A nurse’s perspective on Urinary Tract Infections

Women are at a higher risk of contracting urinary infections because of the close proximity of the urethral opening to the vagina and anus. Organisms from these areas can easily move to the urethra and into the bladder causing infection.

There are a number of things that can be done  to prevent UTI’s:

1. Wiping from front to back. If you have to wipe more than once use another tissue.

2. Increase  fluid intake, up to 6 glass of water each day. The fluid will dilute the urine making it more acidic.     An acid-ash diet is recommended to increase the acidity of the urine : cranberries, prunes, plums, whole grains and eggs, to name a few.

3.Avoid bubble baths and tub baths.  This causes irritation .Take showers instead.

4. Wash perineal area before intercouse.

5. Avoid tight clothing; underwear, panty hose and slacks. Tight clothing cause irritation. Wear cotton underwear.

6. Use a position for sexual intercourse that does not put pressure on the anterior vaginal wall. Void after intercourse.

 

Hyacinth Ellis, RN

Bladder Infections

Bladder infections are among the most common reasons for which people seek medical attention. Indeed, urinary tract infections (UTIs) are the commonest bacterial infections in adult women. Bladder infections may reflect underlying abnormalities in the urinary system and can lead to serious medical complications if ignored.

Bladder infections are usually caused by bacteria that are normally found in the urethra (or urinary passage). Normally, these bacteria do not cause problems as they are routinely flushed from the urinary tract by passing the urine. In certain circumstances, these bacteria are able to gain access to the bladder, and if they multiply in sufficient quantities, may cause an infection of the bladder. Certain risk factors predispose to bladder infections:
• Women have a greater risk of developing UTIs because of the shorter urethra. The bacteria therefore have a much shorter distance to travel to get to the bladder
• Sexual intercourse increases the risk of a bladder infection by increasing the risk of introducing bacteria into the urethra
• Use of a spermicide during sexual intercourse
• Pregnancy
• Medical conditions associated with a suppressed immune system, such as diabetes
• Urinary retention, which results in the inability of the bladder to empty correctly. This includes patients with bladder problems from spinal cord injuries as well as urinary obstruction from prostate enlargement.
• Urinary catheters, especially if these are left in place for more than a week
• Urinary tract abnormalities
• Bladder stones
Two of the most common bacteria that cause UTI are E. coli and S. saprophyticus.
The most common symptoms of bladder infections are:
• Burning with urination
• Passing urine more frequently
• Blood in the urine
• Fever and chills
• Lower abdominal pain
Left untreated, urinary tract infects can ascend to the kidneys. A more serious infection called pyelonephritis may then result. Pyelonephritis is a potentially life threatening infection that often requires hospitalization and intravenous antibiotic therapy. A simple office urinalysis often confirms the diagnosis but gives no information about the bacteria which actually caused the infection. For that, the urine is sent for culture. With the culture, the actual cause of the bacteria is determined, as well as the types of antibiotics that are likely to be effective in treating the infection.
Bladder infections are treated with antibiotics. The antibiotic selected will depend on the most likely bacteria as well as the resistance pattern of the bacteria in a given locale. For simple infections, treatment duration can be as little as 3 days, whereas more complicated cases may be treated for a longer duration. A medication to reduce urinary discomfort is sometimes prescribed. This medicine often causes a temporary discoloration of the urine. For recurrent bladder infections, a prophylactic antibiotic is sometimes prescribed in an effort to reduce the frequency of infections. A Cochrane Review (2009) looked at 10 studies in which cranberry juice was used to prevent recurrent bladder infections. The reviewers concluded that cranberry juice was effective in reducing recurrent UTIs in women. It was not clear from the analysis what “dose” of cranberry juice was optimal in preventing the infections and it did not seem to be as effective in men. Catheter associated UTIs are often preventable and are a significant public health concern in hospitals and nursing homes. The rate of these infections can be reduced by avoiding unnecessary catheterizations, proper insertion technique and removing catheters as early as possible.
Bladder infections are a fairly common problem faced by primary care doctors and are usually easy to treat in the early stages. Prompt treatment, preventative efforts and evaluation for underlying causes in cases of recurrent infections are important in preventing complications.

Vitamin D

Vitamin D is a hormone that is essential for proper bone health.  A precursor to Vitamin D called 7-Dehyrocholesterol is found in the skin.  Ultraviolet B radiation (from sunlight) converts this precursor to Vitamin D.  The effectiveness of this radiation may be affected by the melanin content in the skin (less absorption in Black people), use of sunscreen (less absorption), cloud cover, and the time spent indoors.  Two additional reactions, the first occurring in the liver and the second occurring in the kidney results in the formation of “active” Vitamin D.  This active form increases body calcium by increasing absorption from the intestines and increasing calcium release from bone, the largest store of calcium in the body.  Calcium’s role in bone formation is analogous to the role of steel in a skyscraper, important in maintaining the rigidity and structural integrity of the bone.

