URINARY TRACT INFECTIONS (UTIs)

URINARY TRACTS INFECTIONS (UTIs)

The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion.

OVERVIEW

Urinary tract infections (UTIs) are infections of any part of your urinary system. Most infections involve the lower urinary tract — the bladder and the urethra (the tube that empties urine from your bladder).

UTIs are more common in women than in men; half of all women will have a UTI at some point during their lives.

Common symptoms include needing to urinate often, pain while urinating, and pain in lower abdomen.

Antibiotics are commonly used to treat UTIs. Drinking more liquids, especially water, can speed recovery and ease symptoms. You can lower your chances of getting a UTI with certain behavioural precautions, like drinking lots of water and washing your hands often, especially before and after using the toilet and before and after sexual activity.

While a UTI can be painful and inconvenient, if it is limited to your urinary system, treatment is fairly straightforward. If, however, it spreads to your kidneys you can develop serious health problems. It is always best to consult a healthcare professional if you experience symptoms of a UTI.

UTIs IN SOUTH AFRICA

South Africa has the highest rate of UTIs among the nine countries making up sub-Saharan Africa. UTIs are a significant health concern here, with some communities reporting 67.7% of women experiencing UTIs. About 50% of South African women will get at least one UTI in their lifetime, while 20 – 40% will have recurrent infections.

Factors contributing to our high UTI rates include poor personal hygiene, a lack of access to clean water, difficulties in accessing healthcare, and underlying health conditions like diabetes and HIV. In South Africa, both diabetes and HIV prevalence is higher in women than in men.

UTI CAUSES

UTIs are caused by bacteria that enter the urinary tract via the urethra and multiply in the bladder. E. coli bacteria cause more than 90% of UTIs, but they can also be caused by certain STIs like herpes, gonorrhoea and chlamydia.

Women are more likely to get a UTI because our urethras are shorter and closer to our anus, where E. coli bacteria are common. It is essential that women wipe from front to back after using the bathroom to lower the risk of this happening.

It is also possible to get a UTI from your fingers. Your hands pick up bacteria and other microorganisms whenever you touch a surface, and these can enter your urethra when you go to the bathroom or during sexual activity. It is always a good idea to wash your hands before and after going to the bathroom or having sex.

UTI RISK FACTORS FOR WOMEN

As well as our physiology – we have a shorter urethra, and the urethra is in closer proximity to the anus, than men – other risk factors for UTIs include:

A previous UTI

Being sexually active (sex can put vaginal bacteria into your urinary tract)

Menopause (causes change in bacteria inside the vagina)

Pregnancy (causes hormone changes in the urinary tract)

Using spermicide (causes a change in bacteria inside the vagina)

Using a diaphragm (inserting it with your hand may add bacteria to your vagina)

Catheters

Anything that affects urine flow, such as kidney stones, a stroke, or a spinal cord injury

Multiple sclerosis

Chronic health conditions like diabetes and HIV

The most common risk factors for recurring UTIs in women who aren’t in menopause are:

Having sex three or more times per week

Spermicide use

New or multiple sex partners

Having a UTI before age 15

UTIs IN MENOPAUSE

UTIs increase after menopause because of the drop in your oestrogen level. Oestrogen raises the levels of healthy bacteria in your vagina and bladder. Lower levels of oestrogen also lower your levels of healthy bacteria, leaving you more prone to bacterial infections.

Vaginal oestrogen creams have been found to be a safe and effective way to manage recurrent UTIs in postmenopausal women. They restore oestrogen levels in the urinary tract and improve vaginal health. Other lifestyle choices that address the symptoms of menopause can reduce the risk of UTIs and improve overall urinary health, like taking probiotics.

UTIs IN PREGNANCY

About 8% of women experience UTIs while pregnant. You’re more at risk if you:

Have a history of previous UTIs

Have diabetes

Have already had a child

Have a low income (a lower socioeconomic status is often linked to poorer nutrition and weakened immunity, making them more susceptible to infections)

It is essential to get treatment if you have a UTI while pregnant. If left untreated, a UTI can raise your risk for a kidney infection, which may result in:

Premature delivery

A low birth weight

Treatment is usually a 3-to-7-day course of antibiotics. However, as not all antibiotics can be taken safely during pregnancy, it is essential that you consult a doctor about your symptoms.

