The Facts About UTIs

A urinary tract infection (UTI) is an infection in one or more parts of the urinary system: the bladder, kidneys, ureters and urethra. If you've had a UTI, you know how painful and persistent it can be, even when the case is mild. The burning during urination, combined with an increased urge to urinate, especially at night, can wreak havoc on your day. If the UTI moves from the bladder to the kidneys, the infection can cause kidney damage when left untreated.

The urinary system is designed to keep out bacteria, but sometimes its natural defenses fail. UTIs develop when bacteria enter the urinary tract through the urethra and begin multiplying in the bladder. Recurring UTIs may indicate other health problems, such as diabetes or an abnormal urinary system.

UTI symptoms

Symptoms of a UTI can range from mild to severe and include:

• A strong, persistent urge to urinate
• Burning sensation while urinating, passing frequent, small amounts of urine, urine that appears cloudy, urine with blood in it or urine that has a strong, foul smell
• Back pain, nausea and vomiting
• Painful intercourse
• Fatigue, fever and vomiting
• Pain in the center of a woman's pelvis and around the pubic bones
• Penis pain in men

How symptoms manifest depends on where the infection has taken hold and its severity. While bacterial infections of the kidneys, or pyelonephritis, are relatively rare, they can be serious.

More commonly, people suffer from urethritis, an infection of the urethra that occurs when bacteria spread from the anus to the urethra. This is why women are taught to wipe themselves from front to back after a bowel movement. If they avoid spreading the bacteria from the rectum to the urinary tract, women can lower their risk of infection.

Cystitis occurs when the infection spreads from the urethra to the bladder and is usually caused by E. coli, a common bacteria in the gastrointestinal tract. Sexual intercourse may also cause cystitis, but the infection can develop in women who are not sexually active. The proximity of the anus to the urethra and the urethra's opening to the bladder on anatomical females is a primary risk factor for cystitis.

Women's anatomy increases UTI risk

Because of the differences in anatomy, people assigned female at birth are 14 times more likely to develop UTIs than people assigned male at birth. The urethra in women is shorter than that of men and is located closer to the anus, which is a breeding ground for bacteria.

Approximately 40 percent of anatomical females will develop a UTI at some point during their life. Risk factors for women include:

• Sexual activity: Sexually active women have more UTIs than people who are not sexually active. Sex with a new partner also increases risk.
• Pregnancy: Pregnancy causes changes in the urinary tract that increase the risk of UTIs, especially from week six through week 24.
• Certain types of birth control: Women who use diaphragms and spermicidal creams may have an increased risk for UTIs.
• Menopause: The drop in estrogen after menopause causes changes in the urinary tract that make women more vulnerable to UTIs. Infections in older women are often overlooked or misdiagnosed.
• Age-related cognitive decline: Dementia and Alzheimer's increase the risk of UTIs if personal hygiene becomes an issue.

Men are less susceptible, but not immune

Though UTIs are more common in women, men can get them, too. In men, UTIs can develop in the urethra, the bladder, the prostate or the kidneys.

Male urethritis is almost always contracted through a sexually transmitted condition, such as chlamydia or gonorrhea. Because men have a long urethra, it is more difficult for bacteria to invade the bladder, which makes infections there relatively rare. A UTI in the prostate causes the prostate to swell and can lead to prostatitis. If bacteria move into one of the kidneys, a serious infection can occur.

Risks to both assigned sexes

UTI risk factors that affect both men and women include:

• Chronic health conditions: An impaired immune response can interfere with the body's ability to fight bacteria. Spinal cord injuries and nerve damage may prevent the bladder from emptying completely.
• Urinary tract abnormalities: These can prevent urine from leaving the body or cause it to back up in the urethra and increase the risk of UTIs.
• A recent urinary procedure: Such procedures include surgery for an enlarged prostate and a biopsy of the prostate, and they can leave UTI-causing bacteria behind.

Diagnosis and treatment

Diagnosing a urinary tract infection may involve urinalysis—such testing examines urine for red and white blood cells and bacteria—and a urine culture to determine the type of bacteria and the appropriate treatment.

Physicians frequently prescribe antibiotics to kill bacteria. Commonly prescribed antibiotics include nitrofurantoin, sulfonamides, amoxicillin, cephalosporins, Bactrim, doxycycline and Cipro.

