Have you ever experienced constipation during an episode of urinary tract infection? Do you think your constipation was due to UTI? We are here to find the best answers to your queries.
Due to close proximity and inborn relationship, the diseases of the urinary bladder and rectum often affect each other. Urinary tract infection is a common medical condition that has a relationship with constipation and other bowel symptoms.
In this article, you will read the basics of the relationship of bladder and rectum, the effect of urinary tract infection on bowel habits, and vice versa. Hope you will enjoy it.
Why do the symptoms of bladder and rectal illness influence each other?
Do you know, your rectum and urinary bladder share a common embryological origin? That means, when you developed as a fetus in your mother’s womb, your primitive bladder and rectum were merged as a single common tube. The name of that organ was cloaca.
The cloaca then differentiated into the urinary bladder in front and rectum behind.
Both of them are now positioned closely within your small pelvis. They are supported by the muscles of the same pelvic floor.
The external sphincter of both the anus and urethra are derived from the same pelvic floor muscles. And both of these sphincters are controlled by the branches of the pudendal nerve.
So when you try to relax your anal sphincter for defecation, the urethral sphincter also gets relaxed.
And the opposite event happens during contraction. The muscles of your bladder wall and rectal wall are under the control of the autonomic nervous system.
The nerve arising from the sacral segments of your spinal cord innervate both organs. And lastly, the control centers of both organs are located in the same area of your brain!!!
Are you being surprised? These are the facts. They are involved in a similar type of function. That is storage and evacuation of urine and faeces respectively. What do you think now? Will it be unusual if they influence each other during an illness?
Clinical studies in healthy volunteers illustrate physiological interactions between the bladder and the distal gut. In a study of young, healthy women the sensation of rectal filling was shown to be decreased when the bladder was full. That means the urge to defecate may be slow with a full bladder.
However, rectal distention did not affect bladder compliance during filling, but sensations of bladder filling were observed at smaller volumes and maximum bladder capacity during cystometry (a diagnostic procedure to assess the condition of the bladder) was significantly reduced.
These findings show that the state of the rectum significantly influences the handling of sensory information from the lower urinary tract. I
t has also been shown that in women with overactive bladder symptoms, rectal distention produces an earlier desire to urinate, compared with a non-distended rectum.
A high prevalence of constipation and anorectal pain disorders in women with urinary incontinence has also been documented.
Symptoms of dysfunctional voiding and disordered urination occurred more frequently in women with defecatory disorders.
We don’t want to make this article complex by discussing all of these medical studies. The main point is bladder and lower gut are closely related and influence each other both in diseased and healthy status. Hope you understood.
Does urinary tract infection cause constipation?
Few UTI patients complain about constipation during their illness.
They think that their constipation is related to UTI. But the correlation is not yet clearly established.
Because not every patient gets this symptom and constipation is a very common condition. So the simultaneous presence of UTI and constipation may be a coincidence.
And many patients with chronic constipation suffer from urinary tract infections. So, it is difficult to prove UTI as a cause of constipation.
But the complaints of patients can not be ignored. Some probable explanations are given here that may help you to understand the cause.
Firstly, we have already discussed that the influence of bladder illness over bowel movements is not unusual. So depending on your body function and psychology, your bowel movement may be slowed down during an episode of UTI.
Secondly, a very common symptom of UTI is fever. And alteration of bowel habits or constipation is very common during any febrile(fever-related) illness. Raised core body temperature reduces gastric motility and increases gastric emptying time. During fever, more water is lost from the body.
Consequently, water absorption from the gut is increased leading to the formation of hard stool. Especially in complicated UTI (e.g pyelonephritis or kidney infection), there may be high-grade fever which may lead to reduced bowel movement and constipation.
Thirdly, doctors often prescribe anti-spasmodic drugs like tiemonium or hyoscine to reduce lower abdominal pain. These drugs reduce gut motility which may contribute to constipation.
Fourthly, a feature of cystitis is overactivity of the bladder which leads to frequency and urgency of urination. To combat the frequency, you will constrict the urethral sphincter reflexly.
