URINARY TRACT INFECTIONS: UTIs…WTF…

Sorry for the sweary innuendo, but get real – the non-innuendo version passes through most ladies’ thoughts when facing their first UTI symptoms (or vaginal yeast infection, for that matter).  Maybe ‘every’ time, not just ‘first’ infection, is even more accurate.  And as you’ll read below, UTI (and yeast)-like symptoms can also be the result of non-infectious pelvic floor disorders…so I’ve had plenty of ‘UTI…WTF’ moments of my own.

Woman comes to pelvic floor physical therapy.  Among other things, she says, “Oh, yeah, I always get UTIs.”

Me: “How do you know they are UTIs?”

Woman: “I had a few bad ones, so I recognize the symptoms immediately.  I just call my doctor and get a prescription and I take antibiotics to prevent one whenever I know I’ll be having more sex.”

Me: “So you never have the urine tested to be sure it is an infection?”

Woman: “No, I haven’t done that in years.”

Unfortunately, there’s a loooonnngggg history of women requesting that their providers medicate their ‘infections’ with antibiotics, when in fact, those infections were never actually confirmed by urine sample.”

To explain more about UTIs – causes, treatment, prevention – we are fortunate to have the following post from Sybil Dessie, MD, an Obstetrician/Gynecologist and Urogynecology Fellow at Boston Urogynecology Associates (Mount Auburn Hospital, Cambridge, MA).  I encourage you to read it through and share it, but in the case that you only read the beginning, we’re starting with a few points on self-management and prevention of UTIs.  One more little way we’re challenging women to own their pelvic health.

“There are several habits people practice to help prevent UTIs that do not have any proof to back them up.  These actions can’t hurt so you can try them and see if they help.  But just remember, no one has ever proven that they actually make a difference.  Ie. don’t spend too much time worrying about them.

  • The first is wiping from front to back after going to the bathroom.  Although this intuitively makes sense, there is no data to confirm that bathroom hygiene habits really make a difference.
  • Similarly, many people urinate after having sex to help “flush out” their urinary tract.  Sorry, there is actually no good data to support this.  (Additional SMF note: We know of an expert pelvic health colleague who actually believes that unless post-sex urination is because of a full bladder, that opening up the urethra to pee a small-ish amount may leave women more vulnerable to infection.  For those who insist on the habit anyway, she suggests pouring lukewarm clean water over the perineum instead.)
  • Finally, drinking a lot of fluids may help keep you hydrated (undoubtedly a good thing!) but probably won’t prevent you from getting an infection.

Urinary tract infections are characterized by burning, pain, the need to urinate often and urgently.  UTIs are caused by an invasion of the urinary tract by an organism, usually bacteria, leading to inflammation.  The bacteria E. coli, a normal gut flora, accounts for approximately 85% of UTIs.  It is estimated that up to one third of all women in the US will have experienced a UTI by age 24.  Women are at much higher risk for UTIs than men due to their shorter and straighter urethras (opening to the bladder).  This allows bacteria a straight shot from the area around the rectum and vagina to the bladder.  Sexual activity, use of spermacides, and post-menopausal status has also been shown to be risk factors for UTIs.

UTI symptoms are usually not subtle and generally worsen over time.  The majority of simple infections can be diagnosed based on clinical symptoms and treated with a short course of antibiotics.  Pyridium, an over the counter pain medication for the bladder, can be taken with the antibiotics to help symptoms until the antibiotics start working.  Just note that this medicine causes the urine to have a bright orange color, so do not be alarmed.

If the symptoms do not improve with antibiotic treatment, it is important to obtain further evaluation from your doctor.  There are many reasons why patients may not get better from their initial treatment with antibiotics.  First, if you did not give a urine sample to your doctor and you were just treated based on your symptoms, it is possible that you are infected by bacteria that does not respond to the antibiotics prescribed.  Although the majority of infections are caused by E. coli, there are several strains of E. coli that can infect the urinary tract, and there are other common bacteria that can cause UTIs.  It is also possible that your symptoms may be due to something other than a UTI.  A lot of other pelvic floor/bladder disorders can cause symptoms of urinary frequency and urgency and pain.  It’s important to see your doctor so that he/she can ensure that you are being treated for the correct diagnosis.

If you develop nausea, vomiting, high fever, or back pain this may be a sign of a more serious kidney infection and you should call your doctor right away.  If you are getting many infections (greater than or equal to 3 in a year), you should discuss evaluation and treatment for recurrent UTIs with your doctor.

So remember, UTIs are common and usually easily treated with a short course of antibiotics.  Anything that becomes more complicated than this should warrant an appointment with your doctor to make sure nothing more serious is going on with your body.

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