Urinary Tract Infections

By Jan Pelletier

Many factors contribute to recurrent urinary tract infections (UTIs) in people with disabilities affecting the bladder. One of the more obvious factors is interference with the normal storing and emptying of urine as a result of the disability. The bladder may be retaining urine instead of emptying completely, for example. Sometimes the bladder is unable to empty at all, or under very high pressure from strong contractions of the bladder. Intervention for bladder management may be recommended by a urologist, to facilitate emptying or to reduce the high pressure in the bladder.

Unfortunately, there is an increased risk for urinary tract infections as a result of the physiological changes occurring with the bladder. So what can be done to minimize the risk? The following suggestions may be helpful.

Don’t Hold Your Water
One approach to reducing UTIs is to drink sufficient amounts of water. This helps to flush out bacteria that have found their way to the bladder. For individuals who use intermittent catheterization (IC), however, a balance must be found between drinking sufficiently to reduce infections and not exceeding a volume of 500 mL with each IC, or the result may be urine backing up into the kidneys.

Generally, an intake of fluid totalling about two to three litres per day is recommended, and it is best if this is distributed as evenly as possible throughout the day. If incontinence is a problem and subsequently intake is avoided, a urologist may be able to recommend interventions that help to keep you dry, so that adequate volumes can be taken comfortably.

Cleanliness... Next to Godliness
Hands should always be washed before and after inserting catheters. The genital area should also be cleansed before insertion of the catheter. Soap and water -- or, if away from home, commercially prepared wet towels (baby wipes) -- can be used. Make sure that the wet towels you purchase do not contain alcohol.

If incontinence is an issue, cleanliness is particularly important. It may be necessary to cleanse the genital area more frequently. Proper incontinence pads may help to absorb urine more readily, keeping it away from the skin. Again, good handwashing cannot be emphasized enough to help prevent the spread of infection.

Natural Preventatives
Cranberry capsules have helped many individuals prevent UTIs. If the problem is significant, it is usually recommended that they take the maximum dosage recommended on the bottle. Individuals taking them report that some brands do not seem to be as effective as others. Also, it does not work for everyone -- for various reasons -- but many people do report a reduction in the incidence of infection.

Garlic pills are also known to be effective in preventing UTIs. Combinations of the cranberry capsules with garlic pills, or with vitamin C, have also been reported to be effective.

Reduce Caffeine
Caffeine is a potent drug that causes smooth muscle contraction, having an effect on both the bowel and bladder. It may counteract some drugs that are meant to keep the bladder relaxed. It is also known that caffeine can make people more prone to getting bladder infections. The reason for this is unclear, and it is more common in children than in adults. However, for recurrent UTIs, reducing caffeine intake may help.

Overall Health
Lifestyle may also play a role in recurrent UTIs. Eating healthy foods within a well balanced diet, as well as including both activity and rest in your day, if possible, will help. Certainly, excessive use of alcohol and non-prescription drug use lower the effectiveness of your immune system.

Do Some Detective Work
Lastly, if persistent, recurring UTIs are a problem, urological investigation may be helpful. A urodynamic test, renal (kidney) ultrasound and cystoscopy can rule out specific causes of infection. Discuss the problem with your physician. It may be possible at least to reduce the incidence of infections.

(Jan Pelletier is the Outpatient Co-ordinator of the Spinal Cord Rehabilitation Program at Toronto Rehab’s Lyndhurst Centre. Toronto Rehab is a fully affiliated teaching hospital of the University of Toronto, specializing in adult rehabilitation and complex continuing care. The hospital’s six clinical programs include cardiac, geriatric, musculoskeletal, neuro and spinal-cord rehabilitation, and complex continuing care.)