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Key facts about managing bladder incontinence 2 - Managing UTIs correctly

Urinary tract infections (UTIs)

As described earlier, people with spina bifida are prone to UTIs.

You must be constantly on the alert for the warning signs and symptoms, which may indicate the presence of a UTI.

Early detection of a UTI will keep you well and out of hospital

The best person to pick up UTI early is you.

The commonest symptoms of a UTI are needing to go to the toilet often and pain when the urine comes out.

Because you may have reduced sensation in the pelvic region, you find it more difficult to notice these signs.

Other symptoms of UTI are:

• smelly or cloudy urine
• fever, nausea or vomiting
• sleepiness or tiredness
• loss of appetite
• headache and fever
• just feeling ‘off colour’.

 Kidney pain and spina bifida: an emergency.
Do not hesitate to get expert help immediately.
Back pain in the kidney region occurs when the kidneys are infected.
Kidney infections are very serious and can damage the kidneys
Kidney infections are always an emergency.
Always see a doctor or go to hospital immediately if you have a kidney infection.

How do I manage UTI?

Prevention is the best cure

• Cranberry juice - the best kept secret in the world. This juice, readily available in supermarkets, will help prevent UTIs by keeping the urine nice and acidic and unfriendly to bugs.
• Drink lots of water, especially when it’s hot. Never get thirsty. UTI bugs grow more easily if you are producing less urine. Drinking lots of water flushes the bugs out.
• Perfect cathing technique prevents UTIs. You can prevent UTIs from occurring by careful cathing.
• Detecting a UTI early is a key to good management. Early detection means immediate antibiotics and knocking over the infection before it gets out of control and into the kidneys.
•You should regularly dipstick your urine with a nitrite stick. These are relatively cheap and available from the chemist or your incontinence nurse. If the sensitive pad on the stick turns red when you dribble some sterile urine over it, a UTI is most probably starting. Go to the doctor immediately!

What if I get a UTI?

• UTIs must be managed quickly and effectively, usually with antibiotic tablets prescribed by your doctor.
• Be sure to finish the course of tablets completely.
• If a UTI gets out of control, it can spread from the bladder up to the kidneys and cause a kidney infection, which is very serious.
• As a result of frequent UTIs, many people with spina bifida have bugs, which have become resistant to standard antibiotics. This will mean a more careful examination of what bug is present (by culturing a urine sample), and the prescribing of a less common antibiotic to kill the bug. The antibiotic may need to be given intravenously (via a drip in your arm). This can mean a hospital stay.
•Single-use catheters (not your usual reusable catheter) must be used when you have a UTI and until the infection has cleared.

What drugs can they help with my bladder incontinence?

• Under the direction of your specialist, medicines can be an important aid in your continence management. The most common agent is ditropan, which relaxes the muscles of the bladder and allows it to hold more urine. This means you will stay drier between cathing.
• These chemicals can have the side effects of dehydration and constipation, which are not desirable for reasons we have already noted.

How to successfully prevent UTIs yourself: a case study
Michael is a 25 year old man with spina bifida who has a history of ‘run away’ UTIs requiring multiple hospital admissions with kidney infections. In one year, Michael was in hospital 10 times.
For Michael, the early signs of UTI included cloudy, smelly urine, fever, tiredness and nausea.
Prevention of UTIs for Michael included a referral to a specialist and urodynamic studies.
Michael was also taught how to prevent UTIs. He drinks a glass of water whenever he is thirsty and even takes a water bottle with him when he goes out. He went over his cathing technique and found he was making mistakes. He was taught to dipstick his urine (to check for UTI) and does this daily and knows the symptoms of an early UTI. Treatment is now started at an earlier stage and the number of his UTI related hospital admissions has decreased to once in the last two years.

UTIs: The effects on your life

Case studies

Poor management

  
Effective management
 

 

How to successfully prevent UTIs yourself: a case study
You have just looked at two totally different continence management scenarios. Sarah, who has taken good care of herself and been regular in consulting her urologist and other members of the spina bifida treatment team. And Carol, whose tragic situation could have been avoided, if she had sought expert advice.

 

Maintaining continence and preventing UTIs and kidney damage
Golden rule 1:
Regular monitoring of your urine system by you and your doctor is the key to staying well.

Golden rule 2:
You are the most important person in maintaining your health and happiness

Golden rule 3:
Prevention is better than cure.

How do I prevent UTIs and kidney damage?

• Cranberry juice daily.
• Drink lots of water, especially in hot weather. Never get thirsty. Drinking lots of water flushes the bugs out.
• Perfect cathing technique prevents UTIs.
• Detecting UTIs early before they get out of control and into the kidneys.
• You should regularly dipstick your urine with a nitrite stick. If the sensitive pad on the stick turns red when you dribble urine over it, a UTI is most probably starting. Go to the doctor immediately.

What tests do I need to have done once a year in adulthood?

• Urological surveillance never stops, no matter how old you are.
• You will require:

- renal ultrasound to check for kidney condition and growth
- renal function tests (blood tests) to check for how well your bladder and muscles are working; what volume of urine is being held and if the pressures in your system are okay.

• Refer to your health planner and make sure you record the times and dates of your regular medical appointments.
• It is essential that you go to all medical appointments and have all the tests your doctors order, even when you feel perfectly well.

See our continence nurse at least annually to:

• check your cathing routine
• review your products and aids - catheter type and size; pads; how to improve your routine, etc.

If you have a stoma, this should be checked by a stomal nurse at least annually.
See the example continence management planner at the end for an example of an annual cycle of good continence care.