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Difference between Upper and Lower Urinary tract infection


The kidneys are responsible for cleansing of the blood and formation elimination of waste products in the form of urine. The urinary tract or the path followed by the urine before it is excreted out of the body starts from the kidney and ends at the mouth of the urinary bladder. The urinary tract consists of two kidneys, the ureters (or tubes that convey the urine from the kidneys to the bladder), the urinary bladder and the urethra. In women the urethra lies in front of the uterus and in men the urethra passes through the prostate gland and the penis. Normally the urine that is formed is sterile and free from any microbial growth.

The infection of this tract is referred to as urinary tract infection and accounts for the second most common cause of a doctor’s visit all over the world. It generally affects the population between 20-50 years with woman are more prone than men. The most common cause of UTI is bacteria (mainly E.coli), however they can be caused by fungi (Candida) or virus (Herpes simplex virus-2). Majority of bacteria that cause UTI enter through the intestine or through the vagina.

The urinary tract infection can be divided into upper and lower sections.

The upper urinary tract infection:

The upper urinary tract consists of the kidneys and ureters and infection to any of these is termed as upper urinary tract infection. Infection of the kidney (pyelonephritis) is extremely dangerous and is manifested by pain in the lower back, fever, chills, nausea and vomiting. These warrant an immediate visit to the doctor. If the infection spreads beyond the kidneys into the blood it can result in septicaemia. These cases are treated by administering intravenous antibiotics.

The lower urinary tract infection:

The bladder and the urethra together form the lower part of the urinary tract. Infection of the urethra (urethritis) or the bladder (cystitis) is manifested as burning during micturition, increased frequency of urination, dark and smelly urine, and blood in urine, cloudy urine, pelvic pain in women and rectal pain in men. The lower UTI cases are treated by administering oral antibiotics.

Causes of UTI

The urinary tract can be infected due to various reasons. Prolonged use of catheter in bedridden patients is the top cause of UTI in severely ill patients. Incomplete emptying of bladder is a perfect place for bacterial growth.  Hormonal imbalance like the reduction of oestrogen affects the normal flora of the vagina. This can increase the risk of UTI in menopausal women. Diabetes reduces the overall immunity of the body making it vulnerable to microbial growth in the urinary tract. Obstruction of the urinary tract both internal (kidney stones) and external (enlarged prostate) may prevent complete emptying of the bladder. This is the most common cause of urinary tract infection. Incorrect bathroom hygiene (wiping the perineal area from back to front) can push the bacteria from the anus to the urethra which increases the risk of infection. Use of contraceptives such as condom, diaphragm or spermicides may increase the risk of UTI in certain individuals.

Diagnosis and Treatment

The diagnosis of UTI can be made by analysing the mainstream urine and blood count. Pelvic ultrasound, intravenous pyelogram and cystoscopy can help to confirm the diagnosis. Antibiotics form the mainstay of treatment of UTI.

Prevention of UTI

A few simple precautions can help lower the risk of UTI. Following correct bathroom hygiene after urinating or bowel movement (wiping from front to back), drinking lots of water, wearing comfortable undergarments and washing the perineal area regularly are ways to reduce the risk of UTI.

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