It's important to follow your doctor's directions for taking antibiotics. Don't stop taking the medicine because symptoms have disappeared and you feel better. Always finish the full course of antibiotics to prevent the infection from returning.

People who have frequent UTIs can develop an antibiotic-resistant infection, at which point their urine may need to be tested against specific antibiotics to give the doctor an idea of which one to prescribe. While tests are being done, patients can take acetaminophen or ibuprofen for pain and drink plenty of water. In complicated cases, where the UTI is severe or has moved into the kidneys, hospital treatment to administer intravenous antibiotics may be necessary to rid the body of the infection.

Complications

UTIs rarely cause complications when they are treated properly and promptly. Left untreated, however, they can cause serious health problems, including:

• Permanent kidney damage if the infection has moved into the kidneys
• An increased risk for pregnant women of delivering low-birth-weight or premature infants
• A narrowing of the urethra in men
• Recurrent infections
• Sepsis, a potentially fatal blood infection

Call your healthcare provider if you have UTI symptoms. Do not try to self-diagnose or self-treat. Contrary to folklore, cranberry juice will not cure a UTI and can, in fact, make it worse if the juice is sweetened with sugar.

If you have been diagnosed with a UTI and develop a fever, back pain or vomiting after receiving treatment, call your healthcare provider. You may need a different treatment.

Prevention

You can usually prevent UTIs by adopting healthy lifestyle habits for urinary tract health. First, practice good hygiene. This is especially important for women because of their anatomy and the capacity for bacteria to grow.

Drink plenty of water and other noncarbonated, sugar-free drinks. Six to eight glasses of water daily can help flush out extra bacteria from the urinary tract. In addition, avoid drinks and foods that are known to irritate the bladder. These include alcohol, caffeinated beverages, carbonated water and soda, citrus juices and spicy foods.

Be mindful of your urination habits. Urine is a waste product that contains bacteria. When you urinate, you remove that waste from your body. Urinating frequently helps reduce the risk of infection, especially for people who have a history of developing UTIs. If possible, urinate immediately before and after sex and wash your genital area with a warm, clean washcloth before having sex. Use the bathroom when you feel the urge to urinate rather than trying to hold it in.

Avoid wearing tight-fitting pants. Looser clothing can help keep you dry and prevent bacteria from developing in the urinary tract. Wear breathable cotton underwear and sleep without underwear or wear loose-fitting boxers or shorts.

Additional preventive measures for women

While practicing good hygiene can help women lower their risk of getting UTIs, women should never use douche products. Douches strip away vaginal flora, change the vaginal pH and create an ideal environment for bacteria to grow.

Baths also increase the risk of UTIs in women by altering their vaginal pH and introducing soap residue and other harmful chemicals into the vagina. Whenever possible, take a shower instead of a bath.

When you use a washcloth, clean the genital area first and the anus last. If you use a hand shower, point it downward and allow the water to run over the vagina rather than directly into it.

Use mild soaps that are made with natural, unscented ingredients. Keep scented products—including feminine hygiene sprays, bubble bath, bath oils, scented powders, scented tampons and scented pads—away from your urethra and vagina.

Condoms can function as a proactive measure against UTIs, as well, as they help prevent bacteria from spreading during vaginal intercourse. Avoid scented lubricants and flavored condoms, which are infused with sugar, and sugar is growth fuel for bacteria.

If you experience vaginal dryness, use only water-based lubricants during sex and avoid spermicide. Some postmenopausal women may benefit from applying a vaginal estrogen cream, which can reduce the risk of UTIs by changing the pH of the vagina. Talk to your healthcare provider about healthy options for treating vaginal dryness.

Additional tips for men

Men should use condoms when engaging in anal sex and avoid oil-based lubricants, which can cause the condoms to break. If you are uncircumcised, wash under your foreskin because the tissue there can be prone to bacterial growth, which can lead to balanitis if not washed daily.

Keep your genitals dry by wearing cotton underwear and changing your underwear frequently, at least daily, and more often if they get sweaty or you experience bladder or bowel leakage.

Take your prostate medications as prescribed to improve urinary flow and reduce the risk of infections.

UTIs are a pain, but proper treatment helps the symptoms subside quickly. Regardless of how stellar your daily hygiene is, you can't always avoid UTIs. You can, however, get over them quickly if you seek medical care as soon as symptoms develop and follow your treatment plan.