18.3.2 Diagnosing UTIs
A woman with a healthy urinary tract will not usually report pain, itching or burning when urinating. However, sometimes a woman has a UTI but she has no signs. It is important to try to tell whether the infection has reached the bladder, or if it has gone further up the urinary tract and reached the kidneys. Kidney infections are more serious and are a greater risk to the mother and her unborn baby.
Testing for UTIs
UTI can be detected by testing the woman’s urine. There are several different tests which are usually done at a Health Centre. There are dipsticks that change colour when dipped into infected urine, or the bacteria may be seen if the urine is looked at through a microscope, or the bacteria can be grown (cultured) in special containers until there are enough to identify them. All these tests require a clean ‘mid-stream’ urine sample.
You learned how to collect a mid-stream urine sample in Study Session 9. How would you explain to a woman how to do it?
You would tell her to begin urinating, but after she has produced the first trickle she should collect some urine from the middle of the stream in a clean container, and stop collecting before she empties her bladder.
Itching or burning while urinating can also be a sign of vaginal infection or a sexually transmitted infection. If you see a patient with these symptoms, refer her to the nearest health facility.
Dipstick, microscope and bacterial culture tests are the only certain way to diagnose a UTI, but they cannot tell the difference between infection of the bladder and kidney infections. You may be able to do this by careful questioning of the woman about her symptoms.
Symptoms of a bladder infection
Ask the pregnant woman if she experiences any of the following symptoms:
- Constant feeling of needing to urinate, even after having just urinated
- Pain or burning while urinating, or straight afterwards
- Pain in the lower belly, behind the front of the pelvis.
If you suspect a kidney infection, refer the mother immediately to the nearest health facility.
Symptoms of a kidney infection
Ask the pregnant woman if she experiences:
- Any signs of bladder infection
- Cloudy or bloody urine
- Fever, feeling very hot and sweating
- Feeling very sick or weak
- Flank pain (in one or both sides)
- Repeated vomiting
- Chills, rigors or shivering persistently.
Another symptom is pain in the lower back, sometimes on the sides (see Figure 18.7). But note that pain along the spine is common in pregnancy and may not be a sign of kidney infection. Normal back pain in pregnancy can be helped with massage, or exercise. If the pain is due to a kidney infection, massage or exercise won’t relieve it.
18.3.1 Prevention of UTIs