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EXPOSED! Why You Keep Getting Urinary Tract Infections (UTIs) | Causes & Prevention

April 16, 2024

One in 3 women will have at least one urinary tract infection by 24 years, and 44% will get it again.

 “Almost half of all women will experience 1 UTI during their lifetime. Specific subpopulations at increased risk of UTI include infants, pregnant women, the elderly, patients with spinal cord injuries and/or catheters, patients with diabetes or multiple sclerosis, patients with acquired immunodeficiency disease syndrome/human immunodeficiency virus, and patients with underlying urologic abnormalities”.

Betsy Foxman

Severe urinary infections (Urosepsis) is responsible for 20-30% of cases of sepsis. The rate of emergency admissions from UTI in the UK has almost doubled in the last five years.

Image of a woman/s urinary tract

What are Urinary Tract Infections

A UTI is an infection of the urinary tract. This includes the bladder and the urethra; the lower part of the tract, and the kidneys and ureters, which comprise the upper urinary tract.

A term you will hear people mention commonly is cystitis, which means ‘bladder inflammation’, a type of lower UTI.

The upper urinary tract infection affecting the kidneys is more serious. It’s also known as pyelonephritis and can result from a progression of a lower infection that’s not treated or completely treated. 

Symptoms of UTIs

If you have an infection of the urinary tract (urethra, bladder, ureters or kidneys), you may have one or more of the following symptoms:

  • painful urination (discomfort, pain, burning, tingling, or stinging associated with urination)
  • low abdominal or pelvic pain
  • frequently passing urine, 
  • smelly/unpleasant urine, 
  • discoloured/ cloudy/blood in urine,
  • tiredness, fever, nausea, vomiting
  • back pain, loin pain (pain along the sides of the abdomen and mid back)

In addition to these physical symptoms, urinary tract infection could have significant impact on other aspects of your life.

These areas are affected more when you frequently experience urine infections:

  • your quality of life,
  • sexual function including libido,
  • work,
  • social life,
  • physical activity,
  • your mental health – especially depression,
  • relationship breakdown, etc.

Women with Frequent Urinary Infections Feel Dismissed

44% of women who have a UTI the first time, will get one again. But a large number of women also experience a UTI several times a year.

It’s incredibily frustrating and distressing to get repeat UTIs like this. Some women relate their experience trying to seek treatment for their problem:

  1. I was told there was nothing wrong.
  2. He implied it was in my head.
  3. I was given only three days of antibiotics and then couldn’t see the GP again.
  4. The dipstick was negative, so I was ignored.
  5. The urine culture was negative; I was told there was no infection.
  • with respect to the 5th comment: everyone is different, and even if you do not have the quantity of growth needed for the test to say you have a UTI, it does not mean you do not have one
Urinary tract infection treatments. Image showing urine dipsticks for diagnosing UTI

What’s the best test for Urinary Tract Infections

The most commonly available test to detect an infection of the urinary tract is the urine dipstick test.

This is simply a test strip ‘dipped’ into the urine that can reveal if there is anything abnormal in it. It’s a good way (painless, not invasive) to idebtify problems happening in the body.

We can detect abnormal sugar and protein levels or if there are pus and white cells in the urine or other chemicals that suggest infection.

It’s almost similar to using a universal indicator paper to test for acids and is easy to read.

You can get some over the counter or in online shops, and it can be helpful for people who suffer frequent infections.

However, the ‘best test’, (which doctors also call the gold standard) that we have at present, is the culture of the mid-stream urine.

Culture means that your urine sample is incubated on a special medium for 24 to 48 hours in the laboratory to detect which germ is present in it.

We started using the culture of the MSU decades ago to diagnose urinary tract infections.

More recently, though, concerns around this test suggest we may need something more up-to-date for making accurate UTI diagnoses.

For instance, the special medium used to identify germs may be limited as it only supports the growth of a few types of germs.

We also know more now about how the bladder works than we did many years ago.

Initially, scientists believed the bladder to be a sterile organ.

Presently, there is a shift in that thinking towards the possibility that some germs live within the bladder wall. There they remain – not as contaminants – but as normal, natural bladder residents; similar to what happens in the gut.

Some doctors who treat bladder-related problems feel the best way to determine the presence of an infection is not relying on the (outdated) culture test but by directly observing if there are infection cells in a fresh urine sample.

What does Blood in the Urine mean (when you have a UTI)

Getting blood in the urine is fairly common when you have a UTI.

The appearance can vary – from the red/brown/pink appearance of the urine. Sometimes, you may pee and it looks like plain blood – which can be quite scary.

Yes, it could be from an infection – and that’s often the most common reason.

It happens due to inflammation leading to bleeding from the tissues within the bladder or the rest of the urinary tract.

It could occur as one of the initial symptoms or after a few hours/days with the infection.

However, it does settle as the irritation in the bladder resolves with treatment.

If blood in the urine doesn’t go away after treatment or there are no signs of infection, your Doctor will need to do more tests or send you to a specialist to perform them.

Other conditions where you may have blood in the urine are kidney stones, or more rarely bladder or kidney cancer.

Causes of UTIs

UTI is usually caused by germs entering the urinary tract/bladder from the gut.

The germs can pass from the anus and enter via the urethra and then into the bladder.

(They may pass through the blood in people with weak immune systems during surgery or when passing a catheter, which people sometimes need for many reasons).

The most common germs involved are E coliStaphylococcus S, Proteus, Enterococcus and more. 

You are more likely to have a UTI as a woman.

Women have shorter urethras, making it easier for germs to travel from the opening of the vulva into the bladder. (The urethra are of different lengths in men and women).

