Posts Tagged ‘urinary tract infection’

Urinary Tract Infections (UTIs) In Men

September 28, 2016

UTIs are just a problem for young women.  Although UTIs are more common in young women, men, too, are not immune to infections of the urinary tract.  One of the most common infections in middle age and older men are urinary tract infections.

Older men (such as, men 70 years and older) are at somewhat higher risk for UTIs because of problems going to the bathroom and/or emptying the bladder. Older post-menopausal women are also at a greater risk for UTIs due to lower amounts of vaginal estrogen, which can change the vaginal climate. The normal flora, ‘good bacteria,’ are looked at as ‘good’ because they kill off other types of bacteria that can cause UTIs. Good bacteria can only grow in slightly acidic vaginal climates and this needs some estrogen. Systemic estrogen replacement options like pills and skin patches do not help with this problem, but vaginal estrogen therapy can be helpful for certain individuals. Talk to your doctor to see if this is a choice for you.

Often, older adults can help stop UTIs by staying hydrated, using the bathroom and getting routine health exams to screen for health problems like high blood sugar that puts you at higher risk for getting a UTI. If you or a loved one wears adult diapers, it’s very important to keep the genital area clean and to change them often.

Other Groups at High-Risk for UTIs

People with high blood sugar and vesicoureteral reflux are at higher risk of getting a UTI. Vesicoureteral reflux is when urine goes backwards from the bladder toward the kidney. Over time, this reflux of infected urine may raise a person’s risk for kidney damage. Vesicoureteral reflux is usually seen in children with UTIs compared to adults. Additionally, some patients with kidney stones and indwelling catheters may also be a higher risk for getting a UTI. An indwelling catheter is a hollow tube that is placed into the bladder through the urethra and left inside your body. The catheter drains urine from your bladder into a bag outside of your body. A catheter-associated UTI happens when bacteria enter the urinary tract through the catheter and cause an infection.

How UTIs are Diagnosed

In most cases, if you think you have a UTI, you should visit a health care provider and give a urine sample for testing. A urinalysis is a test that looks for white blood cells, red blood cells, bacteria, and or other chemicals such as nitrites in your urine. A proper urinalysis can pinpoint an infection and a urine culture can help your health care provider choose the best antibiotic for treatment. It is vital to get a urinalysis and culture performed to make sure you have an infection and require care. Use of antibiotics when not needed, can be tricky, and can lead to greater rates of bacterial antibiotic resistance.

It should be noted that some individuals get a urinalysis result that shows bacteria, but the individuals are not having any symptoms of a UTI. This event is common in older adults. If the individual has bacteria in their urine, but has no symptoms, treatment is not right. Treatment should be given to individuals who have bacteria and associated UTI symptoms.

In closing, it should be noted that studies on cranberry juice and linked supplements are mixed. Some studies show that cranberry supplements can be helpful and other studies show that they don’t help stop UTIs before they happen. Be sure to read about the pros and cons of cranberry products, and decide if they’re right for you. For now, practice these tips to lower your risk of getting a UTI.

Tips for Preventing UTIs

  1. Drink plenty of water.
  2. Urinate often.
  3. Don’t hold it.
  4. Keep your genital area clean.
  5. Empty your bladder before and after sex

 

Bottom Line:  UTIs are common in men and women.  Men after age 70 are at a risk for UTIs.  The symptoms are burning on urination, frequency of urination, passing cloudy urine, and even blood in the urine.  The diagnosis is easily made with a physical examination, a urine exam, and occasionally other imaging studies.  Treatment with antibiotics is usually effective.

Do’s and Don’ts of Douching-It May Cause Your UTI

August 9, 2014

I am 56 y\o female with recurrent urinary tract infections. I have been douching for many years and I was told by my urologist that the douching may be the culprit of my UTIs. Is that true?

Douching clears out the normal good bacteria of the vagina, which can upset the balance of bacteria in the vaginal area and make it easier to get UTIs. Allowing that bacteria to stay inside the vagina is a natural way to protect yourself from UTIs. Therefore, if you are prone to recurrent UTIs, then I suggest you deep six the douching.

What can you do to prevent UTIs?

Keep yourself hydrated. One of the best ways for preventing UTIs is to stay well hydrated, Drinking water can flush out bacteria from your bladder and lower your chances of getting a UTI.

I recommend urinating after sexual intimacy. Sexual activity may massage bacteria from the vagina into the urethra, the tube from the bladder to the outside of the body, which can then multiply and create an infection. Urinating after sex will expel the bacteria in the urethra and prevent the bacteria’s access to the bladder.

