Urinary Tract Infection (UTI) Treatment in Indore

A urinary tract infection is bacterial infection anywhere from the urethra to the kidneys. It is one of the most common infections in women, with a very large proportion experiencing at least one in their lifetime. The two clinical questions that matter are how high in the tract the infection has reached, and why it keeps coming back, because a simple bladder infection and a kidney infection are very different situations.

Types of UTI

1. Cystitis (lower UTI): Infection of the bladder, causing burning, frequency and urgency without fever. The commonest presentation.
2. Urethritis: Infection of the urethra, often sexually transmitted in younger patients.
3. Pyelonephritis (upper UTI): Infection reaching the kidney, with high fever, chills, flank pain and vomiting. This is a serious infection needing prompt treatment.
4. Complicated UTI: Infection in the presence of stones, obstruction, catheters, pregnancy, diabetes or in men, all of which require fuller evaluation.
5. Recurrent UTI: Two or more infections in six months, or three or more in a year.

Causes and Risk Factors

1. E. coli from the bowel, responsible for the large majority of infections
2. Female anatomy, with a short urethra close to the anus
3. Sexual activity and use of spermicides or diaphragms
4. Inadequate fluid intake and habitually holding urine, a very common factor in working women with poor washroom access
5. Menopause, where falling oestrogen thins the urothelium and alters protective vaginal flora
6. Diabetes, particularly when poorly controlled
7. Kidney or bladder stones, and any obstruction to urine flow
8. Prostate enlargement in men and incomplete bladder emptying
9. Urinary catheters and pregnancy

Symptoms

1. Burning or pain while passing urine
2. Frequency and urgency, often passing only small amounts
3. Lower abdominal or suprapubic discomfort
4. Cloudy, strong-smelling or blood-stained urine
5. Fever, chills, flank pain and vomiting when the kidney is involved
6. In elderly patients, confusion or a general decline may be the only sign
7. In infants and children, unexplained fever, irritability and poor feeding

When to See a Doctor

See a doctor for burning urination lasting more than a day or two. Seek urgent care for fever with chills and flank pain, for blood in the urine, for vomiting, or for symptoms during pregnancy, where untreated UTI carries a risk of preterm labour. Any UTI in a man warrants evaluation, since male UTIs are uncommon and usually indicate an underlying cause such as prostate enlargement or a stone.

Treatment for UTI

1. Urine routine and culture: Culture with sensitivity should be sent before starting antibiotics wherever possible, since antibiotic resistance in India is high and empirical choices frequently fail.
2. Targeted antibiotics: Chosen according to culture results and given for an adequate duration: short courses for simple cystitis, longer courses for pyelonephritis and complicated infection.
3. Hydration and symptomatic relief: High fluid intake, urinary alkalinisers and analgesia.
4. Investigate recurrent infection: Ultrasound of the kidneys, ureters and bladder, post-void residual volume, blood sugar, and in men prostate assessment. Recurrent UTI is a symptom to be explained, not simply retreated.
5. Treat the underlying cause: Stone removal, relief of obstruction, prostate treatment or correction of incomplete emptying. See kidney stone treatment and BPH treatment.
6. Prevention: Adequate fluids, not holding urine, passing urine after intercourse, wiping front to back, and vaginal oestrogen in post-menopausal women, which markedly reduces recurrence.

What Happens If You Delay Treatment

An untreated bladder infection can ascend to the kidney within days, and pyelonephritis can progress to bloodstream infection and sepsis, particularly in diabetics, pregnant women and the elderly. Repeated kidney infections cause scarring and permanent loss of renal function. In pregnancy, even symptomless bacteriuria is associated with preterm labour and low birth weight, which is why it is screened for and treated. Equally important, recurrent UTIs that are simply treated again and again without investigation frequently turn out to be caused by a stone, an obstruction or undiagnosed diabetes that would have been found with one ultrasound and a blood test.