Being pregnant is not at all a piece of cake. Apart from the routine nausea, vomiting, pain, cramps and mood swings body undergoes many other changes. These changes are not insignificant or gradual. Body changes tremendously. Thus during pregnancy a woman may become prone to many infections which are not that dangerous normally. So it is very important to take proper care and prevent those infections, for the well being of mother as well as the baby. One such infection is bladder infection. Some information which will help you to prevent it is given below

What is bladder infection?

Bladder is a muscular bag like structure which holds our urine. It s made of special muscles known as “detrusor muscles.” these muscles can expand like a single unit and hold the urine. In females, bladder is situated in front of uterus while in males in front of rectum. Bladder infection is infection to the bladder due to various pathogens. Thus in women bladder infection and pregnancy are related. Bladder infection is also known as urinary tract infection and is mostly a complication of lower urinary tract infection.

Why it is more prone in females?

Bladder infection is present in 20% of women. The chances of infection are 30% more in women than in men. And also the chances increase by 10% in pregnancy. The reasons are-

Shorter urethra– In males the length of urethra is 20 cm while that of female is just 4 cm. Thus the lower urinary tract infection can travel to bladder more easily in female than in male.

Proximity– The opening of the urinary tract is near to that of rectum in females. Rectum is very rich in bacteria. These bacteria can easily infect the urinary tract in females.

Sexual intercourse– in coitus, the risk of transmission of infection from male to female is higher than passing from female to male. This is because male organ enter into the female. Making a female more prone to infection.

Why more dangerous in pregnancy?

In pregnancy the chances as well as the risk of urinary tract infections increase. Complete care should be taken to prevent them. These infections should be treated immediately because they possess a greater threat to the mother as well as the baby. The reasons for it are-

Stasis of urinary bladder– during pregnancy, there is decrease in movement of bladder, causing stasis of bladder. This helps the bacteria in urine to multiply quickly. Thus increasing the chances of infection.

Frequency of micturition– during pregnancy, uterus obstruct the bladder, restricting its movements, thus increasing the frequency of micturition. This results in concentrated urine also the sphincter of the bladder are affected and thus increasing the chances of bladder infection.

Estrogen level– estrogen has a protective role in prevention of bladder infection. During pregnancy the level of progesterone hormone in high thus making a woman more prone to urinary infection.

Proximity of bladder- bladder is situated just in front of uterus. Also the opening of both i.e. the urethra and vagina are situated very near. Thus a bacteria causing bladder infection can infect the uterus easily. The lymph nodes to both are common; the blood supply is also closely linked.

Chances of influx of urine– during pregnancy there is lot of stress on the pelvic muscles. Also during delivery lots of tension is added on them. So due to this stress and tension there might be injury to the sphincter causing urinary reflex in the uterus. It is very dangerous.

Causes, Symptoms, & Treatment of  Bladder Infection During Pregnancy

Causes of infections

Infections can be caused due to various bacteria sometimes due to fungus also. Some of the organisms causing infection are-

E.coli– these bacteria are responsible for 80-90% of the urinary tract infection.

Proteous– infection due to proteus is mainly a hospital acquired infection through catheterisation

Pseudomonas– infection due to this bacteria is also a common hospital acquired infection

Klebsellia– klebsellia is also commonly present in intestine. Thus infects the urinary tract.

Staphylococcus– one of the most common yet most dangerous infections.

Vaginal yeast– it is found mainly in immunocompromised patients.

Predisposing factors for infection

The following conditions increase the risk of infection

Lower oestrogen level– estrogen has a protective role in urinary tract infections. Lower estrogen level makes a women vulnerable for the infections

Keeping bladder full for a longer duration– this gives the bacteria a greater chance to multiply. Thus cause an infection.

Pelvic surgery– any kind of pelvic surgery opens door for infections. Sterilization is very important. But still urinary infections are most easily acquired infections

Catheterization– catheterization means inserting a tube in the urethra, to void the bladder. This is done when no option is available. Since catheterization for more than 24 hrs causes infection in 50% of cases, while catheter for more than 4 days causes infection in 100% of the cases. So if a patient has to be catheterised all the preventive measures are taken. Urine is checked regularly for infection and catheter is kept for minimum time.

Immunocompramised disorders– like diabetes and HIV make a person more prone to infections.

Poor hygiene.

Route of infection

Ascending route– it is the commonest route of infection. The infection travels from the lower urinary tract to the bladder.

