Pyelonephritis - Kidney infection & Incontinence

Pyelonephritis is a painful condition that causes an urgent and frequent need to urinate. It can be serious, so don’t ignore it.

What causes Pyelonephritis?

Pyelonephritis, or a kidney infection, is caused by bacteria travelling up the urethra, to the bladder and on to the kidneys.

Bacteria is commonly present in the urethra in small numbers and doesn’t usually cause an issue as it’s flushed out when urinating. It only becomes an infection when it ‘takes hold’ and reaches a critical mass that the body struggles to combat.

The bacterium responsible for kidney infection is usually Escherichia coli (E. coli), found in the bowel, as well as on and around the genitals. Anatomically, women are more prone to the condition because of the proximity of the vagina, urethra and anus. The female urethra is only about 4cms, which allows bacteria to get to the bladder, and potentially on to the kidneys faster than in males.

The transmission of bacteria can occur because of poor toileting habits. Girls should be taught to wipe from front-to-back after urinating or opening their bowels. Wiping from back-to-front can spread bacteria to and around the urethra, which can then make its way inside and take hold, rapidly multiplying and causing an infection.

Anyone using a catheter is also prone. A catheter is a thin, flexible tube inserted through the urethra and into the bladder to drain urine. It might be used by men who have an enlarged prostate and are having difficulty emptying their bladder. This is called Urinary Retention and if left untreated, can be a dangerous, even life-threatening, condition.

Regardless of why a catheter is used, either temporarily (such as post-operative) or ongoing due to bladder issues, hygiene is paramount to avoid a kidney infection. Any bacteria on the catheter will be inserted with it, and in the warm, moist environment, can quickly multiply and become an infection. So, make sure hands, equipment and the external area around the urethra are thoroughly cleaned before the tube is inserted.

Sexual activity can trigger Pyelonephritis in women. This typically starts as a urinary tract infection, also known as a UTI. Although the bladder and kidneys are part of the urinary tract system, the term UTI is most commonly used to describe an infection in the urethra. Left untreated, it can then travel through the system to infect the bladder (also called cystitis) and on to the kidneys and cause Pyelonephritis. You can read more about the treatment of UTIs in this article, titled ‘Will A UTI Go Away On Its Own?’

How is Pyelonephritis diagnosed?

If a doctor suspects Pyelonephritis, there are several threads to diagnosis.

Symptoms

It’s important to be frank with your doctor about your symptoms, including incontinence. Other indicators that you should relay include:

• Urgent and frequent urination, but often passing only a small amount
• Involuntary loss of urine (incontinence) and the inability to ‘hold on’
• Feeling like the bladder isn’t emptying completely
• An extremely painful, burning sensation when urinating, sometimes
• described as ‘passing razor blades’
• Pain in the lower back, pelvis, abdomen or groin
• Cloudy or bloody urine that can have a particularly unpleasant smell

Signs of infection

In addition to discussing urinary symptoms, your doctor will also be interested in signs of infection. Depending on how severe it is, these can be:

• Nausea or vomiting
• A high temperature
• Shivering
• Dehydration
• Diarrhoea
• Feeling unwell

Physical examination

The doctor may press on various areas around the kidneys and lower back, checking for sensitivity and inflammation.
To confirm the diagnosis, a sample of urine will be tested for bacteria and other microorganisms as well as pus (dead white blood cells that have been ‘fighting’ the infection).

Is Pyelonephritis a sexually transmitted disease?

No, Pyelonephritis is not a sexually transmitted disease, but it’s associated with sexual activity, and the onset of a UTI in women may be behind that misconception.

The correlation is very strong, with the American website Everyday Health claiming that “almost 80 percent of premenopausal women with a UTI have had sex within the previous 24 hours.”

Sexual activity distributes bacteria towards and around the urethra, and certain physical contraceptives can aggravate the problem further. Diaphragms, for example, can inhibit urine flow that might otherwise flush bacteria out of the urethra.

Adopting practices like cleaning the genital and anal area before sex and urinating afterwards can help reduce the risk of a UTI. If you’re using a physical contraceptive and experiencing reoccurring infections, discuss alternatives with your doctor.

It’s worthwhile remembering that not all UTIs evolve to become Pyelonephritis and if treated early, most shouldn’t even reach the bladder.

What is the best treatment for Pyelonephritis?

For most cases, a prescribed course of oral antibiotics should be enough to resolve the infection. If your pain is severe, ask your doctor about medications, including powders to mix with water and drink, that can help ease the stinging when urinating. If pain is mild, paracetamol may be sufficient to manage it.

Drinking plenty of water to help flush out the infection is advised, and you should experience improvement within two to three days.

If you have a complicating condition, disease or current treatment in addition to Pyelonephritis, your doctor may prefer to have you treated in hospital. Such circumstances would include:

• HIV or other immune suppressing conditions
• Cancer, chemotherapy or radiation treatment
• Pregnancy
• Diabetes
• Anaemia
• Being over 60 years old

In-patient treatment might also be necessary if the infection is severe, you’re in extreme pain, are unable to pass urine or very unwell.

Reducing the risk of Pyelonephritis

The best way to avoid kidney infection is to avoid a UTI. Although not a guarantee, these simple habits can reduce the chances of developing a UTI.

• Drink plenty of water every day to flush bacteria out of the tract
• Go to the toilet when you feel the urge – don’t hold on. Try not to rush and make sure you’ve completely emptied your bladder. Some women find standing up and sitting down again can help with this
• On the toilet, always wipe from front to back
• Have a shower instead of a bath
• Urinate after sex to flush away any bacteria
• Physical contraceptives like condoms, IUDs, spermicides and diaphragms, can contribute. If you are suffering frequent UTIs, you might wish to discuss options with your health care professional

Bacteria breeds best in warm, moist environments often created by synthetic fabrics and tight pants, so chose cotton underwear and looser clothing to keep the area dry and cool.

Additional articles on Urinary Tract Infections, Cystitis and Pyelonephritis

UTI: Facts and Tips Covering who is most prone to UTIs and tips to avoid infection.

Will a UTI go away on its own? This article includes the latest on alternative treatments.

Managing incontinence from a bladder infection

Even if you usually have excellent control, can comfortably ‘hold on’ for extended periods of time and have a strong pelvic floor muscle - an infection can compromise everything. The frequent and sudden urgency to pass urine can catch you out, leading to leakage. This can be just a few drops through to being unable to stem to stream once it’s started, so losing the entire content of your bladder. While your treatment is taking effect, you may feel more secure with a discreet product specifically designed to absorb the thin, fast flow of urine, keeping you dry and odour free.

If you’re only losing a few drops or a small gush, a TENA Liner may be the right choice. There’s also an extensive range of absorbency levels in the TENA Pads range are an excellent option, being highly absorbent, discreet under clothing and incredibly comfortable.

If you’re unsure of which is the best product for your needs, use the Product Finder Tool where you can also order free samples.