 

Causes of Vitamin D deficiency include

  • Decreased skin production (higher in Black people, the elderly, use of sunscreen)
  • Inadequate dietary intake
  • Decreased absorption (impaired fat absorption, ulcerative colitis)
  • Increased loss of Vitamin D (associated with the use of certain medications)
  • Severe liver disease
  • Kidney disease
  • Obesity

 

 

The prevalence of Vitamin D deficiency has been estimated to be approximately 50% (based on a 30 ng/mL cutoff).  Severe deficiency can cause rickets in children.  The lack of adequate calcium for bone development results in growth retardation, increased risk of fractures, bowed legs, abnormal skull development and bone pain.  In adults osteomalacia may result, with similar consequences except for the growth retardation seen in rickets.  Less severe deficiency can result in osteoporosis as a result of decreased calcium absorption and inadequate bone mineralization (with calcium).  This increases the risk of fractures, especially among post menopausal women.  There are some studies that indicate that inadequate Vitamin D levels may increase the risk of certain cancers (breast cancer, colorectal cancer and prostate cancer have been evaluated), and reduce the risk of heart disease.  However these findings remain controversial and will likely need more studies before definitive recommendations can be given.  Other studies have evaluated whether Vitamin D may reduce the risk of diabetes, hypertension and multiple sclerosis.

 

As mentioned, fish oil, fortified cereal and dairy products and egg yolk are good dietary sources for Vitamin D.  Each of these may conflict with other dietary recommendations.  For example, individuals may be allergic to fish, may be on a strict diet that does not allow for the extra carbohydrate intake associated with cereals or may be unable to tolerate dairy products.  In such cases supplementation is recommended (always check your doctor first).  The recommended dietary allowance (RDA) for Vitamin D is 600 international units daily for adults 70 and under and 800 units daily for adults over 70.  For those with Vitamin D deficiency, the requirements will be higher, and will depend on the severity of the deficiency.  There has been some controversy regarding the appropriate daily intake of Vitamin D.  Some sources recommend much higher levels of intake than the published RDA values.  If there is any doubt, it may be useful to have your Vitamin D level checked to determine whether your intake is adequate.

 

Pre-Diabetes – An Opportunity for Change

People with pre-diabetes live in that uncertain realm where one is not quite normal and not quite diabetic. Of course, the definition regarding who is and who is not a diabetic is arbitrary, and based on a strict numerical determination. A fasting blood sugar more than 125 milligrams per deciliter automatically puts you in the diabetes category, while a fasting sugar less than 100 mg per deciliter qualifies you as “normal” (at least where blood sugar is concerned). If you have a fasting sugar between 100 to 125 mg per deciliter, you fall in that no man’s land called pre-diabetes. To make it more confusing, diabetes can also be defined in terms of the blood sugar level 2 hours after ingesting 75 g of glucose (the fasting method is more commonly used). A level of at least 200 mg per deciliter renders you diabetic, while a level below 140 mg per deciliter confers normalcy. A level between 140 to 199 mg per deciliter earns the pre-diabetes designation. Researchers and physicians alike are concerned with this group of individuals because experience has shown that people with pre-diabetes are at increased risk of developing diabetes. In fact pre-diabetics have a six-fold increased risk of developing diabetes compared to individuals with normal blood sugars. Also, even among those pre-diabetics that do not develop diabetes, the risk of complications (kidney disease and eye disease are the most important) is increased. In 2007 the US Department of Health and Human Services estimated that 57 million people had pre-diabetes. It is obviously a huge public health issue.

Scientists are still working on the exact cause of pre-diabetes. However, several factors have been associated:
Obesity
Physical inactivity
A family history of diabetes
Previous gestational diabetes
High blood pressure
African Americans, Alaskan Natives, Asian Americans, American Indians, Hispanics, Pacific Islanders

In terms of blood chemistry, people with pre-diabetes have been found to have a condition called insulin resistance. With insulin resistance, insulin has diminished effectiveness in transporting glucose from the bloodstream into cells. Glucose therefore accumulates in the bloodstream (resulting in higher blood glucose), while the cells may be relatively deficient in glucose, its chief source of energy.

The Diabetes Prevention Program was a study involving over 3,000 participants. The study participants were randomized into different groups: a group receiving intensive diet and exercise counseling, a group receiving the diabetes drug Metformin, a placebo group, and a group receiving the diabetes drug Rezulin. This arm of the study was discontinued because a high incidence of liver problems with Rezulin. The study found that the group who exercised and change their diet lowered their risk of developing diabetes by 58%, while the group that took Metformin lowered their risk of developing diabetes by 31 %. The lifestyle intervention group ate less fat and ingested less calories and exercised 30 minutes at a time at least 5 days a week and were able to lose 5 to 7 % of their body weight.

Our message here is simple
• About a quarter of US adults have pre-diabetes
• If you have not been tested, especially if you are in a high risk category, please get tested now
• Simple lifestyle changes, including modifying your diet and exercising about 2-1/2 hours per week can result in a significant reduction in your risk of developing diabetes.