Drinking cranberry juice also seems to make it harder for bacteria to infect the urinary tract. Cranberry juice contains active compounds that are not destroyed by the digestive system after people drink them, but instead work to fight against bacteria, including E. coli, which is the most common bacteria causing UTIs. It appears that cranberry juice seems to prevent bacteria from sticking to the bladder wall.
Urinate frequently as holding urine probably can increase risk of having UTIs.

Wear cotton underwear. Bacteria grows in a moist, warm environment, so it’s a good idea to wear cotton underwear and clothes that aren’t too tight to allow air to flow and to keep the area dry. Avoid tight fitting jeans and exercise clothing.
See a doctor for persistent symptoms. If you don’t get better quickly with these non-medical suggestions or you have more than 3-4 infections per year, then it is time to obtain a medical opinion.

Bottom Line:
UTIs are a common malady affecting nearly every woman at some time during her adult life. There are several suggestions provided in this blog that you can do to decrease your likelihood of recurrences.

FAQ From My Patients

April 12, 2014

I am frequently asked questions by my patients and the answers may be of interest to you. If you have any questions that you would like me to answer, please write me at nbaum@neilbaum.com. to your good health.

I am a 60 yr. woman with recurrent urinary tract infections. I was told to drink cranberry juice. Is that effective?
Studies have documented that within eight hours of drinking cranberry juice, the juice could help prevent bacteria from developing into an infection in the urinary tract. Previous studies have suggested that the active compounds in cranberry juice work to fight against bacteria, including E. coli. Naturopaths believe in the medicinal value of cranberries. My own experience with hundreds of patients is that cranberry juice helps but you must drink 4-6 glasses a day, which is also a lot of sugar. So I suggest the cranberry juice pills. Anyone who suspects they have an infection should see a doctor, but drinking cranberry juice may be an easy, inexpensive way to help keep E. coli at bay.
I have chronic prostatitis. Is zinc helpful for this condition?
Zinc plays an important role in maintaining and improving prostate health. While zinc is found in every organ, tissue and cell in the human body, in males, the prostate has more zinc than any other tissue except bone.
As men get older, they tend to exercise less and their diets change as well, often causing them to fall short of the recommended daily allowance of zinc. Men who don’t have significant levels of zinc in their diets tend to have higher instances prostatitis. They also have higher prostate cancer rates.
The recommended daily allowance for men is 11 milligrams. Zinc is found in many popular foods, including meat and poultry, as well as oysters, beans, nuts, crab, lobster, whole grains, fortified breakfast cereals and dairy products.

My urologist told me that I have a varicocele. Will this cause me to have a problem with infertility?

Yes it may. Varicoceles are enlarged varicose veins that occur in the scrotum. They are fairly common, affecting 15 out of 100 men overall and one of the most common causes of male infertility because the heat from the dilated veins affect sperm production. Varicoceles occur most often in the left testicle. A varicocele repair is done to improve male fertility and is accomplished on an outpatient basis with improvement in the sperm producing in 3-4 months after the procedure.

I had radiation therapy for prostate cancer and now have a loss of my sex drive. What is the cause?
Men who receive radiation therapy for prostate cancer often receive injections to lower the testosterone level to decrease the growth of the cancer. Testosterone is responsible for the sex drive or libido. Often the testosterone level will return to normal after the medication is discontinued after the radiation therapy. In some instances men can receive testosterone one year after radiation if the PSA level stays at a low level. I suggest you have a discussion with your urologist about the use of testosterone in men with prostate cancer.

Deciding Upon the Prime Cut- The Circumcision Decision

December 28, 2012

No descriptor required!

No descriptor required!


Parents often ruminate about the decision to circumcise their young baby boys. Certainly if you are of the Jewish faith, there is no question that you will consider cicrcumcision for your new baby boy. For non-Jews, and non-Moslems, the decision is much more difficult.

New evidence is out that circumcision reduces the risk of sexually transmitted diseases. A review of current medical research points out that the medical benefits of circumcision outweigh the risk of the procedure. Circumcised infants are 90
% less liekly than uncircumcised infants to develop urinary tract infections. Later in life, the circumcised boys are at a lower risk of contracting HIV, herpes, penile cancer, and human papilomavirus, which when passed to female partners, can cause cervical cancer. The serious complicaitons occur in only about 0.2 percent of baby boys who under the operation.