Haematogenous– sometimes infections travel through blood through any septic focus in the body. For e.g. Septic bowel, intestinal infection etc.

Lymphatic– the lymphatics of bladder are adjacent to the kidneys and the genitals. The infections from these organs infect the lymph nodes and may travel to bladder through it.

Symptoms

Foul smell– urine gets a foul smell. It may smell fishy, sweet or an unbearable smell. Normally urine should be odourless. Any deviation from it should be checked and reported to doctor.

Dysuria– dysuria means decrease in urinary volume. During pregnancy, the frequency of urination should increase. But if you notice decrease in urinary volume, then report it to your doctor.

Change in frequency– urinary tract infection causes change in frequency if urination. Any deviation from normal frequency should be reported. But increase in frequency in pregnancy is normal.

lower abdominal pain– there might be pain in the bladder, which may be referred to the lower abdomen

Painful bladder– a sharp pain in bladder may be experienced.

Burning sensation while urinating- most common symptom of urinary tract infection.

Urgency– normally our bladder has a capacity of 500 ml. We get an urge to urinate at 250 ml. till 500ml urine is comfortably stored. As an adult we become trained for an unfavourable situation. We can hold up to 1L of urine. But after 500 ml there is pain and discomfort.

Pus or blood cells in urine– presence of pus or blood cells in urine is a serious condition. It is an indicator of infection. If any such condition in experienced, then it should be immediately reported.

Nocturia– there is unusual increase in urination during the night time. It is not necessarily always associated with urinary tract infection. Intake of fluid, humidity and coolness are also responsible. As well as during pregnancy it is normal for the frequency to increases.

Dysparuria-dysparuria is a sharp pain in the genitals before, during or after sexual intercourse. It is also not necessarily always associated with urinary tract infections.

Investigations

For investigation sample of urine is required. Following are the ways to collect a sample of urine.

Midstream urine sample-it is the commonest method. Taking midstream sample is very important, as the urine at the start flushes all bacteria from the tract. To take a sample, you should first clean the genital area. Then by separating the external labia, some of the urine should be voided and then the sample should be taken without stopping the flow between the urine.

Supra pubic aspiration-it means directly obtaining the urine sample from the bladder. It is rarely done. Since bladder is innervated by many nerves, it is a very painful procedure. But the urine which is obtained is very fresh and a perfect sample. It is done if a person is unable to urinate and implanting a catheter is also risky.

Catheterization-It is inserting a tube through urethra. It directly voids the urine through bladder. The greatest risk for it is urinary tract infection.

These sample then undergo the following tests

Culture-urine is cultured for various bacteria. Most common is coli. Culture is done when specific antibiotics are required any when there is recurrent or resistant infection.

Microscopy-microscopy is observation of urine sample directly through microscope, for the presence of red blood cells, white blood cells or pus. Also pathogens can be seen directly if present.

Drug sensitivity testing-for a recurrent urinary tract infection drug sensitivity has to be done. Since many of the bacteria have became resistant to common antibiotics.

Treatment

General measures

• Regular voiding of urine– urine should not be held for longer duration. Voiding of urine should be regular to prevent infection.
• Proper hydration– drinking plenty of water is a great way to avoid urinary tract infections. Low amount of water in body makes urine concentrated, which irritates the urinary tract. Also it may cause urine to stand in bladder for longer duration. Making that person more prone to the infection.
• Maintaining hygiene– maintaining personal hygiene is the golden rule for prevention of any kind of infection.

Antibiotic treatment-antibiotics are used to for treatment of urinary tract infections. But as we all know drugs during pregnancy drugs should be avoided as much as possible. So as we all know prevention is always better than cure.

Prevention

Maintaining proper hygiene-proper hygiene should be maintained. Vagina has an acidic ph, thus it protects itself from bacteria. But sometimes, the bacteria may overpower it. Washing vagina with soap and water increases its ph this increases the risk of infection. So interior of vagina should not be washed, it is self cleansing. In case of any foul smell vaginal cleansers are available, they can be used. Clean undergarments should be worn. Areas around the vagina should be cleaned properly.

Prophylaxis for coital infection-it is advisable to avoid sexual intercourse if partner suffers from any urinary tract infection.

Plenty fluid intake

Taking prescribed dose of antibiotic-antibiotic should be taken as prescribed. If dose is not taken completely then infection may reoccur with drug resistance.This was some information about urinary tract infection. Special attention should be given during pregnancy. Prevention is always better than cure!