Frequent urination, waiting for urination, female

Frequent urination may be caused by physiological reasons, such as increased water intake or cold weather, or it may be caused by disease. There are many types of diseases in this regard, especially when the body is accompanied by other symptoms, such as frequent urination and waiting for urination in women. The most likely cause of this situation is urinary tract infection, and you need to figure out your condition as soon as possible. Now let's look at urinary tract infection.

Clinical manifestations of urinary tract infection

1. Acute simple cystitis

The onset is sudden, and the onset in female patients is often related to sexual activity. The main manifestations are bladder irritation signs, namely frequent urination, urgency, pain when urinating, discomfort in the bladder area or perineum, and a burning sensation in the urethra; the degree of urinary frequency varies, and in severe cases, urge urinary incontinence may occur; the urine is turbid, there are white blood cells in the urine, terminal hematuria is common, and sometimes it is hematuria throughout the process, and even blood clots are discharged. Generally there are no obvious systemic infection symptoms, and the body temperature is normal or there is a low fever.

2. Acute simple pyelonephritis

(1) Urinary system symptoms include bladder irritation signs such as frequent urination, urgency, and pain during urination; hematuria; low back pain on the affected side or both sides; obvious tenderness or percussion pain at the costovertebral angle on the affected side;

(2) Symptoms of systemic infection such as chills, high fever, headache, nausea, vomiting, loss of appetite, etc. are often accompanied by increased white blood cell count and increased erythrocyte sedimentation rate.

3. Asymptomatic bacteriuria

Asymptomatic bacteriuria is a hidden urinary tract infection, which is more common in elderly women and pregnant women. Patients do not have any symptoms of urinary tract infection, and the incidence rate increases with age.

4. Complicated urinary tract infection

The clinical manifestations of complicated urinary tract infection vary greatly, and are often accompanied by other diseases that increase the risk of infection or treatment failure, with or without clinical symptoms (such as frequent urination, urgency, dysuria, dysuria, low back pain, costovertia angle tenderness, suprapubic pain and fever, etc.). Complicated urinary tract infections are often accompanied by other diseases, such as diabetes and renal failure; they also cause many sequelae, the most serious and fatal of which include urosepsis and renal failure. Renal failure can be divided into acute and chronic, reversible and irreversible.

treat

1. Urinary tract infection in non-pregnant women

(1) A three-day therapy is recommended for the treatment of acute simple cystitis, which consists of taking oral co-sulfamethoxazole, ofloxacin, or levofloxacin. Because the efficacy of single-dose therapy is not as good as the three-day therapy, it is no longer recommended. In areas where the resistance rate of pathogens to sulfamethoxazole is as high as 10% to 20%, nitrofurantoin can be used for treatment.

(2) For the treatment of acute simple pyelonephritis, it is recommended to use antibiotics for 14 days. For patients with mild acute pyelonephritis, the course of treatment can be shortened to 7 days using high-efficiency antibiotics. For mild cases, oral quinolones can be used for treatment. If the pathogen is sensitive to trimethoprim-sulfamethoxazole, this drug can also be taken orally. If the causative bacteria are gram-positive, treatment can be with amoxicillin alone or amoxicillin/clavulanate potassium. For severe cases or those who cannot take oral medications, they should be hospitalized and treated with intravenous quinolones or broad-spectrum cephalosporin antibiotics. For those who are resistant to β-lactam antibiotics and quinolone antibiotics, aztreonam can be used for treatment. If the pathogen is a Gram-positive coccus, ampicillin/sulbactam sodium can be used, and combined medication can be used if necessary. If the condition improves, sensitive antibiotics can be selected for oral treatment based on the urine culture results. Regimen adjustment and follow-up are very important during medication. Urine culture should be performed every 1 to 2 weeks to observe whether the urine bacteria turns negative. Quantitative urine bacterial culture should be performed at the end of the treatment and 2 and 6 weeks after stopping the medication. It is best to review it once a month thereafter.

(3) Complicated urinary tract infection The treatment plan for complicated urinary tract infection depends on the severity of the disease. In addition to antimicrobial treatment, it is also necessary to simultaneously address anatomical and functional abnormalities of the urinary system and treat other underlying diseases. If necessary, nutritional support therapy is also required. If the condition is severe, hospitalization is usually required. First of all, the underlying diseases such as diabetes and urinary tract infarction should be controlled promptly and effectively. If necessary, joint treatment with relevant professional doctors such as endocrinologists is needed. Otherwise, it is difficult to cure the disease with antibiotics alone. Second, treat with broad-spectrum intravenous antibiotics empirically. During the medication period, the treatment plan should be adjusted in time according to changes in the condition and/or the results of bacterial drug sensitivity tests. Some patients may need combination therapy, and the course of treatment should be at least 10 to 14 days.

