How Common Is Nausea During Menopause?

The main symptoms of urinary tract infections in menopausal women include frequent urination, urgency, dysuria, nocturia, urinary insufficiency, and tension incontinence. However, in the early 20th century, these urinary tract dysfunctions received little attention. With the deepening of basic theory and clinical research, people have recognized the pathophysiology of these symptoms, and provided more reasonable means for the evaluation and treatment of the disease. Urinary tract infections can be divided into upper urinary tract infections and lower urinary tract infections. The former includes pyelonephritis, renal cortical infections, perirenal abscesses, and renal empyema, while the latter includes cystitis and urethritis.

Basic Information

Visiting department

Obstetrics and Gynecology

Multiple groups

Older women

Common locations

Urinary system

Common causes

Decreased keratinocytes, reducing vaginal self-purification, and bacteria are prone to multiply in the vestibule and vagina

Common symptoms

Chills, fever, headache, nausea, vomiting, low back pain, pain in the kidney area, frequent urination, urgency, dysuria, etc.

Causes of menopausal urinary tract infections

Causes of urinary tract infections in elderly women: reduced keratinocytes, reduced vaginal self-purification, and bacteria are prone to multiply in the vestibule and vagina. Although women are susceptible to urinary tract infections, whether they develop disease or not depends mainly on the internal factors of the body, which are closely related to weakened body resistance, changes in anatomical and physiological characteristics of the urethra, and abnormal internal environment. The bacteria that cause urinary tract infections are mostly Gram-negative bacilli, accounting for about 62.6%, mainly including Escherichia coli and Escherichia coli, accounting for 60% to 80%, followed by Proteus, Klebsiella, and gas production. Bacillus, Pseudomonas aeruginosa, etc. Gram-positive cocci account for 33.6%, of which 55.6% are staphylococci and streptococci. In addition, fungi, viruses, and parasites can be seen. There are also complications or urinary tract infections caused by nosocomial infections. In most cases, E. coli infections are limited to the lower urethra, and Proteus infections are common in the upper urethra. Intestinal flora, there are many more anaerobic bacteria than aerobic bacteria, but urinary tract infections caused by anaerobic bacteria are rare.

Clinical manifestations of menopausal urinary tract infection

Urinary tract infections in the elderly, the above urinary tract infections are more common, only 35% of the patients due to urinary tract irritation, the rest of the symptoms are mostly atypical.

Upper urinary tract infection

According to the severity of inflammation, the clinical manifestations are quite different. In addition to the aforementioned urinary tract irritation and tenderness in the bladder area, it is often accompanied by systemic manifestations, such as sudden onset, chills, fever, headache, nausea, vomiting, low back pain, and pain in the kidney area. Those who are mild also have no obvious symptoms.

2. Lower urinary tract infection

It may be asymptomatic, or it may be manifested as frequent urination, urgency, and dysuria, and in severe cases, cloudy pus and urine are called urinary tract irritation. Sometimes accompanied by poor urination and residual urination, lower abdomen fullness and pain, difficulty urination, and sometimes impulse urinary incontinence. In severe cases, severe bladder spasms, frequent urination and poor urination.

Menopausal urinary tract infection test

Acute inflammation may occur in the acute phase, such as an increase in the number of white blood cells and an increase in the percentage of neutrophils, but the following tests are more meaningful for diagnosis.

Routine urine test

It is the easiest and most reliable test method. It is advisable to leave the urine for the first time in the morning. Where more than 5 (> 5 / HP) white blood cells per high-power field of view are called pyuria, about 96% of patients with symptomatic urinary tract infection (UTI) can develop pyuria.

2. Urine bacteriological examination

More than 95% of UTIs are caused by gram-negative bacteria, and saprophytic staphylococci and enterococcus faecalis can occur in sexually active women. And some bacteria parasitic on the urethra, skin and vagina, such as Staphylococcus epidermidis, Lactobacillus, Anaerobic bacteria, Corynebacterium (diphtheria) and so on rarely cause UTI. Except for special cases, the presence of more than two types of bacteria in urine cultures is more suggestive of sample contamination.

3.UTI positioning check

Including invasive and non-invasive tests. Bilateral ureteral catheterization is highly accurate, but urine must be obtained through cystoscopy or percutaneous puncture of the renal pelvis, so it is not commonly used for traumatic examination. The bladder irrigation method is simple and easy to use, and it is commonly used in clinical practice with accuracy greater than 90%. Non-invasive tests include urine concentration, urine enzymes, and immune response tests. Acute and chronic pyelonephritis is often accompanied by renal tubule condensation dysfunction, but this test is not sensitive enough to be used as a routine test. Some patients with pyelonephritis may have elevated lactate dehydrogenase or N-acetyl-BD aminograpease in the urine, but lack specificity. Urine enzymes that can help UTI localization are still being studied. Recently, it is more commonly used to detect antibody-coated bacteria in the urine. Bacteria from the kidney are coated with antibodies, while bacteria from the bladder are not coated with antibodies. Therefore, it can be used to distinguish upper and lower urinary tract infections, but the accuracy is only 33%. In addition, the determination of urinary 2 microglobulin can also help identify upper and lower urinary tract infections. Upper urinary tract infections can easily affect the reabsorption of small molecule proteins by the renal tubules, urinary 2 microglobulin is elevated, and lower urinary tract infections are urine 2 Microglobulin does not rise.