As the sphincter of the urethra and rectum is controlled by the same muscles and nerves, the anal sphincters will also be constricted. So the rectal motility and defecation reflex will also be inhibited leading to constipation.
And the overactive bladder itself is related to constipation. The mechanism is unclear, but there is evidence that supports the claim. A study shows that patients with interstitial cystitis often suffer from constipation.
The prevalence of chronic constipation is higher among patients with overactive bladder.
Another interesting study shows that neuromodulation of voiding symptoms brings secondary changes in bowel functions.
Neuromodulation is a treatment procedure that is used to alter nerve activity by drugs or electrical impulses. It is often used to treat an overactive bladder by targeting the nerves of the bladder.
Surprisingly bowel function is also altered after using this procedure for bladder dysfunction. It proves that an overactive bladder influences bowel function.
In urinary tract infections especially with cystitis, overactivity of the bladder is very common. If this overactivity leads to constipation, would that be unusual?
All of these factors may lead to constipation during UTI. However, these are theoretical hypotheses and further research are required to establish the correlation.
Does UTI cause stomach or bowel problems?
From the name, you know that UTI is a disease of the urinary system. It doesn’t infect your gut.
So, why should it cause bloating, stomach upset, or bowel problems?
You will definitely relate these symptoms to gastrointestinal diseases. That’s the usual rule.
But surprisingly some patients with UTI tell that they are suffering from vomiting, abdominal distention, bloating, diarrhea, etc. These unusual symptoms are not clearly explained, some possible causes can be figured out.
Firstly, you may have concomitant gastrointestinal problems contributing to these problems. The same bacteria causing UTI can infect your gut at the same time. These may lead to nausea, vomiting, bloating, or diarrhea.
Secondly, in a complicated UTI, you may experience some unusual symptoms. If the infection reaches your kidney causing pyelonephritis, there may be nausea, vomiting, severe back pain, and even mental confusion.
In severe pyelonephritis, kidney function may be impaired leading to the accumulation of toxic waste products in the body.
These toxic substances lead to the development of systemic symptoms mentioned above.
Thirdly, you may suffer from constipation as we have discussed above. Excessive collection of fecal matter in the colon may lead to abdominal pain, distention, gas formation, and bloating. Treatment of constipation will reduce the symptoms.
Fourthly, your gastrointestinal problem may be the side effects of the drugs you are taking for UTI. For severe pain, you often take a painkiller like Ketorolac, Naproxen, etc.
These drugs may cause acidity, irritation, or even erosion to your stomach.
You may suffer from gastric pain, bloating, nausea, vomiting, etc if an anti-ulcerant (e.g. omeprazole) is not taken with such painkillers.
Antibiotic is the mainstay of treatment in urinary tract infection. But most of the antibiotics can cause nausea, vomiting, and even diarrhea.
Broad-spectrum antibiotics kill the normal bacterial flora of the intestine along with pathogenic organisms.
Due to the loss of the protective colony of good bacteria, some opportunistic organisms like Clostridium difficile get the chance to grow up.
Colonization by this bacteria may increase your bowel movement leading to bloating and diarrhea. Talk to your doctor if you develop such problems.
How do constipation and UTI affect children?
The adverse effect of chronic constipation on the urinary system is more pronounced in children.
Functional constipation in early childhood increases the risk of urinary incontinence, vesicoureteric reflux, recurrent urinary tract infection, and kidney dilatation.
Children can’t express their symptoms properly. Hence the history of constipation is often overlooked in children with urinary problems.
Many children are born with congenital bowel problems that lead to chronic constipation (e.g. Hirschprung’s disease). These children may suffer from recurrent UTI until treated for the underlying problem.
But, some kids have no organic problem. They often hold their poops for a longer period which leads to habitual constipation. Functional constipation is the cause of 95% constipation among healthy children and has a high prevalence (0.7%-29%) worldwide.
In constipation, pressure from the loaded and distended rectum on the bladder neck obstructs urine flow and thereby impair bladder emptying.
