Recurrent Urinary Tract Infections Require Careful Investigation And Treatment

Question: Our four-year-old daughter was recently diagnosed with her fourth urinary tract infection. Her first infection happened when she was 5 months old. After the second infection, our doctor referred her to an urologist. She had ultrasound and X-rays, and we were told that she might need an operation later. Since then she has had two more infections, and the last one was quite bad, with high fever for several days. Can you suggest what we can do to prevent these infections?

Answer:

It looks like your daughter has a fairly serious urinary problem. In order to answer your question about prevention, let me explain in more detail about the female urinary system.

All of us have two kidneys that filter waste from our blood and produce urine. Each kidney has a small tube (called ureter) that brings urine to the bladder. At the junction of the ureter and bladder, there is a one-way valve that prevents backflow of urine. The bladder holds urine until it is full, then sends a signal to the brain to empty the bladder through the urethra.

In females, the urethra is very short and ends between two small folds just in front of the vagina. This area of the female is called the introitus. In males, the urethra passes through the penis. Bacteria that cause urinary infection have to climb from outside the urethra into the bladder. That is why females get more urinary infection: bacteria have a shorter distance to get to the bladder.

Most of the bacteria that cause urinary infections are normal germs found around the female introitus. Why they cause infection in some but not in others is not totally clear. Some of these bacteria are more “invasive” and cause infection more easily. Research has also shown that in some women, bacteria can attach easily to the urethra, therefore getting an easier foothold to start infection.

Moisture is also an important factor. Because of the anatomy of the introitus, moisture and urine tend to stay. Normal bacteria break down urine into ammonia, which is very irritating to the introitus, causing inflammation and infection.

Abnormal development of the urinary system can also cause bladder and kidney infections. If the one-way valves between the bladder and the two ureters are not developed properly, urine can flow backwards from the bladder into the kidneys. This will allow bacteria to travel up to the kidneys and cause kidney infection.

In general, kidney infection is more serious than bladder infection. These patients look sicker, with high fever, headache, backache, or vomiting. Whenever there is kidney infection, there is a chance of damage to the kidneys.

In contrast, bladder infection is often milder. The symptoms include lower abdominal pain, frequency (feeling the need to urinate when the bladder is not full), urgency (has to rush to washroom), pain or burning feeling during urination, and sometimes cloudy or blood in the urine.

Treatment of urinary tract infection requires antibiotics. For simple bladder infections, antibiotics by mouth are effective. Most doctors recommend treating for 3 to seven days, although research suggested a single large dose of antibiotic can be effective.

For those who have kidney infections, it may be necessary to give intravenous (IV) antibiotics for the first few days to control infection, then finish the course with oral antibiotics.

In recurrent urinary tract infection, it is important to prevent some, if not all, of the infections. A daily antibiotic (at a lower dose) over 6 to 12 months is effective. For those who have back flow of urine to the kidneys, antibiotics may have to be continued for several years. Some of them may require an operation to stop the back flow of urine and prevent future infections.

You may have heard of the danger of antibiotic overuse. In this particular situation, preventative use of antibiotics is not overuse and does not harm the body. However, your physician should supervise this treatment.

In addition to antibiotics, there are other important strategies. Washing the introitus area daily can remove urine and prevent infection. You should teach your daughter to wipe herself from the front to the back after urinating, which avoids bringing germs from around the anus. Wearing underwear that allows air circulation can be helpful too.

Drinking cranberry juice (or eating dried cranberries) have been shown to reduce bladder infection. This may be worth trying in addition to all other measures discussed here.

In some females, constipation seems to be associated with urinary tract infection, although the reason is not clear. Sometimes preventing constipation can completely stop this infection. Bubble bath has also been associated with bladder infection, and should be totally avoided.

If she likes to hold the urine for a long time, she should change this habit. Keeping urine in the bladder for too long encourages bacteria to grow there and set up infection. Drinking lots of water and regular urination can reduce the growth of bacteria.

Lastly, if a person has repeated infections, especially kidney infections, it is important to check out whether there is an abnormality in the urinary system. Some of these problems can be corrected by surgery.

In summary, recurrent urinary tract infection is a serious problem that requires careful investigation and management.