If you had UTIs as a child or your mum had frequent UTIs, you may also be more likely to get them.

Habits/Conditions that Increase Your Risk of a UTI

  • After sex – you can transfer germs from the vulva skin easily to the bladder through the urethra: emptying your bladder soon after sex can help reduce the chance of multiplying germs inside.
  • Holding your urine for prolonged periods
  • Wearing tight outfits/nylon undies
  • G strings could encourage germ transfer, especially if not kept clean and changed often.
  • Poor hygiene – specifically wearing unclean undies or not wiping the genital area properly
  • Taking bubble baths or using scented soaps
  • Changes to the vulva associated with menopause.
  • Poorly controlled Diabetes Mellitus, pre-existing urinary tract conditions – having UTI as a child, recurring UTIs, kidney stone disease, urinary tract abnormalities and others.
  • The ability of bacteria to stow away in the bladder could explain why some women suffer from symptoms even after completing a course of antibiotics.
Image showing some Urinary tract infection medications

Urinary Tract Infection Treatments – Antibiotics and more?

In the UK, when a woman has an uncomplicated UTI, we would usually treat her with antibiotics for three days.

This is a standard recommendation that most doctors will follow from NICE (National Institute for Health and Care Excellence).

The short course reflects the nature of an uncomplicated infection, the shorter urethra women have. There are also concerns about avoiding needless, prolonged antibiotic prescriptions. 

An uncomplicated UTI means an infection with typical germs, a woman who is not pregnant, and doesn’t have relevant anatomical or functional urinary tract conditions. There are no pre-existing medical problems or conditions like a weakened immune system.

In everyone else – pregnant women or men or those with relevant issues, we treat for seven days.

This is based on the guidelines, but many times, women with uncomplicated UTIs need to have more than three days treatment. Your doctor may suggest you carry on for seven days if the symptoms are still present.

This should always be done under the supervision of your health provider at the same time to avoid complications or missed diagnoses.

Common antibiotics are Nitrofurantoin, Trimethoprim, Amoxicillin, and Cefalexin. There are other antibiotics like Co-amoxiclav, Fosfomycin, Pivmecillinam and so on, but usually, if we suspect an infection, it’s one of the first three in most people. 

Preventing UTIs – what Doctors suggest

Knowing women’s risk of frequent UTIs, what should you do to avoid the problem?

Specialists recommend that if you are sexually active, take precautions to prevent UTIs developing after sex. Having sex frequently is associated with increased risks of UTI!

Multiple sexual partners – and having a STI (sexually transmitted infection) in the past also puts women at greater risk.

For those prone to recurent UTIs, avoid using spermicides with barrier birth control methods like the condom or diaphragm which could increase the chance of germs multiplying quickly in the bladder. Condoms with non-spermicidal lube reduces the risk of UTI

Additionally, if you have repeat UTIs, you can take steps to lower the chance of getting a further UTI. (Note that some of these methods do not have scientific data suporting them, but may provide some benefits).

  • Wipe yourself from front to back after using the toilet, and keep your genital areas clean and dry always
  • Pass urine as soon as possible after sex
  • Wash the vulva (especially the skin around the vagina) with water before and after sex
  • Keep a habit of drinking plenty of water daily to help flush out your bladder
  • Ensure you empty your bladder fully when passing urine (by waiting a few more seconds and squeezing and relaxing the pelvic floor muscles to ease urine out of the bladder)
  • For very mild bladder irritation, some women find cystitis sachets or cranberry drinks helpful. There is no scientific data supporting these can kill germs that cause UTI. Some cystitis sachets may work by making the urine less acidic and preventing germs from thriving in the bladder. Cranberry contains D-mannose, a type of natural sugar which clings to some germs in the bladder and helps to flush them out of the bladder. However, taking cranberry drinks may expose you to ezxcessive amounts of sugar, to get the dose that may help with a UTI!

Promising solutions…

Recently, people are developing resistance to antibiotics. This may explain the increasing rates of repeat infections, or emergency admissions with severe UTI.

In addition, we do not have new antibiotics in development that could help with the germs causing UTIs.

So looking for other solutions to help women treat repeat infections?

  1. D-Mannose extract – taken as a powder or tablet. In this case, there is no danger of taking excessive quantities of sugar, while getting the benefits of the effect of the treatment
  2. Methenamine…Hiprex. This is not a new kid on the block. It’s a non-antibiotic urinary antiseptic that may help women with frequent UTIs
  3. Vaccine – An oral vaccine that’s been in use in some places for several years has shown to be effective in reducing the risk of UTIs in women who suffer from recurrent UTIs. It is yet to be licensed in the UK, but watch this space. According to the scientists who developed this vaccine:

“This is a very easy vaccine to administer and could be given by GPs as a 3-month course. Many of our participants told us that having the vaccine restored their quality of life. While we’re yet to look at the effect of this vaccine in different patient groups, this follow-up data suggests it could be a game changer for UTI prevention if it’s offered widely, reducing the need for antibiotic treatments.”

Dr Bob Yang, Consultant Urologist at the Royal Berkshire NHS Foundation Trust

More Reading

Editing by  AskAwayHealth Team

Disclaimer

All  AskAwayHealth articles are written by practising Medical Practitioners on a wide range of healthcare conditions to provide evidence-based guidance and help promote quality healthcare. 

The advice in our material is not meant to replace the management of your specific condition by a qualified healthcare practitioner.
To discuss your condition, don’t hesitate to contact a health practitioner or contact us directly.

Image Credits: Canva

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