4. Ultrasound inspection

Is the most widely used and easiest method at present, it can screen for urinary dysplasia, congenital malformations, polycystic kidney disease, renal stenosis caused by renal artery stenosis, stones, severe hydronephrosis, tumors and prostate diseases. .

5.X-ray inspection

Because acute urinary tract infections are prone to bladder ureteral reflux, intravenous or retrograde pyelography should be performed 4 to 8 weeks after the infection is eliminated. Acute pyelonephritis and uncomplicated recurrent UTI do not recommend routine pyelography. For patients with chronic or long-term cure, if necessary, plain radiography, intravenous pyelography, retrograde pyelography, and bladder ureterography during urination can be performed to check for obstruction, stones, ureteral stenosis or compression, renal ptosis, urinary congenital Malformations and bladder ureteral reflux. In addition, you can also understand the shape and function of the renal pelvis and calyx to distinguish it from renal tuberculosis and renal tumors. Renal angiography can show that the small blood vessels of chronic pyelonephritis are distorted to varying degrees. If necessary, a renal CT scan or magnetic resonance scan can be performed to rule out other kidney diseases.

6. Nuclide nephrogram examination

Learn about renal function, urinary tract obstruction, bladder ureteral reflux and residual bladder urine. The renal chart of acute pyelonephritis is characterized by backward peak movement, the secretion segment appears to be delayed by 0.5 to 1.0 minutes, and the excretion segment declines slowly; the slope of the chronic pyelonephritis secretion segment decreases, the peak becomes blunt or widened, and then moves backward, the excretion segment begins The time delay is parabolic. But the above changes are not obviously specific.

Menopausal urinary tract infection diagnosis

The diagnosis of urinary tract infection cannot be based solely on clinical symptoms and signs, but mainly on laboratory tests. The diagnostic criteria:

1. Regular clean middle urine (requires urine to stay in the bladder for more than 4 to 6 hours). Quantitative culture of bacteria, colony count 105 / ml.

2. For reference, the number of white blood cells in the middle part of the clean centrifuge is greater than 10 / HFP, or those with symptoms of urinary tract infection.

With 1, 2 can confirm the diagnosis. If there is no 2, then re-examination of urinary bacterial culture, if still 105 / ml, and the same bacteria twice, you can confirm the diagnosis.

3. For bladder puncture urine culture, if the bacteria are positive (regardless of the number of bacteria), the diagnosis can also be confirmed.

4. If there is no condition for urine bacterial culture count, you can clean the middle section of urine before the treatment (urine stays in the bladder for more than 4-6 hours). The regular method of centrifugal urine sediment Gram staining can find bacteria, such as bacteria> 1 / oil microscope vision Combined with clinical symptoms, diagnosis can also be confirmed.

5. Urine bacteria in the number of 104 to 105 / ml, should be re-examined, if still at 104 to 105 / ml, you need to combine clinical manifestations or do urinary bladder urine culture to confirm the diagnosis.

Treatment of menopausal urinary tract infections

General treatment

Postmenopausal women's estrogen replacement therapy can effectively prevent recurrent urinary tract infections.

2. Antibiotic treatment

(1) Principle Select sensitive drugs. When no bacterial culture or drug sensitivity results are obtained, temporarily select antibiotics that are effective for Gram-negative bacteria. The symptoms still do not improve after 72 hours of treatment. The antibiotics should be changed according to the drug sensitivity results. The main antibiotic for renal excretion is selected, but the physiological decline of renal function in the elderly should be reduced according to creatinine calculation, and drugs with low renal toxicity should be used as far as possible. Due to the increase of drug-resistant strains, it is necessary to choose suitable antibiotics, and determine antibiotic dosage forms, treatment courses and medication methods according to different conditions and different infection sites.

(2) Method Lower urinary tract infection: take the single dose therapy such as amoxicillin, norfloxacin or other quinolones for the first time. Treatment of cystitis without complex factors, the cure rate can reach 100%. For multiple post authors, 3-day therapy can reduce the chance of recurrence. Upper urinary tract infection: Choose antibiotics based on drug sensitivity. Elderly women with good physiques have no definite comorbidities, infections from non-hospital acquirers, and mild to moderate upper urinary tract infections. Broad-spectrum antibiotics that are effective against cocci and bacilli can be used. Quinolones, second-generation cephalosporin antibiotics, are effective after 2 to 3 days of treatment, and continue to be used for 2 weeks; if they are not effective for 3 days, antibiotics should be reselected according to drug sensitivity. After 14 days of treatment, the negative rate is 90%. If the urinary bacteria are still positive, you should refer to the drug sensitivity, re-select powerful antibiotics, extend the course of treatment for 4 to 6 weeks, and pay attention to whether there are coexisting factors. Symptoms of poisoning or concomitant diabetes, kidney stones, urinary tract obstruction, long-term use of immunosuppressive agents, advanced age, etc., should be administered by second or third generation cephalosporins or quinolones for a period of not less than 2 weeks.