Bottom Line: The circumcision decision is often difficult for most parents to make. I suggest you speak to your pediatrician and obstetrician about the “prime cut.”

A Burn In the Urine-Managing Urinary Tract Infections (UTI)

June 15, 2012

One of the most common afflictions affecting most women and many men are urinary tract infections. UTIs are eight times more common in women than men. Initial symptoms typically include burning at the time of urination, frequent and intense urge to urinate, with discoloration of the urine ranging from cloudy to even bloody.

A bacteria, E. Coli, is responsible for 75% to 90% cases of acute uncomplicated cystitis. UTIs can also be caused by sexually transmitted disease (STD) such as Chlamydia and Mycoplasma. Other possibilities of painful urination include pelvic inflammatory disease, radiation cystitis, and hemorrhagic cystitis.

Bacteria causing urinary tract infections

E. Coli bacteria – common cause of urinary tract infections

Your doctor can make a presumptive UTI diagnosis in symptomatic women if there is either burning with urination and frequency without vaginal symptoms. The diagnosis can be confirmed with urinalysis showing positive nitrite or positive leukocyte esterase. The ultimate diagnosis is based on urine culture which grows out the bacteria and tells the doctor the best drug or antibiotic for treating the infection.

Uncomplicated cystitis does not cause fever. If a patient has a fever the UTI may have spread to the kidneys. A bacterial infection of the kidney is referred to as pyelonephritis and the symptoms often include pain in the back or side below the ribs, nausea and vomiting.

Urinary tract infections in men are often the result of an obstruction or blockage of the urinary tract — for example, a urinary stone or enlarged prostate — or from a catheter used during a medical procedure.

Optimal empiric therapy for nonpregnant women with uncomplicated UTI is with trimethoprim-sulfamethoxazole (TMP-SMZ, Bactrim, Septra) 160 mg/800 mg orally b.i.d. for three days. Other antibiotic options include ciprofloxacin (Cipro), levofloxacin Levaquin), or nitrofurantoin (Macrodantin).

Cranbeery juice and supplements are thought to be a good alternative preventive treatment for recurrent UTIs. Rich in vitamins C and E, antioxidants and anthocyanins, cranberry may help prevent E. coli from attaching to the bladder wall as well as bladder stone formation, and provide symptom relief for cystitis.

Bottom Line: UTIs are common in both men and women and can be easily diagnosed with a history, physical exam, and examinatioin of the urine. Treatment is effective with antibiotics. If it burns when you urine, call your doctor.

Cranberry Juice Does Not Prevent Urinary Tract Infections-Another Medical Myth Bites The Dust

March 29, 2011

According to a report in Clinical Infection Diseases (2011;52:23-30), a placebo beverage fared better than cranberry juice in protecting against repeat urinary tract infections (UTIs) in 319 female college students presenting with acute UTI. The women were assigned to drink either eight ounces of cranberry juice or a placebo juice twice a day for six months or until another UTI developed. Although the investigators expected to see a 30% recurrence rate in the placebo group, the actual overall recurrence rate was 17%, with the cranberry-juice group experiencing a slightly higher recurrence rate than the those girls taking the placebo drink. according to a report in Clinical Infection Diseases (2011;52:23-30).

 

Cystitis-How To Leave Home Without It

March 11, 2010

What does sex, bubble bath and thongs have in common?  Answer: They may all be causes of cystitis.  If you are a woman who has ever suffered from cystitis then you will know just how debilitating and miserable it can be, you you can perhaps take comfort from the fact that you are far from alone.  It seems that at last 20% of women have had an attack at some point in their lives, and 20% of those will get more than one episode a year.

There is certainly no mistaking the feeling it brings, which usually starts with a strong sensation of needing to urinate.  When you try to go, it either burns horribly, or nothing seems to come out.  You may have a full, uncomfortable sensation in the bladder, plus an aching back and stomach and a general feeling of being unwell.  The most common cause is an infection caused by bacteria.  It isn’t only a female problem but far more common in women than men.  The reason is that the internal plumbing of women is much shorter than in a man and the relationship of the rectum which is usually the source of the bacteria is closer to the urinary tract in women than in men.

