The pain of being a woman
Most of you will know what a urinary tract infection (or UTI) is – if you’re female, at least 50 per cent of you will have had one or more during your lifetime, and if you’re lucky enough to have escaped thus far without one, you have probably heard your friends bemoaning their symptoms – running to and from the toilet to pee, and burning pain are not fun at all.
UTIs are common, and much more so if you are female, pregnant, sexually active, menopausal, have an underlying bladder or kidney problem, or an impaired immune system.
They are caused by bacteria getting into the urinary tract – the area that starts with the tube to the outside known as the urethra, and leads up to the bladder and then on to the kidneys.
The bacteria that cause most UTIs normally live in the gut and around the anus. In general, they don’t cause infection in the gut, but if they travel into the urinary tract via the urethra (through wiping after going to the toilet, for example) the bacteria thrive and multiply, creating symptomatic infection.
Symptoms that might suggest a UTI include:
Pain on passing urine (often described as burning)
Needing to pass urine very frequently
Only passing small amounts when you do go ‘‘Urgency’’, so the need to go ‘‘right now’’ to the toilet, but then often needing to go again a few minutes later
Blood in your urine (known as haematuria) Cloudy or smelly urine (though without any other symptoms, this can actually be a normal thing for some people)
Pain in your lower abdomen or lower back
For elderly people sometimes the only symptom can be confusion, so it is important to consider this as an underlying cause.
If your symptoms include fever, nausea, vomiting, rigors (shaking and shivering, and feeling very hot or cold), or severe back pain, it is possible the infection has travelled to your kidneys, which is much more serious and requires urgent medical care.
Although these symptoms are all typical for a UTI, they can be caused by other things as well so it’s important to get them checked out and know exactly what is going on for you.
Viruses and yeasts such as candida, chlamydia or herpes can cause similar symptoms, but require quite different treatment.
Some people will suffer from a condition known as interstitial cystitis which can give pain and discomfort, but without any infection at all.
And for men, sometimes these symptoms can be a warning sign of an enlarged prostate, rather than a UTI.
A smaller number of people will get recurrent urinary tract infections which can impact on their lives. This may be due to an inadequately treated primary infection – for example, using antibiotics that aren’t ‘‘sensitive’’ enough to get rid of the bacteria so the initial infection comes back – or could be due to an underlying problem such as kidney stones or scarring in the tubes (ureters) or kidneys that feed into the bladder.
If you get three or more UTIs in a few months, it is a good idea to get some testing done to figure out why this might be happening.
If your symptoms include fever, nausea, vomiting, rigors, or severe back pain, it is possible the infection has travelled to your kidneys, which is much more serious.
Testing for a UTI is pretty simple – a doctor or nurse can ‘‘dipstick’’ your urine, which will indicate whether or not infection is likely to be present.
Often this will be enough to initiate treatment, providing you aren’t unwell in any other way.
A fresh urine sample is important to give the best result, and should ideally be ‘‘mid stream’’, which means letting the first part of your urine go into the toilet before collecting the next bit.
This hopefully avoids getting too many bugs from your skin into the sample.
If there is anything complicated about your symptoms (for example, you are getting recurrent problems, are elderly or have allergies to certain antibiotics), your doctor will likely suggest sending your sample to the lab so they can find out exactly what bacteria is causing the problem, and recommend a specific antibiotic that will work.
For more complex cases, your doctor may suggest blood tests and ultrasound scans to check the kidneys and urinary tract are looking and functioning as they should.
For anyone with a recent change in sexual partner, or any risk of sexually transmitted infection, a sexual health check should also be done to rule out that as a cause of your symptoms.
Treating UTIs is usually straightforward:
Go to a health provider
This is important, even if you have had UTIs before and think it will go away on its own. The majority of UTIs require treatment with antibiotics, and if left alone there is a risk the infection will spread to the kidneys – this is called pyelonephritis and is far more serious, requiring treatment with high dose antibiotics and often hospital admission. The earlier you catch your UTI, the less likely this is to happen.
Drink plenty of fluids
Being dehydrated makes you more likely to get a UTI. Having plenty of fluid on board will do the reverse, and will ‘‘flush through’’ the kidney system. Some people find cranberry juice helpful, and for others a mixture of salts called Ural is useful at alleviating symptoms, but there is no scientific evidence that either is sufficient on their own to get rid of an infection.
Take your antibiotics as recommended
Your doctor will give you the most appropriate antibiotic for your age and stage of life, and can change the dose or drug choice if your symptoms aren’t resolving quickly. Make sure you finish the full course, and go back for more testing if your symptoms either don’t settle or come back again.
If you are getting UTIs associated with either the menopause or sex, talk to your doctor about things you can try.
A course of low dose preventative antibiotics can help avoid recurrent infection, and using some topical oestrogen if you are menopausal can make the genital tissues less fragile and prone to infection.