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Urinary tract infection and incontinence

Did you know that if you are experiencing bladder weakness, you are also at greater risk of urinary tract infections (UTIs)? There are many different reasons for this, and the symptoms of a urine infection are varied (bladder pain, pain when urinating, and bladder problems can be indicators). The good news is that bladder infection treatment is readily available in most cases.  

Illustration of how bacteria infects the bladder in a urinary tract infection
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What is a urinary tract infection?

UTIs can happen when harmful bacteria invade the urinary tract. Usually, the infection is caused by our own bacteria ending up where they don’t belong. The most common of these bacteria is E. Coli, which normally lives in the intestine, and can sometimes invade the urinary tract, which is near the rectal area. However, a number of other bacteria can also be responsible.
 
What are the most common symptoms of a urinary tract infection?
 
  • A painful or burning sensation when urinating 
  • Frequent urination and a constant urge to urinate 
  • Small amounts of urine each time 
  • Traces of blood in the urine 
  • Dark, cloudy or strong-smelling urine 
  • Feeling cold, but not usually with a fever 
  • Sudden urinary incontinence 

What is the difference between Lower and upper UTIs?

The most common type of UTI occurs in the lower urinary tract, infecting the urethra and bladder. Highly virulent strains can, if left untreated, spread further up to the ureters and the kidneys, in the upper urinary tract. The symptoms of upper UTI are considerably worse, and may include back pain, nausea and fever. Such a kidney infection is serious and can potentially damage the kidneys or even cause kidney failure. If left untreated it can also lead to urosepsis, this is when the infection enters the bloodstream. This condition requires intensive care.


Are the symptoms always the same?

Some elderly people with low immune response, or suffering from diabetes mellitus can have very vague and seemingly unrelated symptoms. Such symptoms can be a general weakness, confusion, nausea, dizziness, sudden incontinence, or increased severity of incontinence. It is important to know what is normal in these cases, to correctly identify changes in their condition for speedy diagnosis and treatment.


Conditions that can be confused with UTIs

Asymptomatic bacteriuria (also referred to as "friendly" bacteria) in the urinary tract is a harmless condition that should not be treated with antibiotics. These bacteria will show no symptoms except for smelly urine in some people. This means that a positive dipstick (nitrite and/or leucocytes) doesn’t prove that there is an ongoing UTI if there are no other symptoms. 
 
Dehydration can also cause dark, cloudy and smelly urine. So, make sure to hydrate properly.

Who is at risk?

UTIs can affect any person at any age, but certain groups are at a greater risk.
 
The main reason women are more susceptible to UTIs has to do with the female anatomy. To begin with, the urethra is shorter than in a man and it is located close to the anus, meaning bacteria can more easily invade the urinary tract. In women, oestrogen hormone levels also decline with age. This can cause the walls of the urinary tract to become thinner and drier. The protective mucous membrane, or mucosa, also becomes less acidic which reduces its ability to fight off infection. This is why oestrogen hormone treatment is recommended to prevent UTIs.
 
Other examples of people at risk of getting a UTI are the elderly, people with diabetes mellitus, persons wearing an indwelling catheter, and residents and patients. 
 
Additionally, not being able to empty the bladder properly can increase the risk of a UTI since bacteria can grow in the remaining urine. Causes for residual urine include constipation, outflow obstruction caused by an enlarged prostate or a prolapse, spinal cord injury and nerve damage, which interferes with the normal function of the urinary tract. 

Is there a connection with incontinence?

Urinary incontinence can affect anybody at any age, but it is more common when we get older and in connection with other medical conditions. Therefore, it is not unusual that people with urinary incontinence to also have additional problems that contribute to a higher risk of UTI. Some examples include not being able to completely empty the bladder, reduced immune defence functions, and chronic illnesses. Bowel incontinence is another factor that increases the risk of infection.  


How to prevent getting a UTI?

The most important method of prevention is to keep the genital area clean and healthy and able to protect itself against infection. Also, flush out bacteria by staying hydrated. Finally, try to make sure you empty your bladder entirely, since bacteria can thrive in the remaining urine. 
 
A few tips on how to avoid UTIs:
 
  • Maintain good general hygiene. 
  • Wipe from front to back after a toilet visit, to avoid transferring bowel bacteria to the urinary tract. 
  • Remove soiled incontinence products from front to back. 
  • Don´t over-wash or use harsh soap in your genital area as it can cause imbalance and irritation.
  • Use TENA wash cream to clean if the skin is fragile, and TENA barrier cream for protection.
  • Dry the skin when changing hygiene products, since bacteria grow better in moist areas.
  • Make sure to properly hydrate. 
  • If you have problems emptying your bladder completely, make sure to sit properly, leaning slightly forward with your feet resting on the floor or footstool. You can also stand up and sit down a few times to get the last drops out.
  • Use high quality, breathable TENA incontinence products with a dry surface.
  • Vaginal oestrogen treatment is often recommended to prevent UTIs.

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