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Some associated conditions that may contribute to the formation of urinary infections are as follows: One to four percent of females from childhood to the childbearing age may harbor bacteria in the bladder or urethra, sometimes without the presence of symptoms. In men urinary infections are quite rare below the age 50. Four to eight percent of pregnant women may have infections, some of them without symptoms. Diabetes is another contributing factor, particularly when sugar is present in the urine. Any impediment to the free flow of urine—tumor, stricture, or stones— results in distention of the kidney and greatly increased frequency of urinary infection. In fact, the reflux of urine in the bladder cavity up to the ureter occurring during voiding will contribute to more infections, particularly children. Infection of the lower urinary passages is sometimes initiated by bacteria carried on catheters or other instruments passed into the urethra and bladder. Sterile technique in catheter insertion can help to reduce this risk. Kidney diseases with resulting high blood pressure may also contribute at times to the lowered defense against infection. Once the diagnosis has been established, treatment can be begun at home. The fluid intake should be increased, usually with water as well as Vitamin C or cranberry juice to render the urine more acid. A special protein found in cranberries and blueberries can combat most urinary tract infection by causing the causative germs to lose their grip on the bladder wall. Thus, the infective organisms become more amenable to bladder rinse-out with normal urination. One glass of liquid per hour up to 12-16 cups per day is recommended. In at least half such cases, the urinary infection will clear itself, with symptoms subsiding over 24-48 hours. Hot and cold sitz baths (see Chapter 17) are helpful, as is the half bath in a hot tub of water followed by a cold spray. Increasing blood flow to the urinary organs, these hydrotherapy treatments aid the body in natural resistance to infection and the clearing of disease. Persistence of symptoms or the underlying presence of diabetes, high blood pressure, or chronic kidney disease should be evaluated with appropriate urine tests, cultures, and medical counsel. INCONTINENCE Involuntary loss of urine is a very troublesome symptom. This may occur in children and when associated with bed-wetting is usually termed enuresis. Up to 4-5 years of age this may be quite common, and when persistent usually indicates some psychological distress. Congenital defects in the formation of the urinary organs may contribute to this disorder, and they can be evaluated with a specific x-ray study, the intravenous pyelogram.