Whenever I see a man with a urinary tract infection (UTI), the first question I ask myself, is why? Men do not get UTIs half as often as women. The reason comes down to their anatomy.
In women, the urethra (the tube that carries urine from the bladder to the outside of the body) is rather short, therefore bacteria have a much shorter way to travel to get into the bladder. In men on the other hand, the urethra is much longer. Therefore, before the bacteria can make it up into the bladder, the man has already urinated, flushing out the bacteria.
There are some circumstances where a man can easily get a UTI. This is usually men who are bed bound and incontinent because of paralysis, or stroke. In these cases they are often wearing diapers. When diapers are not changed frequently enough, bacteria have a chance to multiply and get into the urethra, eventually reaching the bladder.
In some cases, the men have catheters inserted into the bladder to continuously drain out the urine into a bag. Because catheters are foreign devices going into the body, they serve as a portal of entry of bacteria. Changing a catheter at least once per month decreases the chance of infections occurring, however the risk of infection is not eliminated altogether.
It is urinary tract infections in younger, relatively healthy men, which raise a red flag. In these instances, a UTI usually signifies blockage of the flow of urine.
The 3 most likely causes for blockage of urine in men are as follows:
1. Urethral stricture – this refers to narrowing of an area or areas along the urethra (the tube draining urine from the bladder). This narrowing is usually the result of scarring from an infection such as gonorrhea, or from trauma after a catheter or other medical device was inserted incorrectly.
2. Enlarged prostate – the prostate gland sits at the base of the bladder, and encircles the urethra. When the prostate is enlarged (from normal aging, inflammation, or cancer), it squeezes on the urethra preventing urine from flowing out of the bladder freely.
3. Kidney stones – urinary stones usually form in the kidneys. They eventually move down, through the ureter (the tube draining urine from the kidney into the bladder), into the bladder, and eventually out of the body. Sometimes because the stone is too large, it gets lodged in the ureter and blocks the flow of urine.
What happens when the flow of urine is blocked?
Essentially, backed up urine is stagnant. Stagnation is a more favorable environment for multiplication of bacteria. When the concentration of bacteria is high enough, the bacteria is now able to invade the surrounding tissues. In the case of a UTI, that would predominantly be the walls of the bladder, and the tissues of the kidneys. Once there is invasion of these tissues, inflammation arises, along with pain, fever, and the other usual features of infection.
In many cases, especially in older men, the problem is not necessarily a sudden blockage of urine like from a stone. Instead, there is incomplete emptying of the bladder. Usually, because of an enlarged prostate, the bladder muscles are not strong enough to push all the urine out through the tiny opening. Therefore the bladder never gets completely emptied after urination. Incomplete bladder emptying can be diagnosed easily by performing an ultrasound immediately after urination. A significant volume of urine will be observed in the bladder.
Is there a fix for all this?
Fortunately, all these blockages are treatable. The urethra can be stretched over time with devices, or a long term catheter placed. For an enlarged prostate, there are medications that can shrink it, or surgery can be performed to remove a part, or all of the prostate. Regarding stones, they can be broken up with shock waves, or surgically removed.
Related post: Why do I still have this UTI?
For incomplete bladder emptying, someone can be taught how to catheterize themself, and this can be done at least once per day, or as prescribed by the doctor. Sometimes, a patient may be instructed to catheterize every few days if it is a less severe scenario.
Men do get UTIs, though not as frequently as women. When a relatively healthy man gets a UTI, it is often an indication that there may be something anatomically wrong with his urinary system, particularly, a blockage. A proper medical evaluation should be undertaken to look for easily treatable causes, rather than solely treating with a course of antibiotics.