A bacteria called E. Coli is usually the culprit.  Since E. Coli coming from the rectum can reside in the vagina and then can have easy access to the urethra or the tube that transmits urine from the bladder to the outside of the body.  This is why it is beneficial for women to wipe from front to back when they use the restroom.  If you swipe the wrong way, you can move the bugs from the rectum into the vagina and then into the urethra.  Another recommendation is to switch from nylon or synthetic underwear to the cooler cotton briefs which discourage the growth of bacteria.  Also, thongs and G strings may be very sexy but they are bad news for cystitis sufferers as the string is an effective way for bacteria to hitch a ride from your bottom to your bladder. Another suggestion is to change the bacterial flora of the gastrointestinal tract.  This can be accomplished by regularly eating yoghurt which contains the good bacteria lactobacillus or acidophilus.

It is also crucial to drink large quantities of water to flush away any bacteria.  Also, it is recommended that sufferers of frequent cystitis go the toilet when you first feel the urge.  The longer you hold in urine, the fuller your bladder is, with more potential for bacteria to grow and proliferate.  Using bubble baths or irritating soaps around the vagina should also be avoided as these agents can upset the delicate balance of acidity and alkalinity in your skin so that bacteria can flourish.

It also appears that sexual intercourse, promotes moving bacteria from the vagina into the urethra.  This then starts the process of bacterial multiplication in the bladder and creates the symptoms of cystitis.  Therefore, it is important for women who get cystitis after intercourse to urinate frequently after sexual intimacy to wash the bacteria out of the urethra so they don’t become permanent residents and create an infection.

For years doctors have recommended cranberries of a method to reduce the attacks of recurrent cystitis.  Initially, it was thought that the cranberries were a source of acid and this prevented cystitis.  Now research has shown that the cranberries contain chemicals that help stop the bacteria from sticking onto the bladder wall.  Because cranberry juice can be quite high in sugar, you might prefer to take one of the cranberry supplements that are available.

Beating back an attack

The first practical step is to consume 2 glasses of water every 20 minutes for the first three hours.  This will help you ladder to flush itself out, and sometimes is enough on it s own to prevent further problems.  If not, gulp down a few glasses of cranberry juice.  Sipping a glass of water with a teaspoon of bicarbonate of soda stirred into it may help the burning sensation when you urinate.

If these simple measures don’t relieve your symptoms in a day or two, you may need to see your doctor and take a short course of antibiotics.  Failure to treat the infection can result in a much more serious kidney infection.  Also, if you have more than 3-4 infections in a 12 month period you will want to see your doctor to be sure there isn’t something else more ominous causing these infection.

You Don’t Have to Depend on Depends-Menopause and Bladder Control-

March 10, 2010

Some women begin to have problems with their bladder and experience overactive bladder (gotta go, gotta go right now) and urinary incontinence or loss of urine at inopportune times at the time or shortly after menopause.

Does Menopause Affect Bladder Control?

Yes. Some women have bladder control problems after they stop having periods (menopause or change of life). If you are going through menopause, talk to your health care team.

After your periods end, your body stops making the female hormone estrogen. Estrogen may help keep the lining of the bladder and urethra healthy. A lack of estrogen could contribute to weakness of the bladder control muscles.

Pressure from coughing, sneezing or lifting can push urine through the weakened muscle. This kind of leakage is called stress incontinence.

Although there is no evidence that taking estrogen improves bladder control in women who have gone through menopause, small does may help thicken the bladder lining and decrease the incontinence.  Your doctor can suggest many other possible treatments to improve bladder control.

What Else Causes Bladder Control Problems in Older Women?Sometimes bladder control problems are caused by other medical conditions. These problems include:

Infections

Nerve damage from diabetes or stroke

Heart problems

Medicines

Feeling depressed

Difficulty walking or moving

A very common kind of bladder control problem for older women is urge incontinence. This means the bladder muscles squeeze at the wrong time and cause leaks.

If you have this problem, your doctor can prescribe medication that can certainly alleviate that problem.

What Treatments Can Help You Regain Bladder Control?Your doctor may recommend limiting foods or fluids, such as caffeine, which are bladder irritants and increase the desire to go the rest room.

There are also pelvic exercises that can strengthen the muscles in the urethra and the vagina.   Life’s events, like childbirth and being overweight, can weaken the pelvic muscles.

Pelvic floor muscles are just like other muscles. Exercise can make them stronger. Women with bladder control problems can regain control through pelvic muscle exercises, also called Kegel exercises.

Exercising your pelvic floor muscles for just five minutes, three times a day can make a big difference to your bladder control. Exercise strengthens muscles that hold the bladder and many other organs in place.

Two pelvic muscles do most of the work. The biggest one stretches like a hammock. The other is shaped like a triangle. Both muscles prevent leaking of urine and stool.

