What is a UTI and why is it happening to me? UTIs are the WORST!

An in-depth guide to UTIs, its causes, treatment options, and preventions you can take

What is a urinary tract infection (UTI)?

UTI are infections of the urinary tract, which includes the urethra, the bladder and the kidneys. The vast majority of UTI registered every year are acute bladder infections (called cystitis in medical speak). They are caused by bacteria entering the vagina, who then move up the urethra (which is the duct between the entrance of your vagina and your bladder) and start multiplying in the bladder. These bacteria most often stem from the E. coli family and can originate from the woman’s own digestive tract (via the anus) or outside sources. Such bacterial infections can result in mild to moderate pain in the bladder, “burning” urine, and an increased urge to urinate. This is what doctors call a “simple UTI.”

Not surprisingly, over 90% of all UTI cases every year are women (have you ever heard a man complain about having a UTI?) and it’s one of the most frequently seen infections with about 150 million individual UTI cases happening every year. Age 16 to 35 is the time when women are most susceptible to UTI, but women in or past their menopause as well as children also are at risk because their immune system tends to be a bit weaker. By the time you are 35 there’s a 50% chance that you’ve already had at least one UTI in your life. That’s for the U.S. population — in developing countries the occurrence of UTI can be much higher due to poor sanitary conditions.

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By far most UTI are the simple kind and typically a cystitis. The standard treatment given consists of several antibiotics doctors can choose from. However, if a woman experiences repeated UTI within a short period of time, or if she gets a UTI while pregnant or diabetic or after a surgery, we’ll speak of “complicated UTI.” This also includes UTI in women older than 60. Every year in the U.S. there are 1.3 million cases of complicated UTI, and they are complicated because there’s an elevated risk that the bacteria will spread to and infect the kidneys. A kidney infection, which you can tell by severe back pain, chills, and high fever (>100), can be fatal if left untreated. Thanks to modern medical advancements, in the U.S. the death rate of complicated UTI merely is 2%, but in developing countries it can be much higher than that.

Do I really have a UTI now?

You are probably reading this article because you’ve already noticed some symptoms, most likely you feel a burning sensation every time you go to the bathroom and urinate more often than you normally would. These are the classic signs, but below is a list of other things to watch out for. Actually, you can have a UTI without any symptoms and wouldn’t even know. This is because the body quickly deals with the bacteria itself before the UTI gets big enough for symptoms to develop. It’s only when your body finds it hard to do so, that symptoms appear. Here’s a list of the most common ones:

  • Burning sensation while urinating
  • Increased urge to urinate (even when nothing comes out anymore)
  • Cloudy and/or blood-colored urine
  • Strong urine odor
  • Abdominal pain and pressure (especially lower abdomen)

The above five symptoms describe a simple UTI. If in addition to them you also get the following symptoms, you should see a doctor as soon as possible, as these are indicators of a complicated UTI, i.e., a kidney infection:
 

  • Back pains in the sides (where your kidneys are located)
  • Fever
  • Whole-body chills
  • Vomiting

Moreover, if you are diabetic or pregnant or older than 60 you should also see a doctor even if you only notice the symptoms of a simple UTI.

You may already have had your fair share of UTI in the past and think you are well prepared for spotting the first signs of a new one. It’s important though to remember that there a few other conditions that can cause similar symptoms of a simple UTI. This includes some sexually transmitted diseases such as gonorrhea and chlamydia. Therefore, it’s a good idea to make it a matter of principle that at the first sign of a new UTI you go see a doctor to get it checked. 

How did I get a UTI?

As mentioned above, E. coli and (to a lesser degree) other bacteria are the culprits. E. coli dwells in the digestive system of mammals and thus also is present in all excreted feces. There are certain factors that raise the risk of E. coli entering the vagina and spreading to the bladder:

  • Female anatomy: the urethra of women is much shorter than in men, which means the bacteria have to travel a shorter distance to the bladder. There’s also less distance between a woman's anus and her urethra entrance than it is the case for men. If bacteria want to make it into the male urethra they first have to ascend up the entire length of the penis or be placed on the very tip of it by accident.  
  • Sexual activity:  Both penis and (as is often forgotten) even the tongue can deliver bacteria into the female urethra. A strict sex hygiene regime therefore is very important. A high risk sexual practice is switching from anal to vaginal sex without interim washing or change of condoms. Moreover, you should avoid sex at all, if you currently are suffering from a UTI, even if the symptoms are only mild. 
  • Pregnancy: during pregnancy there’s a greater risk of UTI developing in your bladder, as the uterus grows in size and then often starts weighing on the bladder. This limits the bladder’s ability to fully drain out all urine (and any bacteria within it). UTI can be harmful to the fetus and, if untreated, lead to such serious issues like pre-term birth and low birth weight. Because of this risk, doctors generally view pregnancy UTI as complicated. 
  • Diabetes: If you have diabetes, UTI can occur more frequently if you fail to carefully manage your blood sugar. Bacteria in the urinary tract fuel themselves on glucose in the urine. The higher the sugar concentration of the urine, the easier it’s for bacteria to multiply and advance in the urinary tract.
  • Certain types of contraception: Diaphragms and spermicide creams sometimes can raise the risk of getting UTI. 
  • Weak autoimmune system: Preexisting autoimmune disorders like cancer or HIV make it more difficult for your body to defend itself against bacterial invasions, which increases the risk of getting a UTI. You immune system may also be compromised if you are older than 60 or currently in chemotherapy.  

