially in boarding schools.
Uncircumcised men, especially those who do not practice good hygiene.
People with multiple sexual partners.
Women who use public toilets.
Pregnant women, as their immunity is compromised.
“At Mulago Hospital, Bukenya says, in a day, an average of 15 patients suffering from UTIs are treated. Out of these, 12 are female and amongst them, three are girls. Simuya adds that he attends to about five children with a UTI weekly.
For effective treatment of recurrent UTIs, it is advisable not to use the medication that was given previously because it would not clear the new infection. “The bacteria that cause UTIs manifest in different forms. So each time the patient returns for treatment, a different combination of antibiotics should be prescribed,” Bukenya emphasises.
According to Bukenya, recurrent UTIs can result in complications of the reproductive system such as pelvic inflammatory diseases, especially in women.
In some adults, recurrent UTIs may scar the kidneys, which over time, can lead to renal hypertension and eventual kidney failure. Most adults with kidney damage have other predisposing diseases or structural abnormalities.
Therefore, recurrent urinary tract infections, even in the kidneys, almost never lead to progressive kidney damage in a healthy person.
When a UTI is not treated effectively, it can result in kidney damage.
Simuya warns, “If not treated, especially in children, may not only damage the kidneys, but can also result in high blood pressure later in life.
This is because when the kidneys (which are meant to get rid of waste products in the body), fail to function, this may result in high blood pressure.”