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INTRODUCTION

Urinary tract infections are a serious health problem affecting millions of people each year.

Infections of the urinary tract are the second most common type of infection in the body. Urinary tract
infections (UTIs) account for about 8.3 million doctor visits each year.* Women are especially prone to UTIs
for reasons that are not yet well understood. One woman in five develops a UTI during her lifetime. UTIs in
men are not as common as in women but can be very serious when they do occur.
*Ambulatory Care Visits to Physician Offices, Hospital Outpatient Departments, and Emergency Departments: United States, 1999±2000. Vital and Health Statistics. Series 13, No. 157.
Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention, U.S. Dept. of Health and Human Services; September 2004.

The urinary system consists of the kidneys, ureters, bladder, and urethra. The key elements in the system
are the kidneys, a pair of purplish-brown organs located below the ribs toward the middle of the back. The
kidneys remove excess liquid and wastes from the blood in the form of urine, keep a stable balance of salts
and other substances in the blood, and produce a hormone that aids the formation of red blood cells.
Narrow tubes called ureters carry urine from the kidneys to the bladder, a sack-like organ in the lower
abdomen. Urine is stored in the bladder and emptied through the urethra.

The average adult passes about a quart and a half of urine each day. The amount of urine varies,
depending on the fluids and foods a person consumes. The volume formed at night is about half that
formed in the daytime.

Normally, urine is sterile. It is usually free of bacteria, viruses, and fungi but does contain fluids,
salts, and waste products. An infection occurs when tiny organisms, usually bacteria from the digestive
tract, cling to the opening of the urethra and begin to multiply. The urethra is the tube that carries urine from
the bladder to outside the body. Most infections arise from one type of bacteria, Escherichia coli (E.
coli), which normally lives in the colon.

In many cases, bacteria first travel to the urethra. When bacteria multiply, an infection can occur. An
infection limited to the urethra is called urethritis. If bacteria move to the bladder and multiply, a bladder
infection, called cystitis, results. If the infection is not treated promptly, bacteria may then travel further up
the ureters to multiply and infect the kidneys. A kidney infection is called pyelonephritis.

Microorganisms called Chlamydia and Mycoplasma may also cause UTIs in both men and women, but
these infections tend to remain limited to the urethra and reproductive system. Unlike E.
coli, Chlamydia and Mycoplasma may be sexually transmitted, and infections require treatment of both
partners.

The urinary system is structured in a way that helps ward off infection. The ureters and bladder normally
prevent urine from backing up toward the kidneys, and the flow of urine from the bladder helps wash
bacteria out of the body. In men, the prostate gland produces secretions that slow bacterial growth. In both
sexes, immune defenses also prevent infection. But despite these safeguards, infections still occur.

Some people are more prone to getting a UTI than others. Any abnormality of the urinary tract that
obstructs the flow of urine (a kidney stone, for example) sets the stage for an infection. An enlarged
prostate gland also can slow the flow of urine, thus raising the risk of infection.

A common source of infection is catheters, or tubes, placed in the urethra and bladder. A person who
cannot void or who is unconscious or critically ill often needs a catheter that stays in place for a long time.
Some people, especially the elderly or those with nervous system disorders who lose bladder control, may
need a catheter for life. Bacteria on the catheter can infect the bladder, so hospital staff take special care to
keep the catheter clean and remove it as soon as possible.
People with diabetes have a higher risk of a UTI because of changes in the immune system. Any other
disorder that suppresses the immune system raises the risk of a urinary infection.

UTIs may occur in infants, both boys and girls, who are born with abnormalities of the urinary tract, which
sometimes need to be corrected with surgery. UTIs are more rare in boys and young men. In adult women,
though, the rate of UTIs gradually increases with age. Scientists are not sure why women have more
urinary infections than men. One factor may be that a woman's urethra is short, allowing bacteria quick
access to the bladder. Also, a woman's urethral opening is near sources of bacteria from the anus and
vagina. For many women, sexual intercourse seems to trigger an infection, although the reasons for this
linkage are unclear.

According to several studies, women who use a diaphragm are more likely to develop a UTI than women
who use other forms of birth control. Recently, researchers found that women whose partners use a
condom with spermicidal foam also tend to have growth of E. coli bacteria in the vagina.

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