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Abstract

UTI which is an infection of ureters, kidney, bladder or urethra is a common health issue among women. The problem is higher for females in geriatric population due to reduced estrogen level. The purpose of the research is to examine non-pharmaceutical measures of reducing the risk of UTI infection and recurrence. The research involves secondary sources of data. It uses various qualitative and quantitative studies which recommend different methods of reducing UTI infection and recurrence. The results show that increasing the amount of water intake, engaging in light physical activities, observing proper genital hygiene, regular urination, moderate alcohol intake, checking on birth control method, regulating a number of sexual partners and adequate dieting can reduce the risk of UTI in senior women. It also advises against the use of sprays and perfumed soaps on vaginal area. The study recommends use of non-pharmaceutical measures since they are not resistant to antibiotics.

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Non-Pharmacological Measures in Preventing UTI Recurrences

Introduction

Urinary tract infection is an attack by disease-causing organisms that may happen anywhere along the urinary system. It may be an infection of ureters, kidney, bladder or urethra. The ailment mostly affects the lower parts of the urinary tract which are urethra and bladder. Women are more likely to get UTI than men due to the nature of their reproductive system. Physicians classify UTI depending on the unique characteristics and the affected parts of the urethra. Acute pyelonephritis is a kidney bacterial infection that causes pain on the upper side of the back. The patient with such a disorder experiences nausea and vomiting, high fever and shaking chills. Cystitis is a urethra bladder infection where the patient has traces of blood in the urine, suffers abdomen discomfort and pelvic pressure. The patient urinates frequently and feels pain in the process. Urethritis causes vaginal smell discharge and causes pain while peeing. The disease is treatable with the use of antibiotics. Women of geriatric population can reduce the risk of UTI recurrence by increasing the amount of water intake, engaging in light physical activities, observing proper genital hygiene, regular urination, moderate alcohol intake, checking on birth control method, regulating number of sex partners and through proper dieting.

Hypothesis

1. Intake of water minimizes the risk of UTI infection.

2. Females can decrease the rate of UTI recurrence by observing proper genital hygiene.

3. Sexually active women are at a higher risk of suffering from UTI.

PICO Problem

UTI is caused by bacteria that enter the system and start multiplying. The system has a defense mechanism that kills the microscopic organisms, which invade its cells. However, the defense mechanism may fail due to various reasons in particular change in PH level. In such a case, the invader bacteria get room to multiply and inflict damage. Cystitis UTI which mostly affect women is caused by Escherichia coli (Flores-Mireles, Walker, Caparon, & Hultgren, 2015). The bacteria are normally found in the gastrointestinal system. In general, it gets into the urethra system due to the short distance between the anus and the vagina. Alternation of anal and regular sex increases the chances of cystitis in women. Urethritis is also caused by bacteria found in the gastrointestinal tract which gets to urethra tract either through sex or because of hygienic issues. Other sexually transmitted infections, namely chlamydia, gonorrhea, herpes, and mycoplasma may also lead to the disease of the urethra. UTI recurrence is a major health problem among women of geriatric population.

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PICO Question

1. Why are women affected by UTI more than men?

2. What are non-pharmaceutical methods that can help to reduce UTI recurrences in the female geriatric population?

Venerability of UTI on Women

It is essential to understand the venerability of UTI so that one could take the necessary precautions. The research by Sammon, et al. (2014) indicates that there are forty to fifty percent chances that a woman will contract UTI at least once in her lifetime. The ration of women to men getting UTI is 8:1. The risk is lower for girls as the number is only eight percent. Most females seeking UTI treatment are of the age from sixteen and forty (Sammon et al., 2014). The risk is higher for geriatric, obese, overweight and pregnant women. The possibility of UTI reoccurring increases with every infection. However, men with UTI infection are more likely to be hospitalized for a longer period than women. The intensity of the disease is greater for men because women notice the UTI signs faster and immediately seek treatment unlike men (Flores-Mireles, Walker, Caparon, & Hultgren, 2015). In most cases, men realize there is a problem after the infection has caused acute damage. The ailment hurts both men and women if not treated in time. For example, it has led to the permanent kidney damage. Pregnant women have a risk of premature delivery of low infant birth weight if they fail to treat the infection. Moreover, it may result in narrowing of urethra tract thus causing pain when urinating.

