Infections of the urinary tract (UTIs) are common and often recurrent, troubling women’s health in particular. These can sometimes be prevented.
Genitals are populated by micro-organisms. Tribes of microbes under the foreskin differ from those in the vagina or the external skin. Smaller populations of “friendly” microbes live in the walls of a healthy bladder. Peaceful co-existence of these zoos is strongly dependent on Lactobacilli. They keep a healthy peace for the parent human by creating an acid environment and making hydrogen peroxide. If Lactobacilli are removed or overrun, the bladder is invaded relatively easily, usually by gut organisms such as Eschericha coli bacteria or Candida fungal species.
One in two women will suffer with a UTI in her lifetime. A shorter urethra is largely responsible. Over the age of 60, infection becomes increasingly common in both men and women. Public health approaches to reduce UTIs must ensure provision of clean water for drinking and washing, as well as protection from high environmental temperatures. Warmer climates increase UTIs in women and kidney stones in men. When infected, urine becomes cloudy and smells bad. Urges to pee come closer together; passing urine gives pain. There may be backaches, shivering, fever and tiredness. Elderly patients or children with a UTI can become confused, wetting themselves or their beds.
Several situations make UTIs more likely to develop in women. Pregnancy, or more frequent intercourse in the previous month, or suffering with a UTI before the age of 15 or using spermicides all significantly increase this risk. Times around menstruation can be challenging for some, as is constipation. Lesser threats come from wearing tight lycra undergarments or wet swimming costumes, using unpleasant toilet seats, menstrual products or attending wild wet festivals! For any particular individual, however, these situations might aggravate a urinary tract infection. Each of us is different; it is worth following messages sent by your body! Bladders can be sensitive, for instance, to caffeine or alcohol – both can increase the urge to pee in most humans.
Infections can track from the bladder to threaten kidney tissues, causing pyelonephritis, stone formation and bloodstream infections. If you should develop bleeding into the urine along with high fevers and nausea, the opinion of a pharmacist or medic will be useful. Bladder volumes vary from 300 to 600 millilitres. Most of us tend to visit the toilet at 200-300 millilitres; this continual flow of acidic urine is a beneficial first line protection, particularly after sexual activity. Urine that is withheld and not emptied from the bladder becomes infected easily.
The waterworks contain defensive proteins such as uromodulin, a string-like protein with long arms that block microbe binding. Such defences are supported by a diet containing vitamin C, D-mannose, cranberries or probiotics. Bush teas from hibiscus, horsetail, parsley or dandelion may work like uromodulin, as well as promoting urine flow – they may be diuretics. Vaginal oestrogen therapies can reinforce Lactobacilli numbers. Hippurate is recommended by some specialists as a urinary antiseptic.
Bladder defences are weaker in type 2 diabetes – the most common immunological problem found in the Caribbean. Urinary catheters promote infection by breaching the urethral barrier. Catheter infections are typically caused by local microbes – often those found in the nearest sink – whether at home or in Hospital. Urine infections can be detected using a dipstick. Formal laboratory tests are mostly automated, so pathogens can be identified along with which antibiotics to use. Treatments for a UTI can be personalised. Antibiotic prescriptions may be based on your previous history of UTIs, or as post-coital prevention, or in relation to a menstrual cycle with a self-start system.
St. Maarten has large numbers of international visitors. Their many microbiomes are likely to include microbes resistant to the routine antibiotics used for UTIs. Tourist resorts often identify antibiotic resistant microbes in the urinary tract infections of locals, spread by contacts with visitors. Handwashing and careful sanitation, particularly around hospitals or care centres are important protections for islanders. Overuse and inappropriate use of antibiotics for UTIs is another driver for resistance in populations of microbes. Clinical medicine has a limited portfolio of antimicrobials available.
UTIs often recur: Antibiotics do not always completely remove invaders. New strategies include vaccines (one is used in Canada, for instance) or the use of phages – tiny parasites that can attack bacteria deep in the bladder wall. Herbal teas are being studied in trials too, as are treatments to stimulate immune responses to bladder invaders. Children suffering with urine infections often have underlying anatomical causes; these are now usually managed with novel, less invasive methods. Urinary infections may not seem exciting, but they are an important contributor to community health, as well as an innovative frontier for therapies. Treatments for unruly microbes are advancing!
Useful resources: nhs.uk/conditions/urinary-tract-infections-utis ~ theurologyfoundation.org/urology-health/bladder-conditions/urinary-tract-infections-uti ~ cdc.gov/uti/about/index.html
By Dr. Colin Michie specializes in paediatrics, nutrition, and immunology. Michie has worked in the UK, southern Africa and Gaza as a paediatrician and educator and was the associate Academic Dean for the American University of the Caribbean Medical School in Sint Maarten a few years ago.
