This is my 6th post in the #UnderstandingUrostomies series and it is a very important one....
Thank you goes to Louise Pearce (who has just started a blog) for writing this post and helping me out while I have been a bit overwhelmed with my recent hospital visit.
What are Urinary Tract Infections (UTI)?
Urinary tract infections are a multifaceted problem and without proper care and attention can lead to serious consequences such as kidney failure and sepsis. UTIs affect urostomates differently where some may have recurrent infections while others may not have any. Infections can occur in the urostomy, ureters, kidneys and sometimes if you still have your own bladder in-situ (called Pyocystis).
Urostomates should be aware of basic human anatomy and how the urinary diversions affect the body so that you are alert to changes in your bodily functions. This means you can spot problems and can get them treated promptly. Any good doctor will tell a patient with chronic illnesses that they know their bodies better than any doctor. It is a good idea to keep a diary of infections, even what is normal for them and any other issues you have with your urostomy. The diary can help Doctors to see patterns that will help them diagnose issues you may not have recognised as important. With smart phone technology, this makes it a bit easier. This can then prevent a simple urine infection from progressing to the point where the bacteria can become resistant to antibiotics.
UTI’s after an ileal conduit /urostomy surgery if left untreated or if not cleared up properly can lead to kidney problems as the infection can travel from the conduit up the ureters to the kidneys and if severe enough can lead to permanent damage or even kidney failure. In rare circumstances or with sepsis it could potentially have fatal consequences. So it is vital that infections where there are symptoms need to be dealt with promptly in people with urostomies especially as we may have other chronic diseases present.
Warning signs of a UTI
- Dark, cloudy urine
- Urine with more mucus (white shreds);
- Strong smelling urine not associated with certain foods
- Back pain where your kidneys are located
- Loss of appetite
- Nausea and vomiting
So if an infection is suspected it should be a collection of symptoms rather than relying on one symptom. It is important to check when you are experiencing one symptom to remember that taking frequent courses of antibiotics if not warranted can lead to antibiotic resistance. Asymtomatic means when your dipstick test may present and look like you have an infection however you do not have any symptoms. In this incidence, antibiotics may not be used because you are not symptomatic and if you use antibiotics too much you will become resistant in the long term.
Tips to help prevent urinary tract infections
- Drink plenty of fluids (at least 6-8 glasses of water each day. This should be increased if you are exercising or if you are experiencing hot weather. The colour of your urine can be a guide if it is getting dark, then you need to increase your fluids.
- Wash hands before and after changing your pouch
- Continue your personal hygiene especially if you still have your bladder (if you think how many times you would go to the toilet before you had your urostomy and how you would clean yourself after urinating). Some people forget to clean themselves regularly during the day. This is especially important if you still have your bladder in place still. People forget it is possible to have infections in your bladder after having had a urostomy especially if you had frequent infections prior to surgery. The bladder can retain a sludge (medical term) the body then tries to make fluid to clear the sludge. It then can cause the body to fight to clear the sludge leaving it open to infection (Pyocystis) or inflammation.
- Use a night drainage bag or container and clean it well.
- Empty your pouch when it is 1/3 to 1/2 full.
- If you have a history of urinary infections, you may want to ask your doctor if you should take vitamin C or cranberry juice. Latest medical studies have shown cranberry is most effective as a preventative rather than as a treatment for infections. **Please Check with your doctor first if on warfarin or blood thinning medications**
Treatment for UTI’s
If a urostomate has frequent UTI’s some Drs will suggest taking prophylactic antibiotics. Within the medical community, there is now much debate over the use of too frequent courses of antibiotics this allows bacteria to mutate and become resistant to antibiotics. One London hospital has chosen a new route of treatment especially for urostomates they have started using a supplement called D-mmanose (which is an over the counter supplement).
D-mmanose is a supplement that is a simple sugar that is sticky and it attaches itself to the bacteria which are present in the conduit, urethra or bladder (if you still have it). When the bacteria multiply this then causes the infection. D-mannose also changes the lining of the conduit, urethra or bladder making it harder for the bacteria to stick to. Bacteria like to grow in places that are warm and wet. This supplement makes it harder for the bacteria to attach itself to the lining of the structures, therefore, the bacteria cannot multiply and instead is passed out in the urine. It also thins the mucus which is present in conduits due to the conduit being constructed from bowel (the piece of bowel from which the conduit is formed from continues to act as the bowel and thus continues to produce mucus as it would if it was still a piece of bowel).