Female anatomy makes it easier to contract UTI. Firstly, the distance between the anuses which contain most of UTI causing bacteria is very short. Any activity such as wrong wiping method after toileting will easily transfer the bacteria to the vagina. The open nature of the female reproductive system makes it easy for disease-causing organisms to enter. The reproductive system of a female is always wet warm giving room for quick multiplication of the bacteria causing UTI. The urethra of a woman is shorter than that of a man. The shortness reduces the distance that bacteria need to travel to reach the bladder. The rate of infection is higher in sexually active women. Some birth control methods also increase the chances of UTI infection. Furthermore, the use of artificial lubrication during sex puts women at higher risk of contracting UTI infection. For example, Sammon et al. (2014) observed that females who apply a diaphragm as a birth control method seek medical treatment for UTI. Women at their menopause are also at greater risk of contracting UTI infection. Estrogen plays an essential role in preventing reproductive system infections. At menopause, the level of estrogen circulation decreases thus leaving a woman exposed to UTI infection. Holding urine for a long time in the bladder provides for multiplication of the bacteria.

A quantitative research by Mody and Juthani-Mehta (2014) relied on the examination conducted by various doctors, and found that some people are born with urinary tract abnormalities that increases chances of getting an infection. For example, one may have an abnormal condition that prevents normal passage of urine. Another defect makes the urine to store in the tract hence transporting the bacteria and allows their multiplication by providing habitant. Some diseases such as kidney stone cause the urine to stay in the bladder for a longer period, which leads to increased chances of UTI. Women with weak immune system are at high risk of suffering the infection since the system is not strong enough to fight the harmful intruder bacteria. Therefore, such people include those with diabetes, HIV/Aids, and other chronic illnesses. The risk of infection is also greater for women who use catheter when they are unable to urinate on their own. Mody and Juthani-Mehta (2014) also observed that the use of catheter is common among hospitalized patients especially those who have undergone surgery, paralyzed population, and those with neurological problems that makes them unable to control their urine passage. Any procedure that the urethra tract is subject to, particularly surgery or inserting medical instruments expose it and increases chances of infection.

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Recommended Non-Pharmacological Measures

Increasing the Amount of Water Intake

Literature review and method. Women at their geriatric period are at high risk of UTI re-infection due to the reduced estrogen level. The most common way of treatment is the use of oral antibiotics. Nevertheless, it may result in resistance to medicines especially in case of recurrence. However, there are different non-pharmacological methods of preventing the infection. The study conducted by a group of physicians shows that high water intake reduces the risk of disease by 47 % (Jochem, 2017). The research applied the quantitative method. The survey involved one hundred and forty women in their premenopausal period that had a chronic recurrence of UTI. It included those who have had more than three infections in the previous year. The women used to take less than one and a half liters of water per day. The research team advised half of the population to maintain the amount of water they took per day while another half increased daily intake to more than one and a half liters per day.

Results. The physicians used the number of infections registered by each group to determine the result. They started counting the number of diseases immediately after they began the study for one year. After a year, the control group which maintained low water intake had registered an average of 3.1 infections. The research group which increased water intake to more than one and a half liters reduced the risk of infection to 1.6 times (Jochem, 2017). The original average number of diseases per year was three. Therefore, the researchers concluded that water intake has a significant effect on minimizing the number of urethra tract infections in women. The study did not determine the specific amount of water that one need to take per day to reduce contamination as it just used 1.5 liters in its experiment (Jochem, 2017). It is evident that dehydration is highly associated with UTI. Water increases the number of times that one needs to pass urine. The high frequency washes away the bacteria from the urinary tract system and denies it enough time to multiply. Besides reducing the rate of UTI recurrence, water intake has other health benefits. Consequently, it is advisable for every woman to take enough water regardless of age.

Engaging in Light to Moderate Physical Activities

Literature review and method. Participating in physical activities has numerous advantages for health. A qualitative research by Pape et al. (2016) showed a connection between leisure time activities and low risk of bacterial infection. Thus, Pape et al. (2016) obtained data of 18 874 patients from Denmark region health survey. The researchers suspected the possibility of bacterial infections by antibiotics prescriptions. They analyzed the results using logistic regression models. They defined low to moderate activities as the people who engaged at least four hours a week in walking, jogging, riding a bicycle, and gardening work as well as other activities of similar intensity.

Results. During one year, 5368 participants engaged in light physical activities filled at least one antibiotic prescription (Pape et al., 2016). The peers who did not participate in physical activities registered higher number of antibiotic medicine. Physical activities lowered the risk of bacterial infections by ten percent. Engaging in light physical activities was more beneficial to women than men. Moreover, there was an acute reduction of suspected cystitis infection among females. Exercising had the same positive impact on people of different ages. Therefore, it is advisable for senior women to engage in physical activities to minimize the risk of UTI and improve their overall health such as maintaining body weight and blood sugar level.

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Proper Genital Hygiene

Literature review and method. Poor hygiene is associated with numerous health issues. Das et al. (2015) conducted a quantitative study to determine the relationship between menstrual hygiene practices, access to clean water and urogenital infections. The research involved 486 women from different social-economic backgrounds. Das et al. (2015) compared the number of infection for females who used reusable pads and those who used disposable ones. The study also compared the number of infections by women from various social-economic backgrounds.

