HomeIntroduction To Spinal Cord InjuryUrinary System After Spinal Cord InjuryUrinary tract infections

4.2. Urinary tract infections

What is a urinary tract infection?
Individuals with SCI are at a high risk for urinary tract infection (UTI). When bacteria get into your bladder or kidneys and cause you to have symptoms, you have a UTI. It is important to know the difference between an infection and bacteriuria (having bacteria in the urine but no symptoms).

Causes of UTI:

Intermittent Catheterization
Whenever a catheter is passed through the urethra (the channel between the bladder and the outside of the body) it can pick up bacteria that are normally on the skin and push the bacteria into the bladder. Bacteria can grow and multiply in the urine if the urine remains in the bladder for a prolonged amount of time (more than 4-6 hours). You can avoid this by emptying your bladder at least once every 6 hours and by drinking enough fluids to keep the urine volume between 300 and 500 cc (1 to 1.5 cups) at each catheterization. Careful hand washing before and after each catheterization is essential and will help prevent UTIs by decreasing the amount of bacteria on the skin.

Indwelling (Foley) Catheters
Because of your spinal cord injury and the fact that you must use an indwelling catheter, you will always have bacteria in your urine. The catheter provides a direct pathway for the bacteria to enter your bladder. The bacteria that live in your bladder can develop into a UTI if your catheter becomes blocked, if your general resistance to infection decreases, or if you don't drink enough fluids and your urine become concentrated.

Symptoms of UTI Warning Signs of UTI

When early signs of infection appear, you can take additional steps to help prevent symptoms of illness.

It is important to note that the appearance and smell of your urine may change because of changes in your diet or fluid intake. If you have changes in the urine but no symptoms (see list above) you do not need to seek treatment for a UTI. People who empty their bladders by self-catheterization may occasionally see small blood clots or red blood visible on their catheters because of trauma (bumping against the bladder or urethra or forcing the catheter past the sphincter). This is not cause for worry unless it happens frequently. Larger amounts of blood, or urine that is red from blood, should always be reported to your health care provider.

Preventing urinary tract infections through self-care

Many people are able to prevent a UTI from developing by taking some self care steps. The most important step for people who do intermittent catheterization and begin to develop symptoms of a UTI is to catheterize themselves more frequently (every 2-4 hours) and increase their fluid intake.

The most important step for people who use an indwelling catheter is to drink plenty of water. Your fluid intake should be enough so that your urine has the appearance of water or is only slightly yellow in color and clear. Changing your catheter after increasing your fluids may also help cut down on the number of bacteria living in your bladder since catheters can become "colonized" with the bacteria that are flushed out of your urinary tract. Generally, changing your catheter every month should be enough to keep you healthy, but people who get frequent UTIs or whose catheters tend to become encrusted with built-up mineral deposits may have to change it more often.

When to call your health care provider

If you develop a fever (temperature greater than 100°F) or if your symptoms are interfering with your life, you should call your health care provider. He or she will want to know your temperature, current symptoms, and whether you have any allergies to antibiotics. Your health care provider will also want to get a urine specimen and will discuss with you whether antibiotics should be started right away or after the results of the culture are available.

How To Collect A Good Specimen For A Urine Culture
The accuracy of any urine test depends on careful collection of the specimen to avoid contamination by bacteria from other sources, such as your hands or the specimen container. Following the instructions below will help ensure accurate results.


Antibiotic Treatment

If your health care provider prescribes an antibiotic for you, ask your pharmacist whether you should take it before meals or with food. Be sure to take all of the medications as prescribed. DO NOT stop taking the antibiotic simply because you no longer feel sick. You need to totally kill the bacteria and prevent the bacteria from becoming resistant. Some antibiotics will change the balance between your body's "good" bacteria and the "bad" bacteria that has caused your UTI. When this happens, an overgrowth of yeast can occur which may result in problems ranging from a skin rash to diarrhea. This can be prevented by taking acidophilus culture, which is available in some brands of yogurt, acidophilus milk, or as a pure culture (available in health food stores).

Remember:

  • Only take antibiotics when needed. Research shows that UTIs that do not include symptoms of illness usually do not need treatment with antibiotics. Use an antibiotic only when symptoms are present. Excessive use of antibiotics leads to resistant strains of bacteria. This means bacteria become immune to antibiotic medications and can be much harder to kill.
  • If you have more than one or two urinary tract infections per year, it can be an early sign of other problems with the urinary system. A complete urologic examination should be included in your medical check up at least once a year.

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