Spinal Cord Injury
Urinary Tract Infections

What is a Urinary Tract Infection?

When bacteria get into your bladder or kidneys and cause you to have symptoms, you have a urinary tract infection (UTI). It is important to know the difference between an infection and bacteriuria (having bacteria in the urine but no symptoms).

UTI Causes

Intermittent Catheterization

Whenever a catheter is passed through the urethra (the channel between the bladder and the outside of the body) it can pick up bacteria that are normally on the skin and push the bacteria into the bladder. Bacteria can grow and multiply in the urine if the urine remains in the bladder for a prolonged amount of time (more than 4-6 hours). You can avoid this by emptying your bladder at least once every 6 hours and by drinking enough fluids to keep the urine volume between 300 and 500 cc (1 to 1.5 cups) at each catheterization. Careful hand washing before and after each catheterization is essential and will help prevent UTIs by decreasing the amount of bacteria on the skin.

Indwelling (Foley) Catheters

Because of your spinal cord injury and the fact that you must use an indwelling catheter, you will always have bacteria in your urine. The catheter provides a direct pathway for the bacteria to enter your bladder. The bacteria that live in your bladder can develop into a UTI if your catheter becomes blocked, if your general resistance to infection decreases, or if you don’t drink enough fluids and your urine become concentrated.

UTI Signs

  • Sediment (gritty particles) or mucus in the urine or cloudy urine
  • Bad smelling urine (foul odor)
  • Blood in urine (pink or red urine)

Note: The appearance and smell of your urine may change because of changes in your diet or fluid intake. If you have changes in the urine but no symptoms (see list above) you do not need to seek treatment for a UTI.

People who empty their bladders by self-catheterization may occasionally see small blood clots or red blood visible on their catheters because of trauma (bumping against the bladder or urethra or forcing the catheter past the sphincter). This is not cause for worry unless it happens frequently. Larger amounts of blood, or urine that is red from blood, should always be reported to your health care provider.

UTI Symptoms

  • Fever
  • Chills
  • Leakage
  • Increased spasms of legs, abdomen, or bladder
  • Feeling the need to catheterize more often (frequency) (intermittent)
  • Feeling the need to catheterize immediately (urgency) (intermittent)
  • Burning of the urethra, penis, or pubic area
  • Nausea
  • Headache
  • Mild low back pain or other aches
  • Feeling “lousy” or tired

Self Care and Prevention

Many people are able to prevent a UTI from developing by taking some self care steps:

The most important step for people who do intermittent catheterization and begin to develop symptoms of a UTI is to catheterize themselves more frequently (every 2-4 hours) and increase their fluid intake.

The most important step for people who use an indwelling catheter is to drink, drink, and drink some more. Your fluid intake should be enough so that your urine has the appearance of water or is only slightly yellow in color and clear. Changing your catheter after increasing your fluids may also help cut down on the number of bacteria living in your bladder since catheters can become “colonized” with the bacteria that are flushed out of your urinary tract. Generally, changing your catheter every month should be enough to keep you healthy, but people who get frequent UTIs or whose catheters tend to become encrusted with built-up mineral deposits may have to change it more often.

When to Call Your Health Care Provider

If you develop a fever (temperature greater than 100°F) or if your symptoms are interfering with your life, you should call your health care provider. He or she will want to know your temperature, current symptoms, and whether you have any allergies to antibiotics. Your health care provider will also want to get a urine specimen and will discuss with you whether antibiotics should be started right away or after the results of the culture are available.

How to Collect a Good Specimen for Urine Culture

The accuracy of any urine test depends on careful collection of the specimen to avoid contamination by bacteria from other sources, such as your hands or the specimen container. Following the instructions below will help ensure accurate results.

  1. Open your sterile container — either one from the hospital or one you have prepared at home. (To sterilize a jar at home, choose a small jar with a snug-fitting lid. Wash it carefully in soap and water and rinse well. Place the jar and lid in a pan of boiling water and immerse for 10 minutes. Remove jar and lid with metal tongs, invert on a dish drainer, and allow to cool.) Do not touch the inside of the jar.
  2. For Intermittent Catheterization — Using a new, sterile catheter, catheterize yourself as usual and allow some of the urine to flow into the jar. Collect at least 30 cc (1 oz.) of urine.
  3. For Indwelling (Foley) Catheters — To collect the best specimen, your catheter should be changed and the urine should be collected immediately from the newly inserted sterile catheter. Collect at least 30 cc (1 oz.) of urine. Occasionally, it may be impossible to change the catheter for specimen collection, and urine may have to be obtained from the indwelling catheter. The specimen will be contaminated by the bacteria that live on the catheter as well as those that live in the urine, and the number of colonies that grow will tend to be larger. Sometimes the laboratory will not be able to accurately determine which bacteria are causing your symptoms.
  4. Never collect a urine specimen for culture from a leg bag or a night bag.
  5. Refrigerate the specimen and keep it cool until you can get it to your health care provider. It should be delivered within two hours of collection.

Antibiotic Treatment

If your health care provider prescribes an antibiotic for you, ask your pharmacist whether you should take it before meals or with food. If you take Vitamin C regularly, you should also find out whether it is okay to continue it while you are taking your antibiotic. Be sure to take all of the medications as prescribed.

Some antibiotics will change the balance between your body’s “good” bacteria and the “bad” bacteria that has caused your UTI. When this happens, an overgrowth of yeast can occur which may result in problems ranging from a skin rash to diarrhea. This can be prevented by taking acidophilus culture, which is available in some brands of yogurt, acidophilus milk, or as a pure culture (available in health food stores). If you develop any symptoms you think may be related to your antibiotic prescription, notify your health care provider.

When you have completed your antibiotic prescription, it is not necessary to get a repeat culture unless your symptoms have not improved. Those who reuse their intermittent catheters find that recurrence of a UTI is less likely if they discard their current catheters and begin using new ones after treatment for a UTI.