UTIs: How to Avoid a Painful Problem

Neeru Singh, MD
November 13, 2020
4 min read

Urinary tract infections (UTIs) affect 150 million people in the world each year. In the United States alone, treatment costs and lost workdays equal more than $3.5 billion dollars spent annually, making UTIs a significant public health problem.

UTIs occur when bacteria or fungi enter the urethra — the passageway between the bladder and the exterior part of the body — then adhere to its mucosal lining, multiply, release toxins, and stimulate an inflammatory response. A wide variety of bacteria cause UTIs, but it is usually bacteria from the skin and rectum. Echerichia coli (E coli) causes the most UTIs worldwide.

While UTIs are more common in females because their urethras are shorter and closer to the rectum, males, especially older men and infantile boys, can also get them. Most UTIs remain in the bladder, but they can spread to the kidneys, creating a more serious infection called pyelonephritis.

There are two classifications for UTIs: “uncomplicated” and “complicated.” Uncomplicated UTIs most often affects otherwise healthy people. Complicated UTIs most often affects people with indwelling catheters, those who are immunocompromised, and those who have urinary tract abnormalities. In the US, approximately 80% of complicated UTIs are from indwelling catheters, and the risk increases with prolonged catheterization or based on factors like gender, diabetes, and obesity.

There are well-established risk factors for UTIs, including gender, sexual activity with a new partner, changes in the normal concentration of bacteria in the vagina or urinary tract, pregnancy, older age, menopause, structural problems with the urinary tract, and poor hygiene. Certain forms of birth control, such as diaphragms and condoms with spermicidal foam, increase one’s risk of getting a UTI. If infected, the most common symptoms are pain or burning while urinating, increased frequency of urination, blood in the urine, the sensation of having to pee all the time, and pressure or cramps in the lower abdomen. If the infection ascends into the kidneys, common symptoms are fever, chills, flank pain, nausea, and vomiting.

Once a UTI is suspected and diagnosed via simple laboratory tests, the most common form of treatment is antibiotics. However, because UTIs are so common and antibiotics are almost always prescribed, the pathogenic bacteria have developed resistance to many of the antibiotics. As the prevalence of multi-drug resistant pathogens increases, UTIs are becoming increasingly difficult to treat. Researchers are exploring new treatment approaches, such as vaccines targeting specific bacterial components. If the pathogenic bacteria are susceptible to an antibiotic, and if the antibiotic is taken as directed, the UTI should go away. However, 20–40% of individuals who have a UTI will have future ones.

Preventing UTI’s is Critical

Because of growing antibiotic resistance, preventing UTIs is critical. One way to prevent them? Urinate when you get the urge and try to avoid holding it in. If you have to go, go!

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Other ways females can avoid an uncomfortable UTI include urinating after sexual activity, especially if with a new partner, drinking 6 to 8 glasses of water a day in order to flush the urinary tract of bacteria, minimizing the use of sprays and powders in the genital area, finding birth control alternatives to diaphragms or condoms with spermicidal foam, and finally practicing good hygiene by wiping front to back and not back to front.

It is best to avoid tight clothing, especially tight workout clothes, and switch to cotton underwear to help stop the buildup of moisture that may create an environment ripe for infection. Some women take probiotic supplements to help boost the “good bacteria” in their urinary tracts and reduce room for the “bad bacteria” to grow, however, there is limited evidence that they prevent UTIs better than placebo. Cranberry juice may help prevent UTIs by reducing the ability of pathogenic bacteria to bind to the lining of the urinary tract. Once a UTI starts, however, cranberry juice is not as helpful.

If you end up having one, it is imperative to be diagnosed and treated to avoid a more complicated infection. However, because antibiotic resistance is a growing concern, it is also important to practice the above-mentioned preventive tips to reduce your risk of getting a UTI.

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Neeru Singh, MD

Neeru Singh, MD, is a Medical Director at Carbon Health. As a primary care physician, she enjoys educating and guiding patients on important health decisions.

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