Another research by Badran, El-Kashef, Abdelaziz, and Ali, (2015) revealed that women who wiped from back to front after toileting registered a high level of UTI. In this survey, females who changed their underwear only once per week registered 35% infection rate while their peers who changed their underwear every day registered an infection rate of 19.16% (Badran et al., 2015). The study used pregnant women as they are at a higher risk of contracting UTI infection.

Results. Das et al. (2015) realized that those who used reusable absorbent pads registered a higher rate of urogenital infections than their peers who used disposable pads. Poor women and those with a low level of education also are exposed to the considerable risk of urogenital infections. UTI was the most registered genital infections. Lack of enough water was the primary factor that increased the rate of urogenital infection to women from the low social-economic background. The study further recommends females to maintain a high level of hygiene especially when using reusable pads. Women who are at their premenstrual age, and still have their menstrual cycle can benefit from genital hygiene education.

Badran, El-Kashef, Abdelaziz, and Ali (2015) suggested that there is a need to educate women on hygienic genital issues as a measure of reducing urogenital infection. Besides regular washing of genital areas, females are recommended to avoid using sprays, medicated or perfumed soaps and powder on their genital areas. It is advisable to use plain water as soaps and sprays can alter the PH level of the vagina. Geriatric women should ensure changing their underwear at least once per day and practice wiping from front to back after toileting.

Discussion on Holding Urine for Long

Holding urine in the bladder increases the risks of urethra tract infections among other health problems. Most women tend to hold the urine as they fear using public or office toilets. They feel embarrassed that someone in the next room is listening to them as they release the bowel. A mature human bladder can hold a maximum of fifteen ounces of liquid. Failure to release the urine for long forces it to stretch beyond this capacity. Under normal circumstances, the nerves automatically send signals to the brain when the bladder is full (Shepherd & Pottinger, 2013). The messages motivate a person to find a restroom and release the pressure. If one gets used to holding urine for long, the bladder muscles became insensitive to the cases when it is full. It stops sending the message to the brain thus one may pass urine involuntarily. The biggest risk is that when holding urine, it becomes a breeding ground for bacteria which causes UTI. Therefore, it gives room for these bacteria to travel to the kidney.

The recommended number of times that one should release urine per day is ten times. One is advised to take a lot of water if they stay for too long without feeling the urge to pass the concentrated and smelly urine. Additionally, vegetables and fruits are essential in increasing the number of times that one passes urine. The research acknowledges that some professions such as teaching make it hard for a person to go to the toilet. They require one to be in a particular position for a long time. A small number of bathrooms in an institution and limited break time increases chances of holding the urge. The doctors advise human resource managers to ensure availability of enough restrooms especially in a place with women who are post-menopause (Shepherd & Pottinger, 2013). On the other hand, regular urge to pass urine while the bladder is not full is a sign of infection, and one should seek medical treatment.

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Discussion on Moderate Intake of Alcohol

Alcohol has many health implications on a human body. Moderate intake of alcohol can help to reduce the rate of UTI infection as it increases the number of times that one needs to use the toilet. Furthermore, high intake of alcohol promotes the development of the infection (Vincent et al., 2013). However, not much research was done on the association of alcohol and the rate of UTI infection. The causative effect has not been determined. People who take a high amount of caffeine also registered the higher rate of UTI infection than their peers who used drinks with less caffeine. Caffeine and alcohol facilitate the risk of disease in senior women. The research conducted in a university setting indicated that although alcohol is a risk factor itself, it leads to careless sexual behavior which is another risk factor for UTI infection. It results in the increased number of sexual activities, impaired judgment on an intimate partner, and engaging in sex with multiple people (Vincent et al., 2013). Individuals under the influence of drugs and alcohol were likely to participate in a combination of anal and vaginal sex, which further promotes the risk. Therefore, women in their menopause are advised to reduce the intake of alcohol as a measure of minimizing UTI.

Discussion on Birth Control Method

Several birth control methods increase the risk of urethra track infection. Vaginal ring, tablet and oral contraceptives which are widely used to control birth have been found to increase chances of UTI (Jarvis, Chan, & Gottlieb, 2014). Oral contraceptives work by lowering the level of estrogen in the body. The estrogen plays an essential role in balancing the level of useful bacteria around the vagina. The decreased estrogen level automatically leads to bacterial imbalance thus exposing the area to infections. Reduced estrogen also induces vaginal dryness which causes painful sex. Bruises caused during sex due to dryness expose one to bacterial infections. The risk increases with prolonged use of contraceptives (Jarvis, Chan, & Gottlieb, 2014). Women who consume oral contraceptives are recommended to use estrogen gels during sex to soften the skin and increase blood circulation hence avoiding bruises. It is also advisable to refuse from oral contraceptives, especially at an older age since the level of estrogen is already low due to premenopausal effect. Reducing it further by the use of such kind of contraceptives will worsen the situation.

