Urinary Tract Infections - UTIs
A urinary tract infection is a bacterial infection that grows within the urinary tract - anywhere from the kidneys, the ureters, the bladder and through to the urethra.
Urinary tract infections can be a particular problem for people with diabetes as sugar in the urine makes for a fertile breeding ground for bacteria.
This is supported by data from the American Diabetes Association (a report at the 73rd Scientific Sessions of the ADA), which showed 9.4% of people diagnosed with type 2 diabetes had a UTI compared to only 5.7% of people without diabetes. 
How serious are urinary tract infections?
Urinary tract infections are characterised by two types:
- Lower urinary tract infections or Cystitis - bacterial infection affecting the bladder and the tube that transports urine from your bladder out of your body via the penis or vagina (urethra)
- Upper urinary tract infections or Pyelonephritis - bacterial infection affecting the kidneys and the tubes connecting the kidneys to the bladder (ureters)
Both types are more prominent in people diagnosed with diabetes.
What is Cystitis?
Cystitis is the medical name for an inflammation of the bladder. This usually develops as result of intestinal bacteria entering the urethra and travelling up to the bladder where it can multiply and irritate the bladder lining.
Whilst less dangerous than upper pyelonephritis, cystitis should be treated early to prevent the infection from reaching the ureters.
What is Pyelonephritis?
Pyelonephritis is the term used by clinicians to describe upper UTIs. In cases of pyelonephritis, bacteria enters the urinary tract and reaches the ureters.
If left untreated, the bacteria can travel up one or both of these tubes to the kidneys and cause a kidney infection (acute pyelonephritis).
This can be very dangerous and often requires hospital treatment.
What causes a UTI?
Urinary tract infections can be caused by a number of factors, such as:
- Bacterial infection resulting from sexual intercourse
- Having sex using a spermicide (vaginal contraceptive)
- Poor toilet hygiene - wiping from back to front after a bowel movement can cause bacteria such as E-coli to spread from the anus to the vulva (outer parts of the vagina) or urethra
- Kidney stones - these can cause the ureter or kidney to become blocked
- An enlarged prostate (male sex gland) - see above
- Damage or irritation around the urethra
- A weaker immune system - common in people with diabetes or HIV/AIDS
Why are people with diabetes at higher risk of UTIs?
Several theories have been proposed as to why UTIs are more common in diabetics than non-diabetics:
- Diabetic neuropathy - nerve damage caused by prolonged high blood glucose can lead to bladder dysfunction. Dysfunctional bladders that contract poorly allow urine to remain in static pools for long periods of time, providing ideal conditions for bacteria to grow in.
- Glucose in the urine - more glucose (sugar) in the urine can also allow bacteria to reproduce more easily.
- Impaired immune response - diabetes can lead to reduced circulation, which in turn can reduce the ability of infection-fighting white blood cells to ingest the offending bacteria and kill them.
What are the symptoms of a urinary tract infection?
The symptoms of lower and upper UTIs are as follows.
Signs of Lower UTIs (Cystitis) include:
- Pain or stinging when passing urine (dysuria)
- Persistent feeling of the need to urinate
- Cloudy and foul-smelling urine
- Abdominal (stomach) pain
- Back pain
- Blood in the urine (hematuria)
Symptoms of Upper UTIs include:
- High temperature / fever
- Constant shivering
- Back pain
- Pain in your side (flank pain)
How are UTIs treated?
Lower urinary tract infections can often be treated by taking antibiotics for a few days. Painkillers may also be taken to treat any associated stomach or back pain.
Upper urinary tract infections may be treated at home or in hospital depending on the severity of your condition. Treatment will typically involve a longer period of antibiotics, at least a week.
The pain can be treated with Paracetemol, although some painkillers such as Ibuprofen are not suitable as they can increase the risk of damage to the kidneys.
How common are UTIs?
UTIs are much more common in women than in men, with most women likely to develop an urinary infection at some point.
This increased risk is partly because, in women, the urethra is nearer the anus, which makes it easier for bacteria to move from the surrounding skin into the urethra.
The urethra is also much shorter in women, meaning there is less distance for the infection to travel to the bladder.
In both sexes, the chances of developing a UTI increase significantly with diabetes.
Can I prevent UTIs from developing?
The following methods may help to lower the risk of urinary tract infection:
- Drinking plenty of water
- Keeping your blood sugar level under good control
- Drinking cranberry juice, although this may push your sugar levels up so be careful
- Going to the toilet after sex
- Making sure you regularly wash your genitals, particular before sex
- Wiping your bum from front to back
- Going to the toilet as soon as you have the urge to
If you experience a lot of UTIs, you may wish to avoid the use of spermicides. If you decide to do this, consult your healthcare team to ask about other forms of birth control.