Because of legal restrictions, MOMSCIS cannot give specific medical advice. The following information is not a substitute for the personal care or advice of your physician. Please discuss any concerns with your physician regarding your medical care. Physicians in the Physical Medicine & Rehabilitation Department at the University of Missouri-Columbia are available to evaluate patient records, and can set up a clinic visit for a medical evaluation. The PM&R Department does extensive treatment of individuals with spinal cord injuries using a wide variety of physical therapies and state-of-the-art medications. Individuals with spinal cord injuries can be examined and treated on an outpatient or inpatient basis. For more information about the PM&R services available or to schedule a clinic visit, telephone the clinic at (573) 884-0033.

Early detection & treatment
of urinary tract infection

By Michael Acuff, M.D.
MOMSCIS Spinal Cord Injury Specialist

Urinary tract infection (UTI) for people with spinal cord injury is a significant problem. Not only does UTI cause symptoms and have possible serious complications, it is also treated by a great variety of methods. Because of the nature of management of neurogenic bladder for people with spinal cord injury, urinary tract infections can be even more complicated than in the general population. For this reason, I have devised an approach that gives the major portion of decision-making power to the person with the spinal cord injury who has a significant urinary tract infection. I have also designed a treatment plan for it. Though I do believe that this is a safety net to prevent patients from becoming acutely ill with urinary tract infection, I also feel that individual autonomy is an important issue when looking at urinary tract infection in people with spinal cord injury. The following instructions are given to empower the person with spinal cord injury regarding his/her own health care.

A prescription for Chemstrip® 2LN urine test strips is given to the individual. The cost of this bottle of 100 strips is less than the cost of a course of antibiotic for urinary tract infection. The instructions are to test the urine with the test strips if a person is experiencing signs or symptoms of a bladder infection.

The instructions are easy to follow and easy to read as to whether the Leukocyte and Nitrateportions of the strip show positive. If an individual does not have signs or symptoms of a UTI, I discourage using the urine test strip to test the urine. I also encourage healthcare providers NOT to test the urine unless the patient has symptoms of UTI.

These symptoms range from increased spasms, sweating, cloudy and smelly urine along with fever and chills. If a person has these symptoms and the urine test is negative for one or both of the segments on the urine test strip, I do not consider a significant UTI to be present. I recommend that the person take Tylenol®, drink plenty of water, and watch for changes in his or her condition over the next several days. If the person’s condition doesn’t change by the next day, a repeat of the test strip can be performed. If both segments on the urine test strip are positive, I consider this a sign of significant UTI that needs to be treated.

Treatment can proceed in two directions at this point. The person can have an antibiotic prescription filled and take according to directions. I do not re-test the urine after the antibiotic prescription has been completed unless the person continues to have symptoms of UTI.

The other course that may be taken if the person does not feel extremely ill or have a fever is a conservative approach that involves drinking large amounts of water and taking one or two cranberry concentrate capsules twice a day. This compound, CranActin®, is not available in drug stores but can be found in or ordered from health food stores. I cannot recommend any other cranberry concentrate, because CranActin® is the only concentrate that contains the active ingredient that has been shown to prevent bladder infections or to decrease bacteria concentration in the bladder. If this condition does not show improvement with either approach within two or three days, the person should consult a physician and have a urine analysis with a culture and sensitivity check.