Pelvic exercises begin with contracting the two major muscles that stretch across your pelvic floor. There are three methods to check for the correct muscles.

1. Try to stop the flow of urine when you are sitting on the toilet. If you can do it, you are using the right muscles.

2. Imagine that you are trying to stop passing gas. Squeeze those same muscles you would use.

3. Lie down and put your index finger inside your vagina. Squeeze as if you were trying to stop urine from coming out. If you feel tightness on your finger, you are squeezing the right pelvic muscle.

Do your pelvic exercises at least three times a day. You can exercise while lying on the floor, sitting at a desk or standing in the kitchen.

Be patient. Don’t give up. It’s just five minutes, three times a day. You may not feel your bladder control improve until after three to six weeks. Still, most women do notice an improvement after a few weeks.

Other treatments include inserting a device, a pessary, directly into the vagina to lift the urethra and the base of the bladder to its proper position behind the pubic bone.  And finally, if the conservative methods of medication, exercises, and dietary modification don’t work, then you should talk to your doctor about one of the surgical procedures that can lift the bladder into the proper position to prevent leakage

Bottom Line: No one needs to suffer the embarrassment of urinary incontinence.

Dr. Neil Baum is a physician at Touro Infirmary and can be reached at (504) 891-8454 or through his website, http://www.neilbaum.com

The Circumcision Decision –The Prime Cut

March 9, 2010

The first concern most men will have about their genital organs occurs right after birth when he undergoes a circumcision….and, unfortunately, the young boy has no part in the decision whether to lop off that precious piece of real estate!

Removal of the foreskin of the penis is one of the oldest surgical procedures known, dating back well over 5000 years. Hieroglyphs picturing ritual circumcision were found in ancient Egypt, and the religious significance of circumcision is described in the Old Testament.

Medical Risks and Benefits

Parents should be assured that the great majority of circumcisions are trouble-free. But circumcision is surgery, and all surgeries run the risk of complications.  The most common complications, which occur in only about 1 percent of circumcisions, are: bleeding, which can easily be controlled with pressure, and minor infection, which can be treated with antibiotics.

The medical benefits of circumcision are small. Uncircumcised boys have a higher risk of developing urinary tract infections (UTIs) than circumcised boys, particularly in the first six months of life  However,  the overall risk of a UTI is still less than 1 percent. Generally, physicians will recommend circumcision for any boy who has two UTIs in the first year of life. A circumcision performed months or years after birth is done surgically under anesthesia, and seems to be associated with fewer complications and less pain and trauma.

Circumcision also has small but measurable benefit in preventing penile cancer, a very rare disease that strikes only about 1 in 100,000 men. Uncircumcised men are three times more likely to develop penile cancer than circumcised men.

Uncircumcised men are also reported to be at greater risk for developing sexually transmitted diseases such as syphilis and HIV infections than circumcised men, but behavioral factors, such as not practicing safe sex, are far more important risk factors.

Overall, the increased risk of developing UTIs, sexually transmitted diseases, or penile cancer is extremely low, regardless of circumcision status.

A Kinder Cut

For those parents who elect to have a circumcision performed on their newborn infant, it is important that the parents select an experienced surgeon to perform the procedure.  The AAP recommends that pain relief with a local anesthetic should be used during the procedure.  Safe and effective forms of analgesia for circumcision are easily accomplished using a local or topical anesthetic consisting of a gel or cream applied to the foreskin before the procedure.  This method has been found to provide adequate pain relief during the 5-10 minute procedure.

Parents considering circumcision should talk with their doctors, and make sure that they are comfortable with whoever will be performing the procedure. Specify in advance what type of anesthesia will be used, and notify the doctor if there are any bleeding disorders in the family.

Parents who choose not to circumcise need to receive instructions on how to care for an uncircumcised penis. The foreskin should never be forced to retract, nor should objects such as swabs or cotton balls be used to clean underneath it. Although most boys will have retractable foreskins by age 3, in some cases, it may take 7 to 10 years. Parents must be patient and allow the process to happen naturally.  All boys who are not circumcised need to be instructed on proper hygiene of the foreskin.  Failure to do so can result in inflammation of the penis and a foreskin that is even more difficult to retract and clean.   Occasionally, this condition, phimosis, or tight foreskin requires a circumcision as an adult.

So if you are considering the “prime cut” for you or your newborn son and have any questions, I suggest you contact your doctor.

Dr. Neil Baum is a urologist and can be reached at 504 891-8454 or on his web site www.neilbaumcom