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BODY WATCH : Faster Relief From a Pressing Problem : The signs are unmistakable--it's another urinary tract infection. Now for the good news: There are better remedies nowadays.

November 01, 1994|KATHLEEN DOHENY | SPECIAL TO THE TIMES

The first clue might be an annoying need to visit the bathroom way too often. That's followed by a burning sensation while urinating and sometimes pain in the pelvic area.

Urinary tract infections most often affect women, but men aren't immune, especially in later life when enlargement of the prostate gland can increase the likelihood.

But lately there's good news for sufferers. Treatment of urinary tract infections--which can involve the bladder, kidneys or the urine-transporting tubes--has become easier in recent years, thanks, in part, to new antibiotics and shorter courses of medication.

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The Stats and the Source: Urinary tract infections, or UTIs, are nearly always bacterial. Women are more prone than men due partly to anatomy. A woman's urethra--the tube through which urine is excreted from the bladder--is shorter, making infection more likely. Infection can occur after intercourse, when bacteria normally found in the genital area can be pushed up into the urinary tract.

UTIs are so common, some experts say, that most women can count on having at least one at some point in their lives. Published figures estimate 10% of women have had UTIs, says Dr. Eila Skinner, USC assistant professor of urology, but she suspects the percentage is actually much higher. "And of those women who get one, 20% will have recurring infections," she adds.

Use of a diaphragm or IUD for contraception can be associated with UTIs, experts say. And what about the folklore that also links horseback riding, bicycling, and wearing tight jeans and tight pantyhose to UTIs?

"There might be some merit to the horseback riding," says Dr. Barton Wachs, a urologist at Long Beach Memorial Medical Center and clinical instructor at Harbor/UCLA Medical Center. As for the risk of the other behaviors, evidence is "mostly anecdotal," he says. But if women notice a link, avoiding the attire or activity might help. "But of course many people who do all these things never have an infection," he adds.

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Home Remedies: At the first sign of infection, many women self-treat by drinking plenty of fluids, including cranberry juice, hoping to flush out the bad bugs. It probably can't hurt in most cases, experts say.

But anyone who's had a type of kidney stone composed of calcium oxalate--the most common kind--should avoid the cranberry juice remedy, Wachs says, because the juice contains oxalic acid. (But others, including a spokeswoman for a cranberry juice manufacturer, counter that there's not enough oxalic acid to do harm.)

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Professional Help: Self-care helps about half of women, Skinner says. If symptoms don't improve in two or three days, see a doctor, she advises.

Seek medical help, too, if the urine contains blood.

Men or children with suspected UTIs should always see a physician because their infections are likely to be associated with potentially serious underlying problems.

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Diagnosis & Treatment: A physician may order a culture of the urine, which can pinpoint the bacteria involved and determine whether kidney stones have formed. "Certain organisms suggest kidney stones or other abnormalities," Skinner says.

Oral antibiotics are the usual treatment. Commonly prescribed are such medicines as ampicillin or nitrofurantoin. Quinolones, a newer choice, have become a common treatment, but they are being overused, says Dr. Philip Hanno, professor and chairman of the department of urology at Temple University School of Medicine. Quinolones--such as ciprofloxacin (Cipro)--should be reserved for "complicated cases," he believes.

"But they're a lifesaver on a Friday afternoon when you can't get a culture (analyzed)," Wachs counters.

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New Versus Old Treatments: Not too many years ago, standard antibiotic treatment for UTIs took seven to 10 days, Hanno says. Now, patients are placed on "shorter and shorter" courses, with two-day regimens common.

Sometimes the medicine is even taken in a single dose, thus increasing patient compliance.

"Within 24 hours after starting an antibiotic you should feel better," Wachs says.

Following antibiotic treatment, however, women are more prone to yeast infections, Wachs says. So he recommends an over-the-counter anti-fungal remedy (such as Monistat 7 or Gyne-Lotrimin) or a prescription anti-fungal medicine.

If a woman has repeated UTIs, a physician might recommend daily use of antibiotics for three to six months to build resistance. Or, some women are given an emergency supply of antibiotics to use when they notice symptoms or to take before and after intercourse.

Women who get more than four UTIs in a year should see a urologist, Wachs says.

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An Ounce of Prevention: Drinking plenty of fluids and voiding after intercourse can help flush away bacteria.

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On the Horizon: Under development is a vaccine to protect against UTIs. While it is not expected to be on the market in the immediate future, Hanno says, it does promise eventual relief to women prone to infections.

How the Urinary System Works Also known as the urinary tract, the system, which filters and disposes of waste from the blood, consist of the kidneys, ureters, bladder and the urethra. The Kidneys This is where urine is formed to help carry out waste from the blood. Located next to the aorta, more than two pints of blood passess through the kidneys every minute. Cross section Cortex, Medulla, Calyces, Pelvis Collecting System After going through the filtration system, or medulla, most of the water and other substances are reabsorbed into the blood. The remaining concentrated urine are collected by the calyces and run through the pelvis. From there, the urine goes to the ureter. The Ureters The tubes that carry the urine from the kidney to the bladder. The Bladder This is where up to a pint of urine is stored. Composition of Urine * 96% water * 2% urea (the main waste product) * 1% sodium chloride (salt)

*Source: AMA Encyclopedia of Medicine

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