D-mannose is particularly efficient in eliminating E-coli which is the bacteria that is present in largest quantities in the conduit which can lead to infection. (E-coli is also the most frequent cause of infection in the bladder) there are other bacteria that can multiply and cause infection such as Klebsiella, pseudomonas amongst others it is only when there is an over growth of bacteria there is a problem as everyone needs a healthy flora and fauna of bacteria for the body to work effectively.
The sugars in D-mannose attaches itself to the bacteria and helps to stop the bacteria from sticking to the bladder walls and prevent the infection from progressing up from the bladder to the urethra and eventually potentially affecting the kidneys. The sugars also coat the bladder walls, conduits, urethra and the kidneys then when you pass urine the bacteria is flushed out too. You will need a high dose to start with. Once the infection is resolved (which may take longer than antibiotics), you will then need a maintenance dose for up to six months.
Taking the D-mannose for a prolonged period of time can break the cycle of repeated infections. Often even as little as 3 years ago, D-mannose was recommended as a last resort when people had tried all antibiotics as it was only by anecdotal evidence that Doctors had heard from patients that it had worked. So they would recommend it but could not prescribe it as no medical studies had been completed to prove its efficiency. In the last three years, scientists and Doctors have carried out medical studies which have shown it works and proved that is effective for urinary infections. In a time where scientists and Doctors are working to find ways of treating infections without the use of antibiotics because of the resistance issues, they are now facing.
This seems to still be fairly new in the UK and not many people have heard of this treatment but clinical trials show its effectiveness. There may also be a question of funding to why it is not used as frequently yet for UTI and kidney infections.
For many years now if anyone had cystitis or urine infection people would recommend Cranberry juice as a cure. Interestingly this has now also caused much debate among medical professionals as to the usefulness of Cranberry juice and supplements. Some wide based studies now are indicating that Cranberry juice is better used as a preventative measure rather than a treatment which goes against what we were told previously. But further trials are needed based on different populations of patients with infections and also different versions of Cranberry such as supplements and dried cranberries.
**Please be aware that if you are on blood thinning medication please do not drink cranberry juice without checking with your medical professionals. Sometimes cranberry juice can affect how these tablets work **
A third treatment previously recommended for treatment of urinary infections was that we should take probiotics and it was marketed as a antidote to antibiotics killing good bacteria and bad bacteria. This theory is widely disputed amongst the medical professionals and natural medicine practitioners.
Medical studies show that the importance of having the correct flora and fauna in the bowel helps prevent infections relating to the whole body as when the body has the correct balance of flora and fauna in the bowel means the body is working as it should and thus giving it the strength to fight off bacteria multiplying out of control causing infection and then is means the body is not fighting against itself. Scientists have found because westernised diets are full of sugar and carbohydrates this interrupts the bowel flora and fauna thus the body is fighting to process the sugar and carbohydrates thus it disrupts the bodies balance and so it is possible that body is weakened by this and it allows potentially that the body is then open to infection.
When you suspect you have an infection, go to your Doctors do not let a well-meaning Doctor or nurse to dip test your urine as it will show it will often give a false positive for infection. Hence if infection is suspected then a clean sample of urine should be collected so that that it is lab tested for the bacteria but also the correct antibiotic for that type of bacteria. This is due to the urine will contain a high number of contaminants from the bowel lining and a high content of bacteria. If you experience frequent episodes of infection you are at risk eventually of damage to the kidneys or sepsis. Please read this post 'How to take a urine sample' on the best ways to achieve this.
If the bacteria have not cleared completely with each course of oral antibiotics over time you will find you have to progress to having IV antibiotics and over time the situation will worsen with each infection and the infection will become more and more infrequent. If this is a frequent situation the Professor who looked after me recommended both my GP and any hospital Doctors when they receive the results of the urine test. They should speak with a microbiologist to test which antibiotics is best to treat each infection. Rather than repeatedly prescribing broad-spectrum antibiotics. Many scientists and Doctors blame this type of prescribing broad-based antibiotics for furthering the process of bacteria becoming resistant to antibiotics.
Thank you, Louise, for your very interesting and detailed post. UTI's for urostomates is probably the top complication that we will suffer from but there are different degrees whereas somebody may only have 1 a year to a few times a month. Personally, I still suffer from UTIs and Kidney infection, however, this is so much less than when I had my Supra-pubic Catheter! As Louise has mentioned we know our bodies best and must act promptly if we suspect an infection.
I would love to hear your from you regarding this topic :)