Real Facts on Urinary Tract Infections

It’s a common misconception that a urinary tract infection (UTI) automatically equals a bladder infection. In reality, a UTI can develop in any part of the urinary tract, including the urethra, bladder, ureters, or kidneys.
The villain in this scenario is bacteria. When a UTI is diagnosed and treated properly, most people won’t have complications.
How can you make sure this happens to you?
 
Symptoms
The Urology Care Foundation – which is the official foundation of the American Urological Association (AUA) – describes a UTI as the lining of the bladder and urethra becoming red and irritated just like your throat does during a cold. This can result in pain in the belly and pelvic area, and may make you feel like urinating more frequently. Sometimes trying to urinate isn’t successful, as only a few drops are released and/or there’s burning. Incontinence can occur, and the urine can smell bad or look cloudy.


Women tend to get more bladder infections than men, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). At least 40 to 60 percent of women will get a UTI in their lifetime, and most of those infections are bladder infections. Additionally, one in four women will be likely to have a recurrence.
We can blame our anatomy for making us more likely to get bladder infections. We have a shorter urethra, which means bacteria have a shorter distance to travel. Men’s urethras are at least 10 cm while ours is only 4 cm. The opening to the urethra is also closer to the rectum in women, and that’s where bacteria live.

Presdisposed
Some people tend to get these infections more than others. It can be a matter of the bacteria itself, so if someone is colonized with bacteria that has a receptor that binds tightly to the bladder mucosa, UTIs become more common, says Dr. Lisa Hawes, a urologist who specializes in women’s urologic care and is a consultant for the AUA on female pelvic health. She says incomplete emptying as well as constipation also increases the risk.
Post-menopausal women often get UTIs because of the change in vaginal flora coupled with the loss of hormones – in other words, less estrogen, says Dr. Hawes. New birth control pills – which cause a change in hormone levels – can also result in a UTI.
Other anatomical reasons for being plagued with UTIs are possible (stones, prolapse, incontinence), says Dr. Aisha Taylor, urologist in the Department of Urology at Magee-Womens Hospital and assistant professor of female urology at the University of Pittsburgh. A specialist can address these causes. Genetic risks are still being studied.

The NIDDK says you’re more likely to develop a bladder infection if you:

• Are sexually active
• Have gone through menopause
• Use certain types of birth control, like diaphragms or spermicide
• Have trouble emptying your bladder completely
• Have a problem in your urinary tract that blocks or obstructs the normal flow of urine (kidney stone)
• Have diabetes or problems with your body’s immune system
• Recently used a urinary catheter
• Had a UTI in the past.
  
  Minimizing re/occurrence
  If infections in the lower urinary tract (like bladder infections) aren’t treated, they can lead to kidney infections. A bladder infection during pregnancy is more likely to become a kidney infection, which is why pregnant women are routinely tested for bacteria in the urine.
  People often talk about avoiding tight underwear or clothing because they can lead to UTIs. This is another common misconception, as this has never been proven. What does help, however, is the following, according to Dr. Hawes and Dr. Taylor:
  
• Drinking lots of fluid (especially water)
• Voiding regularly without holding too long
• Avoiding constipation (sometimes Miralax is needed)
• Voiding within 30 minutes after intercourse
• Dietary cranberry supplementation

Treatment
The most likely treatment is antibiotics, but it depends on the diagnosis. The NIDDK says that researchers are studying ways to treat or prevent bladder infections without antibiotics, because the bacteria that cause these infections can become stronger and harder to fight when antibiotics are taken repeatedly. Alternate approaches can include probiotics, vaginal estrogen, and “watchful waiting.”
Recent research led by Dr. Stefan Heytens from the University of Ghent, Belgium, published in Clinical Microbiology and Infection has found that the majority of women who had UTI symptoms probably did have a bacterial infection, even when nothing was detected through standard urine testing. A more sensitive test was able to pick this up. The consequence is that testing might be unnecessary for women with symptoms of an uncomplicated UTI. It’s not yet determined whether all women with these symptoms would benefit from antibiotics.

Dr. Hawes has seen this data and says there’s a company she knows of that advertises a urine test they claim is better than a culture, similar to the test in the study. She’s used it before, but has found many glaring inconsistencies in the results. “Although there may be something to this concept, the tests available at this time are not helpful in my opinion,” she says. “Perhaps the test will be better refined with time.”

Dr. Taylor wasn’t surprised by the study either, but says the finding doesn’t contradict her approach. “We treat symptoms and await culture results (OTC medication or prescription strength medication),” she says. “By the time culture results are back, women feel better with this approach.” She looks forward to more sensitive tests to aid in UTI diagnoses.


In the meantime, evidence shows that treating the symptoms of frequency, urgency, and painful urination with a urinary analgesic and waiting for culture data to be available has the same microbiologic outcomes as treating with just antibiotics, says Dr. Taylor. “In fact, this strategy addresses patients’ symptoms sooner and better than antibiotics alone,” she adds.


Often missed with patients is a chronic nonbacterial cystitis, which can be misdiagnosed as a UTI and treated as such, says Dr. Hawes. They have UTI symptoms with a negative culture. This inflammation of the bladder can be improved with proper treatment, not antibiotics. “The take-home message here is that if you feel like you have a UTI and you seek treatment, ask the treating physician to send a culture!” says Dr. Hawes. “This ensures a bacteria is present [if it is in fact a UTI, and] an antibiotic is necessary.”