In the studio now for our "Your Health" segment tonight is
Dr. Madeline Dick-Biascoechea, a clinical assistant professor of
obstetrics, gynecology and reproductive sciences
at the University of Maryland School of Medicine and
Director of urogynecology and pelvic reconstruction
at the University of Maryland Medical Center.
Doctor, thank you for being with us.
Thank you.
We're here to talk about something that's very common,
can be very painful and is little discussed, UTI's.
What is that?
UTI stands for urinary tract infections.
It's an infection somewhere in the urinary tract including
the kidneys, ureters, bladder, or the urethra.
How common is it? Are there numbers?
Is it more women or men?
It accounts to about seven to eight million visits to the office every year.
And a hundred thousand admissions to the hospital a year.
So, it's very common.
It is twice as common in women than men.
How does it typically happen?
I mean obviously, you know, you have an opening
in the body and bacteria can get in. That's what happens?
Basically. Bacteria can come from the perineum
or the area of the genitals or rectum
and then it invades through the urethra into the bladder.
How does somebody know they have one?
What's the first symptom?
So, symptoms can include urinary frequency,
going more than usual to the bathroom,
urgency, having to go very quickly to the bathroom
and feeling a very uncomfortable burning sensation when you urinate.
They can also have a pain in the lower abdomen.
Some people can have a fever and
some can even have blood in the urine.
Is pain the first symptom?
It can be anything. Some people have more
urgency and frequency and some people have more pain.
Every person is different.
It sounds like one of those things we're getting medical attention quickly
is a good idea but it may not be clear to everybody
what's going on initially.
So, most people, if you're healthy and you
increase your fluid intake and the symptoms are not too severe
you can probably clear it on your own.
But if the symptoms are severe or they persist for
more than three or four days, you should definitely go to the doctor.
And especially the first or second time it happens
you want to go to the doctor very quickly because it's very uncomfortable.
Everybody makes the same association, when I saw
on the notes what we were talking about, my first thought was cranberry juice.
Yes. Is there anything to that as a cure or preventative for UTI's?
So, there are a number of things that we used for prevention.
Unfortunately, we don't have a great amount of research on this yet.
And some other research is contradictory
but I also I always tell my patients to, you know, try everything.
So, I don't usually recommend cranberry juice because it has
a lot of calories and you don't want all that extra sugar.
So, cranberry tablets, there is also increasing the fluid intake,
urinating right after intercourse,
and for some women that have recurrent urinary tract infections,
meaning that they have more than two in six months
or more than three in a year, we also may
give antibiotics to take every day for prevention.
Preventatively? mm-hmm.
Or what we call prophylactic.
What would the risk factors be in men for this?
Unfortunately, I see mostly women. Right!
But older men that can have
prostatitis, or an infection of the prostate
and show up with urinary tract infections
and anything that could potentially place bacteria that
is in the skin or in the rectum in the urethra.
Is the sort of thing where we're generally staying
reasonably hydrated, drinking a good amount, not a crazy amount, of water
is a good idea for everybody?
Yes, definitely. Almost two liters of water a day is plenty.
Making sure you have good hygiene, especially in women.
Wiping front to back is very important
so you don't bring the bacteria that's in the rectum
towards the vagina or the urethra.
And having, in general, a good healthy lifestyle.
Let's take a phone call, Baltimore County this is Erika.
Thank you for the call, go ahead.
I'm interested if there's anything in herbs, natural, plants to take.
Very good. Thank you, thank you for the phone call.
Natural therapies?
Like I said, cranberry tablets are good.
There's a supplement that's called D-MANNOSE
it's a type of sugar and you can find it as one of the supplements
in the pharmacy. That has been also in some studies shown
to prevent recurrent urinary tract infections.
But that's basically...
If an infection is allowed to continue without treatment,
what are the potential consequences?
So, certain patients are more at risk of complications during a
urinary tract infections.
Patients that are immunosuppressed because they're
taking certain medications, pregnant women, older patients might get then
ascending infections, what we call infections that go up from the bladder
towards the kidneys.
