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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, but the good thing is that there are things you can do to prevent an infection.

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

What is a Urinary Tract Infection?

UTIs are a result of harmful bacteria making their way into the urinary tract and causing an infection. In most cases, the bacteria which invade the lower urinary tract come from our own bodies.
There are many different bacteria that can cause a UTI, but the most common type is E. Coli, which normally lives in the intestine and can infect the urinary tract when the urethra is exposed to faeces. However, sometimes other bacteria are responsible. 
What are the most common symptom for a bladder infection?
  • Painful or a burning sensation when urinating 
  • Frequent urination and 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 UTI?

The most common type of UTI is a Lower Tract Infection, then the bacteria has infected the urethra and bladder. Highly virulent strains can, if left untreated, spread further up to the ureters and the kidneys, causing an Upper UTI. The symptoms will then get considerably worse with e.g. 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 general weakness of their condition, confusion, nausea, dizziness, sudden incontinence or increased severity of incontinence. It is important to know what is normal for these particular people and recognise any changes in their condition for speedy diagnose 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 getting a UTI has to do with the female anatomy. The urethra is shorter than in a man and it is located close to the anus, from where bacteria can 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 dryer. 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 example of people at risk of getting a UTI are the elderly, people with diabetes mellitus, a person with 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 also have additional problems that contribute to the higher risk of a 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 a UTI.  

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:
  • Good hygiene is the easiest way to prevent a UTI
  • 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 sensitive genital area as it can cause imbalance and then cause 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