Managing Urinary Tract Infections
Living with chronic spinal cord injury involves not only leading a healthy lifestyle, but also managing complications and instituting preventative measures where one can. The focus on health maintenance should be on prevention, rather than treating problems when they arise. I want to focus on an important issue: urinary tract infections (UTI). Common questions:
How do I know when I have a UTI?
What should I do if I suspect a UTI?
How do I minimise my risk of developing a UTI?
What follow up is recommended?
In the SCI person, complications related to the urinary tract were at one stage the leading cause of death amongst spinal cord injured persons. Due to increased awareness of urological issues and better management and follow up in the acute and chronic phases of SCI, the leading cause of death in SCI persons is now related to cardiovascular events. One has to remember that the bladder is not static after injury and will change in time. You may have started on a permanent catheter, progressed to intermittent self catheterisation, or even reflex voiding using a sheath. Whatever method you may be using, be assured that this will change with time. The most important thing to understand is that lifelong follow up is essential. This ensures that complications (which are normally asymptomatic) are picked up early and can be treated before becoming problematic. Once you leave rehabilitation I recommend the following steps:
- Annual check-ups with your rehab doctor. Not only looking at spasticity, seating, skin care, pain, depression, medications, etc. But also amd most importantly looking at the bladder.
- Annual bladder investigations – either an ultra sound of the bladder and kidneys, or on occasion an x-ray study (CT scan or IVP). These studies can identify if there are stones, or other problems in the urinary tract.
- Annual blood tests (kidney function tests).
The above recommendations will help prevent problems, or identify problems as soon as possible. If you suspect you have an UTI, which symptoms should you look out for and what should you do? Prudent use of antibiotics should always be encouraged. One of the greatest concerns amongst doctors who treat spinal injured persons regularly is the growing trend to use antibiotics when not indicated. UTI in spinal injury are identified according to specific criteria. The common mistake made by GP’s is to treat an UTI on the basis of a urine test strip. These test strips will always indicate infection in spinal cord injured persons. This is due to the fact that the urine in SCI persons is never sterile – it will always show abnormal urine test strip results. This does NOT indicate infection and antibiotics should not be taken for this. Taking antibiotics when not required, only encourages the emergence of resistant bacteria, which leaves doctors with little, or no sensitive bacteria when treatment is required. Antibiotics should therefore only be prescribed if the patient has a systemic fever of above 38C, cold shivers, rapid pulse, feeling unwell with a loss of appetite, headache and nausea or vomiting. When this occurs a urine sample, taken from the catheter directly and not the bag, should be sent to the laboratory to identify the bacterial culprit so that the correct antibiotic can be prescribed.
One can minimise the risk of infection by following a simple guide.
- Drink plenty of water at least 1.5 to 2 litres per day. Up to 3 litres per day if you are on a catheter. This ensures the bladder is continually being flushed.
- Change the catheter regularly if on a permanent catheter – a good quality silicone (NOT latex Foley) catheter should be used.
- Use a clean technique for self cath. If changing an indwelling catheter, then do so in as sterile a fashion as possible.
- The use of “natural antibiotics” such as cranberry tablets or Buchu is good – this helps protect against infection.
- There is no evidence to suggest that taking an antibiotic on a chronic preventative basis is of any value.