This mechanical effect also inhibits the bladder by stimulation of detrusor muscle( the muscle which contracts your bladder) receptors which may cause vesicoureteral reflux (VUR) and UTI.
Even sub-clinical UTI ( when you actually have an infection, but there is no overt symptom) can lead to renal scarring, increasing the risk of hypertension and chronic renal failure (CRF).
Children with recurrent UTI are noted to have large faecal reservoirs. Some children have asymptomatic bacteriuria, which is clinically silent or mild.
But these children may have VUR in 11% of cases of which 19% to 35% are school-going children.
VUR itself increases the risk of UTI as we have already discussed.
Voiding dysfunction such as urinary incontinence and urinary retention is also significantly increased in children with constipation.
It thus appears that there is a correlation between constipation and urinary incontinence, VUR, and UTI.
A study shows that constipated children are at 6.8 times more risk of urinary problems compared to those having no constipation.
The more severe constipation, the more prominent the urinary problems are. So, if your child suffers from recurrent urinary tract infections, check his bowel habit.
Study shows that treatment of constipation, alleviate the recurrence of UTI in most of the cases.
Does constipation cause urinary tract infection?
Now we are going to discuss the opposite question.
The role of constipation as a risk factor of urinary tract infection in both children and adults is well established.
Chronic constipation leads to different urological problems including urinary tract infection. The probable factors are discussed below:
- Frequent but incomplete evacuation of the bladder
In chronic constipation, the accumulated stool in the lower colon becomes hard. This puts pressure on the urinary bladder from the back but obstructs the way to complete contraction.
So, you will feel a frequent urge to urinate. But, the bladder will not be cleared completely.
The increased amount of residual urine will provide the bacteria with an opportunity to grow in the bladder.
- The increased load of Escherichia coli
As stool is staying longer than usual in the colon, the most common bacteria of the gut E.coli continues to multiply.
The increased load of the pathogenic organism increases the risk of contamination and infection of the urinary tract.
- Backflow of urine
Impacted or accumulated hard stool often pushes the bladder which may lead to backward flow of urine to the ureter. This usually happens in patients with weak or malfunctioned vesicoureteric junctions.
The vesicoureteric junction prevents the backflow of urine to the ureter and kidney. Persistent rise of the post-voided residual volume of urine increases the pressure over the junction.
This may weaken the junction in long term, or worsen the previously malfunctioned one. The backflow of urine through this junction is called vesicoureteric reflux (VUR).
VUR increases the risk of recurrent UTI a lot. This is more common in children.
There is a lot of studies that support that constipation is related to urinary tract pathologies. A study shows that lower urinary tract symptoms in the adult male were independently associated with low stool frequency, hard stool type, and loose stool type.
Three or fewer bowel movements per week were associated with nocturia, incomplete bladder emptying, and urinary hesitancy. These increase the risk of having a UTI. Studies in middle-aged women also support a high prevalence of constipation among patients suffering from urinary tract dysfunction.
How do constipation and UTI affect the elderly?
Aged people are at increased risk of constipation and UTI. Older people often suffer chronic constipation. Moreover, they often have other risk factors like diabetes, prostatic enlargement, etc.
The prevalence of stroke, diabetes, spinal cord injury, and other neurological disorders is also high among elders. These conditions often damage the nerves involved in the function of the urinary bladder. As a result, the bladder can,t store or empty urine properly. This is called neuropathic bladder which is a risk factor of UTI.
Constipation potentiates the risk of urinary tract infection. Symptoms of constipation and cystitis are often overlooked among this group of the population due to the presence of other comorbidities. So, diagnosis and treatment get delayed, which leads to the development of complicated UTI.
This situation can be avoided by treating constipation. A prospective study in constipated elderly with concomitant lower urinary tract symptoms demonstrates that the medical relief of constipation also significantly improves UTI.
So, that’s all for now. Hope you have got your queries answered. If this article helped you a little, that will be a great pleasure for us. If you liked this article, don’t forget to share it with your friends and family. And if you have anything more to ask, feel free to contact us. Stay healthy, stay safe. Thanks.