Introduction
The physician must think of a UTI causing abdominal pain. An infection of the urinary tract (UTI) includes an infection of the kidney tissue, which is a pyelonephritis. This can be new, which is an acute pyelonephritis, or recurrent, in which case it is a chronic pyelonephritis. Chronic pyelonephritis is usually associates with a valve incompetence between the ureter and the bladder, which leads to vesicoureteral reflux.
With this condition it is possible, particularly in women, for bacteria to travel against the urinary stream into the kidney and then invade the kidney tissue.
Symptoms of a UTI causing abdominal pain
Urinary tract infections are 50-fold more common in women than in men in the middle age group.
With acute pyelonephritis there is an acute onset of a high fever with chills, nausea, vomiting, flank and abdominal pain. The physician will detect a costovertebral tenderness of the kidney on the affected side. In chronic pyelonephritis the symptoms can be much more subtle. With respect to both cases there is usually a urinary tract infection with white blood cell casts in the urine on microscopic examination. Urine samples obtained by sterile technique grow bacteria on agar Petri dishes. Patients with chronic pyelonephritis show irregularities of the kidney(s) with scarring on intravenous urography. A cystogram shows reflux from the bladder into one or both ureters.
Treatment a UTI causing abdominal pain
Usually a patient with chronic pyelonephritis needs to see a urologist. However, girls with more than 3 urinary tract infections per year likely also should see a urologist. They are the ones at risk for undetected vesicoureteral reflux, which the urologist can treat with ureter reimplantation. This surgical technique can restore the normal valve function and ensure that no more kidney infections occur.
Urologists advise women who have two to three urinary tract infections per year, but do not need surgery as follows
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1. void immediately after sexual intercourse
2. drink cranberry juice frequently, it may cut down urinary infections
3. if this still is not preventative of urinary infections, then a low-dose prophylactic antibiotic therapy is very successful. Trimethoprim-sulfamethoxazole (brand name: Bactrim) 1/2 regular strength tablet daily or three times weekly is used for this purpose. Alternatively, trimethoprim (brand name: Proloprim) at 100 mg daily or three times weekly can be used. Others used are ciprofloxacin(Brand name: Cipro) or nitrofurantoin (brand names: Furadantin, Macrodantin) at half the dose used otherwise. Sometimes the urologist recommends a 2 or 3 year prophylactic therapy like this.
4. As pregnant women are at a higher risk for pyelonephritis, a similar prophylaxis program as for non pregnant women is given.
5. In postmenopausal women it has been shown that estrogen replacement (bioidentical estrogen cream topically) can markedly reduce urinary tract infections (Ref. 10)
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References
1. DM Thompson: The 46th Annual St. Paul’s Hospital CME Conference for Primary Physicians, Nov. 14-17, 2000, Vancouver/B.C./Canada
2. C Ritenbaugh Curr Oncol Rep 2000 May 2(3): 225-233.
3. PA Totten et al. J Infect Dis 2001 Jan 183(2): 269-276.
4. M Ohkawa et al. Br J Urol 1993 Dec 72(6):918-921.
5. Textbook of Primary Care Medicine, 3rd ed., Copyright © 2001 Mosby, Inc., pages 976-983: “Chapter 107 – Acute Abdomen and Common Surgical Abdominal Problems”.
6. Marx: Rosen’s Emergency Medicine: Concepts and Clinical Practice, 5th ed., Copyright © 2002 Mosby, Inc. , p. 185:”Abdominal pain”.
7. Feldman: Sleisenger & Fordtran’s Gastrointestinal and Liver Disease, 7th ed., Copyright © 2002 Elsevier, p. 71: “Chapter 4 – Abdominal Pain, Including the Acute Abdomen”.
8. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
9. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008
10. Dr. John R. Lee and Virginia Hopkins: “Hormone Balance Made Simple – The Essential How-to Guide to Symptoms, Dosage, Timing, and More”. Wellness Central, NY, 2006
