Urinary Tract Infection

What are urinary tract infections (UTIs)?

Urinary tract infections (UTIs) can be categorized as lower or upper UTIs. Lower UTIs involve the bladder, whereas upper UTIs affect the kidneys. Kidney infections are also referred to as pyelonephritis. Most UTIs can be treated with oral antibiotics such as Nitrofurantoin or Trimethoprim, but some upper UTIs may require hospital admission and IV antibiotics.

UTIs are often caused by bacteria present on the skin near the rectum, vulva, vagina, and urethra. When these bacteria enter the urethra, they can cause a UTI or kidney infection. The most common bacteria involved in UTIs is E-Coli, but there are several other bacteria and some fungi that can cause cystitis.

Various risk factors for UTIs include:

• Dehydration: When you’re dehydrated you produce less urine, which means that you are less likely to flush out any bacteria that have got inside the urethra.
• Being immunocompromised: If you are immunocompromised, your immune system is less able to defend your body from infection, making it more likely you will experience UTIs. In rare cases, fungal infections can cause cystitis, but this most commonly happens in immunocompromised patients, therefore it is important to get any yeast infection or fungal infection treated as soon as possible.
• Wiping back to front when you go to the toilet: If you wipe from back to front when you go to the toilet, you are more likely to transfer bacteria from around the rectum or vagina to the urethra, leading to infection. You should always wipe front to back after using the toilet.
• Sex: Sex is a common cause of UTIs and kidney infections. During sex, it is easy for bacteria from the vagina or rectum to enter the urethra and cause a UTI. There are several things you can do to help protect yourself from UTIs related to sex:
  • Keep sex toys clean. Always wash them thoroughly after use and store them in a clean place.
  • If you enjoy anal play, make sure that any sex toys or fingers are washed thoroughly before they touch your vagina again. If you have anal sex, it is important that the condom is changed and/or the penis is washed before any vaginal penetration.
  • Use the toilet after having sex and wipe from front to back.

The signs and symptoms of cystitis are:

• Pain or burning sensation when urinating
• Needing to urinate frequently
• Feeling an urgent need to urinate
• Sensation of bladder fullness
• Lower abdominal discomfort
• Pain above the pubic bone
• Blood in urine
• Strong smelling urine
• Feeling that your bladder has not been completely emptied after urinating

Some additional symptoms are more common if you have an upper UTI or kidney infection. These include:

• Flank pain
• Pain in your back beneath the rib cage
• Swelling of the lower back - often on one side
• Fevers and chills

If you experience these symptoms, it is a good idea to seek medical attention - you may be admitted to hospital for IV antibiotics and monitoring.

UTIs are generally diagnosed by asking about your symptoms. Sometimes, a urine test will be done to confirm. If you experience recurrent cystitis, a urine culture may be done to learn more about the infection and its cause.

The symptoms of a UTI include:

• Pain, burning or stinging when urinating
• Urge to urinate quickly and frequently
• Strong smelling urine
• Blood in urine
• Lower abdominal pain

A urine test involves inserting a dipstick into a urine sample. A dipstick is a card strip with patches containing different chemicals. This is dipped into the urine to identify the presence of blood, glucose (sugar), protein, infection and other factors.

It is worth noting that the symptoms of UTIs can also be caused by other conditions. If your urine test is negative or if your symptoms do not resolve after treatment with antibiotics, you may be evaluated for the following diseases: STIs, cervicitis, vaginitis, or pelvic inflammatory disease.

Risk Factors

There are several risk factors for UTIs. Both medical conditions and lifestyle factors can predispose you to UTIs. So if you have any of the following conditions, you should be extra aware of the lifestyle factors that could make you even more likely to experience a UTI.

Conditions:

• Diabetes: In diabetes, your urine can have a high glucose (sugar) content, this creates an environment in which bacteria are more likely to survive and grow, developing into an infection.
• Compromised immune system: If you are immunocompromised, your body is less able to defend itself against pathogens, therefore you are more susceptible to a range of infections, including UTIs. Immunocompromised people can get UTIs caused by a fungal infection, but this is very rare in people with a healthy immune system.
• Spinal cord injury: People with spinal cord injury can sometimes lose control over their bladder. This makes them more susceptible to UTIs as they may need to use a catheter (tube inserted through the urethra into the bladder) and they may find it harder to know when they have fully emptied their bladder. Both of these factors increase the likelihood of experiencing a UTI.
• Catheter use: As mentioned above, catheter use can increase your risk of UTIs. A catheter gives bacteria a means of entering the bladder without having to compete as much with the body’s immune system.
• Uterine or bladder prolapse: If you have a prolapse in your lower urinary tract, it can be harder for your bladder to empty fully, this makes it less likely that you will flush out any bacteria, and more likely that you will get a UTI.
• Kidney stones: Kidney stones can cause a block in urinary system that increases the chances that you will experience a UTI.
• Enlarged prostate: While UTIs are unusual in men, due to the length of the male urethra, an enlarged prostate is a risk factor. An enlarged prostate can cause urinary retention which increases your chances of a UTI.
• Pregnancy: The uterus (womb) sits directly above the bladder. As the baby grows inside the uterus the drainage from the bladder can become partially blocked which increases the risk of you getting a UTI.

Lifestyle Factors:

• Sex: We are not saying that you should avoid sex, but you should know that hygiene is really important during and after sex to protect yourself from STIs. You should keep the following factors in mind:

  • During sex it is easy for bacteria to travel from around the vagina or anus into the urethra. Therefore, it is a good idea to always urinate after sex.

  • If you have anal sex, a condom should always be changed or the penis should be washed before any vaginal penetration.

  • If you use any sex toys (or fingers) anally, they should be washed thoroughly before being allowed near the vagina.

  • If you use any sex toys, you should make sure they are washed thoroughly after use and stored in a clean container.

• Wiping from back to front after using the toilet: If you wipe from back to front after urinating, you are more likely to transfer bacteria from the anus or vagina into the urethra. Always wipe from front to back.  
• Dehydration: You produce less urine when you are dehydrated. This means that urine can sit in the bladder for longer, making it less likely you will flush out any bacteria before they cause an infection.
• Using diaphragm contraceptives: Diaphragm contraceptives are inserted inside the vagina. This increases your risk of UTIs because diaphragms can put pressure on the bladder, making it harder to empty your bladder and there is a greater risk that you may transfer bacteria to the urethra when inserting a diaphragm.
• Hovering: Many women will ‘hover’ just above the toilet seat when using a public toilet. This can make it harder for you to empty your bladder fully, increasing your chances of a UTI.

Without treatment, UTIs will resolve in 20-40% of women. But if a UTI is left untreated it can travel to the kidneys and cause a kidney infection. Therefore, if you experience UTI symptoms, it is a good idea to speak to a doctor.

Antibiotics such as Trimethoprim or Nitrofurantoin are prescribed for at least three days, but your symptoms may last longer than this.