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Urinary tract infections (UTIs) occur when bacteria invade the normally sterile urinary system, causing inflammation to the epithelium. If the infection is found in the urethra and bladder, it is considered a lower urinary tract infection. When the infection goes above the level of the bladder and into the ureters and kidney, it is considered an upper urinary tract infection or pyelonephritis (Huether & McCance, 2017). Risk factors for UTIs include female gender, diabetes, sexual intercourse, urinary incontinence and/or retention, and immobility (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).

Lower urinary tract infections are most commonly caused by intestinal microbes like E. Coli. These pathogens bind to the urinary epithelium and create an inflammatory response. This response created edema and stretching of the bladder wall, which signals the stretch receptors to relay the feeling of fullness. This created the urgency, frequency, dysuria, and low back pain that are commonly felt. If left untreated, the epithelial wall will become more and more damaged, eventually leading to bleeding, ulcerations, and even gangrene (Huether & McCance, 2017).

Upper urinary tract infections, or pyelonephritis, can be caused by the pathogen climbing and spreading into the upper part of the urinary system. Unlike lower urinary infections, upper urinary infections can also be caused by contaminated blood flowing through the kidneys. If left untreated, abscesses can form in the adrenal medulla and cortex. Back or flank pain and costovertebral tenderness are symptoms that are more unique to the upper urinary infection and can help differentiate along with diagnostic testing. Fibrosis formation in the tubules can form after the initial infection (Huether & McCance, 2017).

Females are far more likely to suffer from urinary tract infections because of the shorter urethra and closer proximity to the rectum (Huether & McCance, 2017). Age is also a factor, as immobility, dehydration, and urinary incontinence increase the risk of developing UTIs. A UTI in an older adult can have different symptoms and manifestations, such as delirium, hallucinations, sudden decrease in mobility, and subsequent falls. These symptoms can be dangerous and may cause significant injury (Armstrong, 2015).

Along with antibiotics, urinary analgesics can help with the discomfort associated with urinary tract infections. Urised is a common urinary analgesic that is prescribed which often has anticholinergic side effects. Patients should be educated on the chance for urinary and/or bowel retention and when to seek treatment (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Encouraging fluid and fiber intake may help offset these side effects.


Arcangelo, V. P., Peterson, A. M., Wilbur, V. & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.

Armstrong, K. (2015). Diagnosing and treating urinary tract infections in older people. British Journal of Community Nursing, 20(5), 226-230. doi:10.12968/bjcn.2015.20.5.226

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

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