And that can present a dangerous situation because
the infection can go into the blood.
Let's take a call from Harford County.
This is Joe. Joe, thank you for calling. Go ahead.
Thanks, Jeff.
67 year-old male, been diagnosed with a distended bladder pentola,
it don't completely void my bladder.
I'm wondering what are the complications or side effects of that malady.
Alright, thank you for the phone call good luck.
You don't treat a lot of men, but...
No, but urinary retention can also happen in women
but both women and men with urinary retention can be more at risk of
urinary tract infections because there is more of a
volume of fluid that doesn't release all the time
and bacteria can then reproduce.
It's more of a favorable environment for bacteria to grow.
With women in particular, does it matter if you are somebody who
takes showers or takes baths and feminine hygiene products.
So, our bodies, that as women, are very good at cleaning themselves.
So, we don't need any feminine hygiene products,
we just need a showers and soap and water is a great thing.
If you do baths and you find that you are having
more urinary or vaginal infections then
that should be one thing that you eliminate first.
How does somebody know when to see the doctor
and once you've seen maybe a family doctor,
when you need a specialist?
Well, if the symptoms are very severe, if they have,
if you can't do your regular daily routine,
if they have been going on for three or four days
and they are not improving, if you have blood in your urine or you have a fever
and if there, if it's an elderly person and they show signs of confusion,
those are all signs that you should be seeing a doctor.
Either family physician or urgent center.
If a patient has repeated urinary tract infections,
again, more than three in a year or more than two in six months,
they should be treated as recurrent urinary tract infections
and they can be seen by a specialist, such as myself as a urogynecologist or
urologists to determine if they have certain
risk factors that we can intervene with.
Is there any research going on that's a particular interest
either in diagnosis, treatment, different antibiotics, and so forth?
Definitely. We have many institutions that are researching
first on the sensitivity of our testing because
there are a lot of bacteria that have been shown to not
show up in the urine culture sometimes.
So, we're working on having better testing for bacteria in the urine
and we're also working on trying antibiotics
that are able to treat resistant infections which
is a very constant struggle for us.
So, somebody in terms of the testing could have an infection
and I guess it's a urine test would come back negative... It may...
but it's a bug that's not being tested for?
It's less likely, I don't want to say that it's common,
but there are some bacteria that may not show up
in the urine culture and still give you symptoms and signs of a urine infection.
Your practice, you also specialize in surgery,
pelvic prolapse. Tell me about that, I mean,
how much of your practice is in different areas?
So, my practice is probably 30 percent prolapse, in which we
help women that have descent in the vagina and uterus.
Probably 50% incontinence. Both urinary and fecal incontinence,
meaning that you leak when you don't want to go to the bathroom or
there's leaking of stool as well.
And another, how much did I say, 50 and 30, so
the other 20%... there's no math on this test, it's okay...
So the other 30% will be recurrent patients with
recurrent urinary tract infections,
patients that have interstitial cystitis,
which is a pain syndrome in the bladder.
Another variety of things.
In terms of the surgical work that you do, how's that evolving?
So, there's kind of a pendulum, right?
Before there were no mention and everybody was mesh
and now most people don't get a mesh for prolapse
but we are finding better ways of
treating prolapse with better surgeries and more long-lasting surgeries.
Let's get one more phone call. Howard County, this is Cathy.
Cathy, thank you for calling. Go ahead.
Yeah I was just wondering, with the retention issue that the other man spoke about,
what does she think about catheterization
a couple of times a day to relieve the buildup?
Thank you for the phone call.
So there are a number of different ways to treat retention.
First and foremost, it's observation.
If a patient does have retention but can
reasonably, although not completely, empty their bladder
and they don't have a problem with urinary tract infections
or other complications of it.
We can just observe. The other two options will be catheterizing
a number of times a day, you would have to obviously consult with your physician
and see what's appropriate.
And then there's a nerve stimulator that
and plant to treat retention as well.
Doctor, we appreciate your time.
Your Health segments are a co-production of Maryland Public Television and the
University of Maryland Medical System.