UTIs are very common in women and it is estimated that cystitis (bladder infection) will affect at least 30% of women at some time in their life. Untreated urine infections can cause septicaemia (bacteria into the blood), but most of the time they are localized to the bladder and result in irritating and bothersome urinary symptoms including
- passing of small and frequent amounts of urine
- pain on urination which can be severe “like passing razor blades”
- cloudy or smelly urine
- bladder pain
- feeling unwell
If a UTI is suspected, it can be confirmed by urine testing with an MSU (mid-stream specimen of urine). This urine specimen is sent to the laboratory to confirm growth of the bacteria that cause UTIs and also to check the sensitivity of the bacteria to various antibiotics.
Recurrent urinary tract infections
Some women are plagued by frequent urinary tract infections. Overall women are more at risk of UTIs because of their short urethra (tube draining the urine out of the bladder) and proximity of the urethra to the bowel. Individual women’s anatomy may make them more prone to infection as can the ability of the immune system to clear certain bacteria from the urinary tract. While urinary tract infections are rarely life threatening, their impact on a woman’s quality of life cannot be underestimated.
Investigations for recurrent urinary tract infections
Women who suffer from frequent urinary tract infections warrant investigation of their urinary tract to ensure that there are no underlying abnormalities in their urinary tract predisposing them to infection, as well to exclude abnormalities that can mimic infections. These investigations can include X-ray imaging of the urinary tract (particularly the kidneys and bladder) and telescope examination of the urethra and bladder to exclude a range of abnormalities that predispose to urine infection. It is also important to confirm the type of infection with a urine specimen (MSU) at the time of symptoms BEFORE starting any treatment with antibiotics.
Prevention of recurrent urinary tract infections
General measures that a woman can take to help reduce the development of urinary tract infections include:
- Wipe from front to back after bowel movements– this helps reduce pushing bowel bacteria towards the urethra and vagina
- Passing urine after intercourse- which helps flush out any of a woman’s own skin bacteria that may have been pushed into the urethra during intercourse
- Use of lubricant gel with intercourse if the vaginal area is dry
- Avoid the use of spermicidal creams and condoms containing spermicides as these can encourage the growth of bacteria that cause UTIs. Some studies have also shown a greater rate of UTI in women using diaphragms for contraception
- Avoid products that may irritate the urethra such as douches, feminine hygiene sprays and excessive washing with soaps. Recurrent UTIs are not related to hygiene, and in fact overwashing the vaginal area can make problems worse
- Prevention of constipation which is a risk factor for urine infection
- Increased fluid intake at the time of a UTI can help flush out bacteria from the urinary tract
Individualised treatment programmes can be tailored to help in early treatment and prevention of recurrent urinary tract infections once any significant abnormalities of the urinary tract have been excluded. A urologist may recommend different treatment regimes depending on the pattern of infections including:
“Self-start antibiotics”- starting antibiotics at home AFTER taking a urine specimen (MSU) to confirm infection.
Preventive antibiotics- a longer course of low dose antibiotics to help eradicate troublesome urinary tract bacteria which can help break the cycle of recurrent urinary tract infection.
“Post-coital antibiotics”- antibiotics which are used after intercourse in women for whom the trigger for infection is sexual intercourse.
Vaginal oestrogen – in the form of a cream or vaginal pessary (NOT the same as hormone replacement therapy) can help prevent recurrent infections in post-menopausal women where the vaginal tissues are dry and prone to colonization by urinary tract bacteria.