Prevention tips and treatment do's and dont's for these uncomfortable infections

The ABCs of UTIs
The urinary tract carries liquid waste from the kidneys through the ureters to the bladder then out the urethra. A healthy bladder can hold between 10 and 20 ounces of urine at a time and triggers the urge to urinate when it's about half full.

Urologist Larrian Gillespie, MD, likens the efficiency of the female urinary system to a French bidet, with the urethra positioned to cleanse the perineal area with bacteria-free urine. When bacteria, typically E. coli that has made its way from the rectum, enters the normally sterile urinary tract, three types of infections can result:

  •  Urethritis: an inflammation of the urethra
  •  Cystitis: an inflammation of the bladder (the most common UTI)
  •  Pyelonephritis, or kidney infection: an inflammation of the ureters and the kidneys (the most serious UTI)

Typically, urethritis and cystitis don't pose serious health threats, although they need to be treated with antibiotics because any infection of the ureters and kidneys can lead to severe illness and permanent kidney damage.

Symptoms of UTIs include:

  • Painful, burning urination
  • Constant urge to urinate, even for small amounts of urine
  • Cloudy or foul-smelling urine
  • Back pain*
  •  Fever, chills, nausea*
  • Bloody urine*

These symptoms indicate a possible kidney infection and should be reported to a doctor immediately.

Contributing factors

Experts agree that several key factors contribute to UTIs. They include:

Sex – Many women begin their struggles with UTIs when they become sexually active, hence the term "honeymoon cystitis." While it's natural for some bacteria to make its way into the bladder during intercourse, that doesn't mean that all sexually active women get UTIs, or that any of them have to, says Dr. Gillespie, who wrote You Don't Have to Live with Cystitis. She points out that UTIs result when the bladder is not emptying properly or it becomes overrun with bacteria, which can happen when an ill-fitted diaphragm partially blocks the bladder neck, or when there are abrasions on urethral tissue to which bacteria can adhere. Abrasions can happen when too much spermicide burns the outer edge of the urethra, when sexual positions drag the urethra up and down repeatedly, or when vaginal dryness leads to irritation (as is often the case in menopausal women).

Fluids – Women who don't drink enough fluids are more susceptible to UTIs because their bladder is never full enough to empty completely, says naturopathic doctor Susan Roberts.

Bathroom habits – Women who go to the bathroom infrequently are also more likely to get UTIs because when urine stays in the bladder longer, more bacteria can multiply. Dr. Gillespie encourages patients to go when they feel the need. While she says it's important to urinate after sex, Dr. Gillespie advises women not to run from the bedroom to the bathroom to "piddle." She recommends drinking a glass of water before sex so that afterward, the bladder will be at least half-full, which enables it to empty more efficiently. For good hygiene, women are also encouraged to wipe from front to back to avoid the spread of bacteria.

Lower back pain – This common cause of UTIs isn't often discussed, says Dr. Gillespie. The pain—after wearing high heels, exercising improperly, during pregnancy or other types of physical stress—adds pressure on the bladder that can keep it from emptying completely.

 Other irritants – Snug-fitting jeans, underwear and pantyhose with nylon crotches and other apparel that continually rub against the perineum and labia cause abrasions on the tender tissue where bacteria can latch on, says Dr. Gillespie. In addition, leaving tampons in while urinating can partially obstruct the bladder neck, and sanitary pads are great breeding grounds for bacteria. Dr. Gillespie advises women to change pads regularly and remove tampons with every trip to the bathroom.

Treatment dos and don'ts

Following basic guidelines can help shorten UTIs and lessen their discomfort.

Get relief : To ease pain and burning, doctors often prescribe pyridium, an anesthetic for the bladder that turns urine bright orange. Now over-the-counter brands like Uristat and Axo that contain pyridium provide the same fast relief. Still, Roberts warns that women who use these medications to mask symptoms without treatment can quickly develop a kidney infection.

Get cultured: Though many doctors now prescribe antibiotics without seeing women with recurrent UTIs, Drs. Gillespie and Roberts stress the importance of taking "clean" urine samples to ascertain what, if any, bacteria is present. Dr. Gillespie thinks that any woman who suffers from recurrent UTIs should be able to test her urine at home with nitrate sticks, which can detect most bacterial causes. Problems result when women automatically treat UTI symptoms with antibiotics, says Dr. Gillespie. "Antibiotics may actually damage your bladder and exacerbate the symptoms of cystitis," she writes. Jong Choe, MD, who specializes in female urology at the University of Cincinnati School of Medicine, points to recent studies that have shown that E. coli bacteria in particular is growing resistant to some broad-spectrum antibiotics that are often prescribed to treat UTIs. "I think we're using more antibiotics than necessary," Choe says. He cautions that empirical use of antibiotics will only breed more resistance and offer less relief to patients. Any woman who suffers five or more UTIs per year needs a complete urologic evaluation to see if she has any other physical problems, says Choe.

Drink up: At the first sign of a UTI, experts advise women to drink plenty of water to dilute the bacteria in the bladder. This not only eases some of the discomfort, it fills the bladder, which can then empty more completely. While acid in cranberries has been proven to keep E. coli bacteria from attaching to the bladder lining, it doesn't kill the bacteria that means cranberries are good for prevention, but not treatment, says Dr. Gillespie. In fact, she discourages women from eating or drinking any acidic food products during UTIs because they could intensify the already high acid level in the bladder.

Take your medicine: For uncomplicated bacterial UTIs, most doctors prescribe three days of antibiotics. Kidney infections may require longer-term antibiotic use, as do cases that quickly recur. For women who experience UTIs after intercourse, Choe sometimes recommends prophylactic antibiotics for before and/or after sex. Staying the course with treatment can help keep future infections at bay.

Taking control
Dr. Gillespie advises patients to examine the possible UTI triggers in their lives and work to minimize their impact by changing contraceptives, habits or diet. She maintains that UTI sufferers need not see themselves as victims.

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