Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

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Section VI: Backcountry Medicine

More complicated and serious infections can develop when the bacteria climb beyond the blad- der to invade the ureters and kidneys. Sexually transmitted infection are also considered more dangerous because the bacteria or virus is foreign to the body and is more difficult to eradicate. In the male, where the urethra is much longer, acute infection of the urinary tract is unusual and may indicate a potentially serious condition. The most common cause is sexually transmitted infection.

Urinary Tract Infection Uncomplicated and easily treated UTIs are gener- ally limited to women. Because the female urethra is only a few centimeters long, it is easy for nor- mal skin or intestinal bacteria to migrate from the outside into the bladder. Normal urination flushes bacteria out of the urethra, preventing this from happening, but this system can be upset in several ways. Perhaps the most common cause of UTI in wilderness travelers is urinary retention. This is usually due to dehydration or simply through lack of opportunity to urinate. Getting out of a warm sleeping bag, bracing yourself against the pitch and roll of a small boat at sea, or negotiating relief around a climbing harness on a big wall can inhibit frequent flushing. Any bacteria entering the bladder and urethra have a longer period of time in which to multiply and invade the mucosal lining.

Urinary Tract Infection

General Principles

The urinary tract is normally sterile. Migration of bacteria from the urethral opening can result in an uncomplicated bladder infection, or a serious kidney infection. The signs and symptoms of uncomplicated (not serious) UTI include low pelvic pain, frequent urination in small amounts, cloudy urine, and pain, tingling, or burning on urination. It is pos- sible to confuse uncomplicated UTI with a vaginal infection because the inflamed vaginal mucosa and external genitalia may sting and itch on con- tact with urine. Treatment of Urinary Tract Infection The standard of care for uncomplicated UTI is oral antibiotics for three to ten days. Temporary measures, pending access to medical care, involve treating UTI with drainage and cleansing like any other soft tissue infection. Keep the external geni- talia as clean as possible, and drink plenty of fluids to promote frequent urination.

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Mechanisms: • Obstruction • Dehydration • Inadequate hygiene • Localized trauma. Treatment:

• Hydration • Antibiotics

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Another predisposing factor for UTI is inad- equate hygiene. Even though the urinary tract is normally sterile, in settings where bathing is dif- ficult the number of bacteria on the outer surface of the skin increases dramatically making inva- sion and infection more likely. A third factor is direct trauma to the urethra. The usual culprit is frequent or vigorous sexual activity, but inflam- mation can also be caused by horseback riding, biking, or a tight wetsuit. The urethral opening becomes inflamed and is invaded by bacteria, resulting in infection.