2. Male cystitis

Prostatitis should be excluded in all male patients with cystitis. For uncomplicated acute cystitis, oral treatment with sulfamethoxazole or quinolone drugs is the same as for female patients, but the treatment course needs 7 days; for patients with complicated acute cystitis, oral ciprofloxacin or levofloxacin can be used for continuous treatment for 7 to 14 days.

3. Urinary tract infection during pregnancy

(1) Asymptomatic bacteriuria The incidence of asymptomatic bacteriuria during pregnancy is as high as 4% to 7%, often occurring in the first month of pregnancy. Up to 40% of cases may progress to acute pyelonephritis. Therefore, it is recommended that urine culture tests should be performed on pregnant women routinely in early pregnancy to detect patients with asymptomatic bacteriuria in a timely manner. It is currently recommended that anti-infective treatment should be taken for such patients. It is recommended to give 3-5 days of antimicrobial treatment based on the results of the drug sensitivity test. One of the following options can be selected: ① Nitrofurantoin; ② Amoxicillin; ③ Amoxicillin/clavulanate potassium. Please come to the hospital for a urine culture review 1 week after stopping the medication, and then review it once a month until the end of the pregnancy. For patients with recurrent asymptomatic bacteriuria, antibiotic prophylaxis can be taken during pregnancy, taking nitrofurantoin or cephalexin every night at bedtime.

(2) For acute cystitis, it is recommended to give 3 to 5 days of antimicrobial treatment based on the results of urine culture and drug sensitivity test. If there is no time to wait for the results of drug sensitivity test, nitrofurantoin, amoxicillin, or second- or third-generation cephalosporins can be given. After treatment, urine culture test is required to understand the treatment effect. If acute cystitis recurs, it is recommended to take cefuroxime or nitrofurantoin orally before bedtime every day until the postpartum period to prevent recurrence.

(3) Acute pyelonephritis The incidence of acute pyelonephritis during pregnancy is 1% to 4%, and it often occurs in the late pregnancy. It is recommended to first give intravenous infusion of antimicrobial drugs based on the results of urine culture or blood culture and drug sensitivity test. If there is no time to wait for the results of drug sensitivity test, ceftriaxone, aztreonam, piperacillin + tazobactam, cefepime, or ampicillin can be selected for treatment. After the clinical symptoms are significantly improved, treatment can be switched to oral antibiotics. The total course of treatment is at least 14 days.

4. Asymptomatic bacteriuria

Antimicrobial therapy is not recommended for premenopausal non-pregnant women, diabetic patients, the elderly, patients with spinal cord injury, and patients with asymptomatic bacteriuria with indwelling urinary catheters. However, patients with asymptomatic bacteriuria who undergo transurethral prostate surgery or other urological procedures or examinations that may cause urinary mucosal bleeding should be treated with sensitive antibiotics based on bacterial culture results.

5. Catheter-related urinary tract infection

(1) Antibiotic treatment is not recommended for most asymptomatic bacteriuria. Some exceptions to this recommendation are the following: nosocomial infections caused by more virulent organisms; patients who may be at risk for serious concurrent infections; patients undergoing urologic surgery; infections with certain strains that cause a high rate of bacteremia; and older female patients who may require short-term treatment after catheter removal.

(2) For symptomatic infection, it is recommended to replace catheters that have been in place for more than 7 days before taking urine samples for culture and before using antimicrobial drugs, or to use other drainage methods such as condom drainage and suprapubic cystostomy drainage. If there is no need to continue the catheterization, it can be discontinued. It is recommended to select effective antibiotics based on the results of urine culture and drug sensitivity test. Broad-spectrum antibiotics can be used empirically initially, and antibiotic use can be adjusted based on culture results. For those with mild symptoms, oral medication can be used, usually for 5-7 days. Patients with severe symptoms, fever, positive blood culture, and difficulty in gastrointestinal administration can choose non-gastrointestinal medication, such as intramuscular or intravenous injection. For severe cases, medication is usually taken for 10 to 14 days. Occasionally, candidal infections may be treated with antifungal therapy. Long-term, unwarranted use of antibiotics is not recommended.