How can I treat a UTI?

Well, you first will need to see a doctor, who will screen your condition and decide whether to prescribe you an antibiotic to kill off the bacteria. Your doctor will consider the severity of your symptoms against the side effects of the drug. Typically, doctors will choose from the following list of antibiotics:

  • Macrobid (nitrofurantoin) 
  • Cipro (ciprofloxaxin) 
  • Bactrim 
  • Keflex (cephalexin) 
  • Monurol (fosfomycyin) 

One big and growing problem with antibiotics is that E.coli are becoming increasingly resistant against antibiotics, especially against the longest-serving ones, like Bactrim. Studies found that in roughly one third of cases where Bactrim was administered to the patient, the bacteria proved resistant and other antibiotics had to be used to finish the job. Therefore, it’s becoming a standard practice in many places to first test which strain of bacteria is causing the UTI before an antibiotic is be prescribed. This will get you the most effective treatment.

Aside from antibiotics, to support your speedy recovery, you should make sure to drink a lot of water. This increases the number of your bathroom visits and thereby helps to flush out the bacteria. Stay away from drinks with alcohol, citric acid, or caffeine as they can irritate the bladder, making things worse. Also, during a UTI it’s advised to dress warm, especially your lower abdomen, as this will ease the discomfort. You can also try heating patches. 

How do I prevent ever again getting a UTI?

Paying attention to good genital hygiene will take you a long way. Wash your genital area regularly and always wipe from the front (vagina) to the back (anus), not the other way around. You can also rinse your genitalia after each time you went to the bathroom. That’s what bidets were invented for.   

Good sex hygiene is equally important, both for you and your partner. It includes cleaning genitals and changing condoms during sex, in particular if you practice anal sex. Urinating after sex will help to clean your urinary system from any bacteria that may have sneaked in during sex. 

Don’t wear excessively tight underwear or pants, particularly not during the summer. The warmth and sweaty moisture in tight jeans is just what bacteria need to colonize your urinary tract. 

Staying hydrated is important, especially in the summer, because you don’t want to have long intervals between bathroom visits. The more often you pee, the harder it will be for E.coli and other bacteria to gain a foothold in your urethra. 

Following these few points of simple advice can significantly lower your risk of getting a UTI again in the future. 
  

References

  1. Pujades-Rodriguez, Mar, et al. “Lower Urinary Tract Infections: Management, Outcomes and Risk Factors for Antibiotic Re-Prescription in Primary Care.” EClinicalMedicine, vol. 14, Sept. 2019, pp. 23–31, www.thelancet.com/journals/eclinm/article/PIIS2589-5370(19)30120-8/fulltext, 10.1016/j.eclinm.2019.07.012. Accessed 29 Jan. 2020.
  2. Kuo, Hann-Chorng, and Jia-Fong Jhang. “Recent Advances in Recurrent Urinary Tract Infection from Pathogenesis and Biomarkers to Prevention.” Tzu Chi Medical Journal, vol. 29, no. 3, 2017, p. 131, www.ncbi.nlm.nih.gov/pmc/articles/PMC5615991/, 10.4103/tcmj.tcmj_53_17. Accessed 29 Jan. 2020.
  3. CDC. “Antibiotic Treatments for Urinary Tract Infections Are Commonly Prescribed To Pregnant Women.” Centers for Disease Control and Prevention, 11 Jan. 2018, www.cdc.gov/pregnancy/meds/treatingfortwo/features/kf-uti-antibiotic-treatments-pregnant-women.html. Accessed 29 Jan. 2020.
  4. Storme, Oscar, et al. “Risk Factors and Predisposing Conditions for Urinary Tract Infection.” Therapeutic Advances in Urology, vol. 11, Jan. 2019, p. 175628721881438, www.ncbi.nlm.nih.gov/pmc/articles/PMC6502981/, 10.1177/1756287218814382. Accessed 29 Jan. 2020.
  5. Ayan Sabih, and Stephen W Leslie. “Complicated Urinary Tract Infections.” Nih.Gov, StatPearls Publishing, 5 Mar. 2019, www.ncbi.nlm.nih.gov/books/NBK436013/. Accessed 29 Jan. 2020.

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