2019, July/August Adirondac
URINARY TRACT INFECTION (UTI) is one of the most common complaints bringing folks to their primary care providers. Since the urinary tract encompasses everything from the kidn s, where urine is made, to the urethra, the final tube through which it leaves the body, a UTI can involve a host of structures. UTIs can range from simple infections in the bladder, which may be more of a nuisance than a real threat to health, to pyelonephritis, an infection of the tissue of the kidney that can be life-threatening. UTIs rarely may spread to the bloodstream, a condition called urosepsis and which carries a very high mortality rate.
The symptoms of UTI generally depend upon what part of the urinary tract is infected. The vast majority of infections involve the bladder, and are associated with painful urination, the sudden urge to urinate, and increased frequency of urination. Systemic symptoms such as fever are not common with bladder infections.
Infections in the kidney tissue itself tend to have more dramatic symptoms. These are the infections that typically have fever and general ill-health. There may be significant back or flank pain with pyelonephritis, as well as gastrointestinal symptoms such as nausea and vomiting.
While UTI may occur spontaneously in an otherwise normal urinary tract, it is also a frequent complication of underlying problems such as obstruction of the urinary tract (as in older men with prostate problems) or with kidney stones.
Treatment of suspected UTI begins with a laboratory examination of a urine sample, which should dictate the appropriate type of antibiotic required, if any.
There is little in the way of first aid available in the event of a suspected UTI in the backcountry. Because of the risk of fulminant (quick and severe) urosepsis, anyone suspected of a kidney infection (fever, back or flank pain, with or without urinary symptoms) should be evacuated for definitive evaluation and care immediately. While bladder infections are not life-threatening, the symptoms can be so disabling that continuation of a trek could be untenable. Maintaining a good fluid intake and emptying the bladder as often as possible may help to minimize symptoms until definitive care can be reached.
Prevention of UTI in the backcountry begins with preparation. Some folks are predisposed to recurrent UTI, sometimes because of underlying problems such as stones or kidney cysts but otherwise for no apparent reason. These individuals may wish to consult with their personal health care providers regarding the potential benefit of carrying a supply of appropriate antibiotic to be used in the event that symptoms were to develop. This is a somewhat controversial approach, but it is certainly worth a discussion prior to embarking on a trek into the wilderness. (This is one of the few situations in which I recommend campers carry antibiotics with them.) Homeopathic remedies such as cranberry juice are either not evidence-based or, when studied, have proven unhelpful.
A couple of situations can predispose to UTI, and could occur on a trek. When urine sits for prolonged periods in the bladder, it may become more susceptible to infection. Thus, both maintaining a good urine output by taking adequate fluid and regularly emptying the bladder during the day and before nighttime are advisable. Constipation may interfere with complete bladder emptying, so avoiding this is also important. Finally, to the extent feasible in the backcountry, women should try to maintain good perineal hygiene.
Tom Welch, MD, is a physician at Upstate Medical University in Syracuse and a member of the Wilderness Medical Society. He is a licensed professional guide and a Wilderness Education Association instructor, and has guided groups in the Adirondacks, Montana, and Alaska. For more information, www.adirondoc.com.Hygiene, Infections, Water