Urinary Tract Infections

Escherichia coli are the bacteria often responsible for most cases of urinary tract infections. However, other pathogenic microorganisms including viruses, parasites, and fungi may also cause UTIs (McLellan & Hunstad, 2016). Urinary tract infections can affect both the lower and the upper urinary tracts.  These infections negatively affect the functionality of the kidneys, the ureter, and the prostate (Walsh & Collyns, 2017). The symptoms of UTIs may differ from one person to another. However, these cases must be treated promptly to avoid complications. This paper addresses the pathophysiology of the urinary tract infections, and highlights the differences between upper and lower UTIs.

Pathophysiology of UTIs

Despite the frequent contamination of the distal urethra with colonic pathogenic microorganisms, the urinary tract is normally sterile and resistant to colonization by bacteria. Infections rarely occur if there is a complete emptying of the bladder, the immunologic and mechanical barriers are intact and the urine acidity level remains normal (McLellan & Hunstad, 2016). The infections occur when the pathogenic bacteria gain access to the lower urinary tract. These bacteria attach, colonize and cause the inflammation of the urethra and the bladder which are the main parts of the lower urinary tract (Walsh & Collyns, 2017). They devised this mechanism to avoid being washed off by urine during voiding. The pathogenic bacteria can also travel through the urethra and reach the upper parts of the urinary tract leading to the infections of the kidneys and the ureter (Walsh & Collyns, 2017).

Similarities and differences: upper and lower UTI

The similarity between the upper and lower urinary tract infections is that they are both caused by pathogenic microorganisms that gain access to the urinary tract system. The two conditions negatively affect the functionality of the urinary system (Jarvis, Chan & Gottlieb, 2014). The structures affected by these infections are one of their major differences. Whereas the lower UTIs affect the urethra and nth bladder, the upper UTIs affect the kidneys and the ureters. The symptoms of upper and lower UTIs also differ significantly. The symptoms of the upper UTIs infections include nausea and vomiting, fever, chills and upper back pain (Smelov, Naber & Johansen, 2016). On the other hand, the symptoms of the lower UTIs include lower abdominal discomfort, pain and burning during urination, hematuria, and increase urination frequency (Walsh & Collyns, 2017).

Patient factor 1: Gender (female anatomy)

The risk of UTIs is higher in women than in men. The high risk is contributed by the short urethra and the proximity of the external genitalia to the anus. This implies that pathogenic bacteria travel a shorter distance to reach the urethra and other parts of the urinary tract than in men (Tan & Chlebicki, 2016).

Patient factor 2: Behavior (sexual activity)

The risk of UTIs is higher among sexually active persons. The risk is even higher among women with multiple sexual partners (Tan & Chlebicki, 2016).

Impact of patient factors on pathophysiology and treatment

Individuals, who are sexually active, can develop UTIs since sexual intercourse drives a large number of pathogenic bacteria closer to the bladder and upper parts of the urinary tract (McLellan & Hunstad, 2016). The closeness of the external female genitalia to the anus predisposes women to the risk of UTIs since bacteria can be easily spread from the anal region to the urethra (Tan & Chlebicki, 2016). During the diagnosis of UTIs, the care provider must look at the sexual activity of a person to determine whether the risk was increased by inappropriate sexual activities and multiple sexual partners (Smelov, Naber & Johansen, 2016). Patients may be advised to ensure they urinate immediately after sexual intercourse to clear pathogenic microorganisms for the urethra (McLellan & Hunstad, 2016). Women may be advised to avoid feminine products that may irritate the external genitalia to reduce the risk of infections (Walsh & Collyns, 2017).

Conclusion

Even though Escherichia coli are the bacteria often responsible for most cases of urinary tract infections, other pathogenic microorganisms including viruses, parasites, and fungi may also cause UTIs. The infections occur when the pathogenic bacteria gain access to the lower urinary tract, attach, colonize and cause the inflammation of the urethra and the bladder which are the main parts of the lower urinary tract. The pathogenic bacteria can also travel through the urethra and reach the upper parts of the urinary tract leading to the infections of the kidneys and the ureter. The risk of UTIs is higher in sexually active women than in men. The high risk is contributed by the short urethra and the proximity of the external genitalia to the anus. Sexually active women may be advised to ensure they urinate immediately after sexual intercourse to clear pathogenic microorganisms for the urethra in addition to avoiding feminine products that irritate the external genitalia to reduce the risk of infections.

References

Jarvis, T. R Chan, L., & Gottlieb, T. (2014).Assessment and management of lower urinary tract infection in adults. Australian Prescriber, 37:7-93 Feb 2014DOI: 10.18773/austprescr.2014.002

McLellan, L. K., & Hunstad, D. A. (2016). Urinary Tract Infection: Pathogenesis and Outlook. Trends in Molecular Medicine, 22(11): 946–957.doi:  10.1016/j.molmed.2016.09.003

Smelov, V., Naber, K., & Johansen, T.E. (2016). Improved Classification of Urinary Tract Infection: Future Considerations. European Urology Supplements, 15(4): 71–80 DOI: https://doi.org/10.1016/j.eursup.2016.04.002

Tan, C.W., & Chlebicki, M. (2016). Urinary tract infections in adults. Singapore Medical Journal, 57(9): 485–490.doi:  10.11622/smedj.2016153

Walsh, C., & Collyns, T. (2017). The pathophysiology of urinary tract infections. Surgery, 35(6): 293-298. https://doi.org/10.1016/j.mpsur.2017.03.007

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