Urinary Tract Infections (UTIs) & Incontinence

A woman’s body copes with a lot as it adapts and changes over the course of a lifetime. As well to the trials and tribulations of dealing with menstruation, pregnancy, childbirth, and eventual menopause, another one of life’s maladies you can expect to face is urinary tract infections or UTIs.

Urinary tract infections (UTIs) are quite common in women of all ages, 50-60% of all women will experience 1 UTI during their lifetime. UTIs occur more often in women than in men, at a ratio of 8:1. This may be because women have a shorter urethra, which may make it easier for bacteria to reach the bladder.

As the name suggests, a urinary tract infection can present itself anywhere within the urinary system which comprises the kidneys, ureters, bladder, and urethra.

Your urinary system is designed so that there is minimal risk of serious infection in the kidneys. This is done by preventing urine from flowing back up into the kidneys from the bladder.

The good news is that while urinary tract infections stay confined to the bladder and urethra, they are easily treatable and not serious or life-threatening. It’s when they head toward and make it to the kidneys that a new set of problems have to be dealt with.

When an infection affects the lower urinary tract (urethra or bladder), it may be called urethritis, or cystitis if it only affects the bladder. When it migrates to and affects the upper urinary tract (ureters or kidneys) it is called urethritis or pyelonephritis if it affects just the kidneys.

UTIs symptoms will differ depending whether it presents in your upper or lower urinary tract. You may have all or only some of these symptoms and you may have both upper and lower UTI symptoms at the same time. The type and severity of UTI symptoms will vary from person to person.

Common urinary tract infection symptoms include:

• burning sensation when passing urine
• pain in your abdomen, pelvis or back
• general feeling of being unwell
• passing urine much more frequently than usual
• feeling an urge to urinate, but being unable to, or only passing a few drops
• urinary incontinence
• feeling like the bladder is still full after urination
• cloudy, bloody or dark, foul-smelling urine

A person with an upper urinary tract infection or kidney infection can also experience:

• chills
• high fever
• nausea and/or vomiting
• loin (lower abdominal) pain
• back pain

The culprit in 80- 90% of UTI cases is a type of bacteria called Escherichia coli, (E. coli) (Bien, 2012). These bacteria normally live in the bowel and around the anus. E. coli bacteria are fairly sedate in their natural environment of the bowel. However, the bacteria will thrive when introduced to urine’s acidic state.

Urinary tract infections normally occur when E. coli bacteria get into the urine and begin to grow. The infection usually starts at the opening of the urethra where the urine leaves the body and moves upward into the urinary tract to the bladder. If the infection isn’t treated at this point, it will continue and can quickly spread to the kidneys.

E. coli bacteria can move quite easily from the area around the anus and the perineum to the opening of the urethra. The two most common causes of this are improper wiping and sexual intercourse. Women are more prone to UTIs because they have shorter urethras, which provide the bacteria with a quicker pathway to the bladder.

The normal process of urination flushes the bacteria out through the urethra. However, if the infection has already taken hold and there are too many bacteria, urinating may not stop their spread.

The danger here is the infection spread further. If it reaches the kidneys, it can cause a kidney infection (pyelonephritis), which can become a very serious and even life-threatening condition if not treated immediately.

Some people are more at risk of developing UTIs than others including:

• Sexually active women — partly because the female urethra is shorter and therefore easier for bacteria to reach the bladder
• People with urinary catheters — particularly those too ill and those who can’t empty their own bladder
• Diabetics — changes to the immune system make a person with diabetes more vulnerable to infection. Also, a higher sugar level in the urine makes it easier for bacteria to grow
• Men with enlarged prostates — this can cause the bladder to only partially empty

Additionally, other factors that increase the likelihood of UTIs include:

• Being pregnant
• Having tumors or stones in the urinary tract
• Using a diaphragm as contraception
• Having a medical condition involving the bladder or kidneys
• Anything that obstructs the flow of urine out of the bladder

Whether your symptoms indicate an upper or lower urinary tract infection, you should seek the advice of your doctor as soon as possible. Your doctor may diagnose a UTI based purely on the symptoms, or they might confirm the symptoms with a simple urine dipstick test in the room. Occasionally, a urine sample will be sent to the laboratory for testing to identify the specific cause of the UTI, and to determine which antibiotic treatment is the most suitable.

A prescribed antibiotic is the best course of action for UTIs. These should start clearing up the infection after a few days.

The type, strength, dosage and how long you need to take antibiotics will depend on the severity of your symptoms and whether your doctor is prescribing for a woman, man, child, or baby.

Important! It is important to complete the entire course prescribed by your doctor, even if you are no longer experiencing symptoms of a UTI.

Some helpful tips for preventing UTIs.

• Drink lots of water.
• Urinate as soon as you feel the need.
• Choose showers over baths.
• Wipe your bottom from front to back to prevent bacteria from around the anus from entering the urethra.
• Make sure you have adequate lubrication during sex
• Cleanse your genital area before sex.
• Urinate after sex to flush away any bacteria that may have entered your urethra.
• Avoid using feminine hygiene products such as sprays or douches.
• If you use a diaphragm, ask your doctor about other forms of contraception you might use.
• Non-antibiotic prophylaxis of UTIs include vitamin C via urine acidification. Cranberry juice or cranberry tablet via inhibition of bacterial (mainly E. coli) adhesion to uroepithelial cells Wear cotton underwear and loose-fitting clothes

If you have a lower urinary tract infection, antibiotic treatment usually clears up the infection. If you leave it too long and the infection spreads to the upper urinary tract, other more serious problems can present themselves including permanent scarring of the urinary tract (which could lead to further problems), pyelonephritis (kidney infection), and beyond that, infections of the blood.

This content should not substitute medical advice from your personal healthcare provider. Please consult your healthcare provider for recommendations/diagnosis or treatment.

Sources

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Wawrysiuk S, Naber K, Rechberger T., Prevention and treatment of uncomplicated lower urinary tract infections in the era of increasing antimicrobial resistance—non‑antibiotic approaches: a systemic review. Archives of Gynecology and Obstetrics (2019) 300:821–828. Available at: https://link.springer.com/content/pdf/10.1007/s00404-019-05256-z.pdf [Accessed 20 Dec. 2022].

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