Discussion on Checking Sex Habit

Sex itself does not cause UTI. The infection is not even classified as a sexually transmitted disease. However, an increase in the number of sexual intercourses leads to a risk of infection. Even though the infection can affect any woman, those who are sexually active are more prone to suffering it. Furthermore, a considerable number of sexual partners facilitates the risk. Sex increases the risk by introducing the bacteria from outside. The sex object, i.e. penis pushes the bacteria on the vaginal surrounding to the upper part of urinary tract thus allowing them to multiply (Jarvis, Chan, & Gottlieb, 2014). The bacteria may also be on the wall of the man’s penis or the sex object. While it might be difficult for married women to reduce the number of sexual intercourse, there are some activities that one can do to minimize the risk of infection.

Women are advised to urinate after sex. The process will help to fight the bacteria that might have been deposited on the track during the sexual intercourse. Urinating will deny the bacteria a habitat where they can multiply thus decreasing the chances of infection. It is advisable to take a bath before and after sex. Women have to ensure proper cleaning on their vaginal and anal areas to remove bacteria that might have been there. They should use warm or cold water. It is also necessary to stick to one sex partner and advise him on safe sex if he cannot have a single sex partner (Jarvis, Chan, & Gottlieb, 2014). Sex toys should be clean and disinfected. They should not be shared in a group as it will promote the transfer of bacteria. In addition, ensuring that one is hydrated will provide for the proper blood flow which will allow antibodies to fight intruder bacteria.

Discussion on Proper Diet

Diet plays a significant role in preventing the rate of UTI. Water intake is a remedy that has been given by many physicians. Food rich in Vitamin C has also been found to reduce the chances of urinary infection. A qualitative research done by Foxman and Buxton (2013) examined the effect of vitamin A on the disease. They relied on a qualitative research done previously by a group of scholars. The study involved twenty-four people who had regular cases of UTI. The control group continued with regular diet while the research group received Vitamin A dose every day. The study observed the patients for six months. The initial rate of infection for the group of patients was 3.58. After six months, the research group that took a daily dose of vitamin A reduced the rate of disease to 0.7 while the rate of infection for the control group did not change. Foxman and Buxton (2013) also relied on the recommendation of various physicians to UTI patients who advocated for the use of food rich in Vitamin A as they can reduce the chances of infection. Besides, such food includes red bell pepper, kales, carrots, sweet potatoes, and apricots among others.

The research also recommends food rich in vitamin C. According to Foxman and Buxton (2013), a diet rich in vitamin C increases the acidity of urine thus preventing multiplication of harmful bacteria. Citric fruits such as lemon and oranges are great sources of vitamin C. Blueberries fruits have antioxidants which help to reduce UTI. The research of the effect of cranberry juice on UTI patients is still ongoing. Some suggest that it reduces the reproduction of bacteria causing the infection while others assert that it does not have any effects. Women are encouraged to consume plenty of fruits and vegetables. Even though not all of them have a direct influence on urinary tract infection, it helps to boost the body immune system. Therefore, they are crucial in building a deference mechanism.

Some food may increase the intensity of UTI infection. For example, sugary items, namely baked items, soft drinks and starchy food, promote UTI infection. Certain bacteria use sugar as food. Hence, a considerable level of blood glucose due to high intake of sugary food will lead to their increase. It is for the same reason that diabetic people contract UTI more than their peers whose blood sugar level is balanced. It is advisable for women in their geriatric period to avoid high intake of food with processed sugar. Proper medication and good dieting for senior diabetic females is a measure of maintaining blood sugar level as well as preventing UTI. Acidic food, particularly citric one, can help to reduce chances of infection. However, it is recommended to avoid them when one already has a disease as they increase the irritation of the urinary tract. One should also refuse from spicy food, specifically when one is not sure of the ingredients. Some spices may trigger or worsen the rate of UTI infection. Watching one’s diet is the best way of preventing UTI and other health issues especially at an old age.

Conclusion

UTI is a common infection of urinary tract. Women are more venerable to UTI than men. The risk of having a disease increases with age, being sexually active and genital hygiene issues. The use of oral antibiotics treats the infection. Various non- pharmaceutical methods that women may resort to in order to minimize the risk of UTI recurrence include increasing the amount of water intake, engaging in light physical activities, observing proper genital hygiene, regular urination, moderate alcohol intake, checking on birth control method, regulating number of sex partner and proper dieting. Water increases the number of times that one needs to pass urine. Its high frequency washes away the bacteria from the urinary tract system hence denying the organisms enough time to multiply. It is also advisable to use disposable pads during the menstrual cycle. Diet rich in vitamin A and C reduces the risk of infection. Nevertheless, nurses and other medical professionals should educate geriatric women on ways of preventing UTI.

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