CHRONIC UTIs

Three or more UTIs a year, or two in 6 months, is considered a recurrent urinary tract infection. In most cases, each infection is caused by a different type or strain of bacteria. This requires a treatment plan from a medical professional. Some treatment options include:

A low dose of an antibiotic over a longer period to help prevent repeat infections

A single dose of an antibiotic after sex, which is a common infection trigger

Antibiotics for 1 or 2 days every time symptoms appear

A non-antibiotic prophylaxis treatment like vaginal oestrogen cream in menopausal women

Scientists are also testing a vaccine for preventing recurring UTIs. Unfortunately, it is not yet commercially available in South Africa.

UTI SYMPTOMS

UTIs don’t always cause symptoms. When they do, they may include:

A burning feeling when you urinate

A frequent or intense urge to urinate, even though little comes out when you do

Cloudy, dark, bloody, or strange-smelling urine

Feeling tired or shaky

Pelvic pain — especially in the center of the pelvis and around the area of the pubic bone

If the UTI has spread to your kidneys, you may also get:

Pain or pressure in your back or lower belly

Nausea and vomiting

Fever and chills

It is essential that you seek immediate medical attention if you experience any symptoms of a kidney infection.

UTI TREATMENT

If untreated, a UTI may clear up by itself in a week or so. This happens about 20% of the time, particularly if you start drinking lots of water. However, most UTIs need antibiotics to go away. As there’s a chance that the UTI will travel up to your kidneys if untreated and cause serious problems, it’s far safer to consult your healthcare provider. A course of antibiotics should clear up the infection in 3-5 days.

It is absolutely essential to seek immediate medical treatment if you experience a fever, chills, or nausea and vomiting.

UTI PREVENTION

There are several lifestyle changes you can make to help prevent UTIs:

Practice good hygiene
Good hygiene is one of the most effective ways to help prevent UTIs:

Wipe from front to back after you use the toilet. And don’t wipe back and forth with the same toilet paper.

Wash your hands both before and after using the toilet and having sex.

During your period, change your period products regularly, both pads and tampons.

Wash your genital area with warm water before sex.
Drink plenty of fluids
Empty your bladder often
Urination can play a big role in getting rid of bacteria from your body:

Empty your bladder as soon as you feel the need to urinate.

Don’t force or rush your body – take your time.

Be sure to empty your bladder completely.

Urinate after sex to flush out any bacteria that may have entered your urethra.
Choose showers over baths
Baths allow bacteria from the skin to enter the urethra.

Avoid loofahs and bath sponges, which can retain bacteria even after being washed. Use a washcloth instead.

Wash your urethral area first (when the washcloth is clean) before the rest of your body. Use a single front-to-back swipe.

Use gentle, non-scented liquid soap rather than bar soap.

Stay away from feminine hygiene sprays, scented douches, and scented bath products; they’ll only increase irritation.
Change your birth control
If you use a diaphragm, unlubricated condoms, or spermicidal jelly for birth control, you may want to switch to another method. Diaphragms can increase bacteria growth, while unlubricated condoms and spermicides can irritate your urinary tract. All can make UTI symptoms more likely. Talk to a healthcare provider about other birth control options.

If you use lubricant during sex, make sure it’s water-based.
Change your clothing
Tight-fitting clothing can create a moist environment, which promotes bacterial growth. Keep your genital area dry by wearing cotton underwear and loose-fitting clothes.

Don’t wear tight jeans and nylon underwear; they can trap moisture, creating the perfect environment for bacteria growth.
Medications that may help
If you’re postmenopausal, talk to your healthcare provider about a vaginal cream that contains oestrogen. These creams may help reduce your risk of developing a UTI by changing the pH of your vagina.

Try methenamine hippurate. This prescription drug is not an antibiotic and so can’t treat UTIs. But it can prevent them from returning, as it can stop the growth of bacteria, according to some studies.

Try D-mannose supplements. Studies are not definitive yet, but some show these can prevent UTIs from returning.

Try supplements with cranberry extracts. While the evidence that these can cure a UTI is small, there is some evidence that they can help prevent a recurring one.

Take extra vitamin C to increase your resistance to infections.