Urinary tract infections are an all-too-common problem for women, afflicting an estimated 26 million American women every year. Urinary tract infections are caused by bacteria growing unchecked in the urinary tract, often by Escherichia coli (abbreviated E. coli), an organism usually found in the intestinal tract.

The seriousness of a urinary tract infection depends on whether it affects only the lower urinary tract or the upper tract as well. The lower urinary tract consists of the bladder, where urine is collected, and the urethra, the tube that carries urine from the bladder to the outside of the body. If the infection affects only the urethra, it is called urethritis; usually any infection that involves the urethra also involves the bladder, in which case it is called cystitis.

The upper urinary tract consists of the ureters (two tubes that carry urine from the kidneys to the bladder) and the kidneys, the organs where urine is made. Infections that travel upward and affect these organs and become systemic are known as pyelonephritis. An untreated infection that spreads to the kidneys can lead to kidney damage, which is serious and even life threatening.

The female urinary tract is not an ideally designed piece of plumbing. First, the opening of the urethra to the outside world is near the opening of the intestinal tract where bacteria thrive abundantly. Second, the female urethra is short, which means that bacteria that get into it can easily travel upstream to the bladder. Men have an extra few inches of urethra, which helps protect them from urinary tract infections.

What puts you at increased risk for a urinary tract infection?

Sexual intercourse, especially increased activity, is one risk factor. Urinary tract infections used to be called honeymoon bladder or bride’s kidney, because women who were having frequent sexual intercourse, perhaps for the first time in their lives, often got these infections. Inadequate lubrication maybe another factor.

Hygiene can be a factor. So can some forms of birth control, including spermicidal foams and jellies or condoms, which may irritate the urethra. Using a diaphragm may predispose a woman to infection; it can press against the urethra, making it more difficult to empty the bladder.

Pregnant women frequently have urinary tract infections, in part because the fetus presses on the bladder and prevents it from emptying completely. The hormonal changes of pregnancy may relax the muscles of the urinary tract, which also allows urine to remain in the bladder or ureters. Women near menopause and postmenopausal women are more likely to get Urinary tract infections than younger women, because the loss of estrogen at this time of life thins out tissues in both the reproductive and urinary tracts, making them vulnerable to irritation and infection.

Figure: In the female urinary tract, infection can spread upward through the ureters and reach the kidneys, causing serious disease

Figure: In the female urinary tract, infection can spread upward through the ureters and reach the kidneys, causing serious disease

Women who have already had one urinary tract infection are likely to have another. Sometimes the repeat infection comes within six months of the first one, sometimes later. Certain sexually transmitted diseases, for example, chlamydia and gonorrhea, that cause inflammation of the urethra can lead to Urinary tract infections. Finally, some women just seem to get them — perhaps because they are genetically at risk.

Can physical or anatomical conditions cause urinary tract infections?

Although most urinary tract infections are caused by bacteria getting into the urethra, a few physical conditions can contribute to infection or cause symptoms similar to those of Urinary tract infections. Kidney stones, which are deposits of calcium, can block the flow of urine and cause infection. Another cause of blockage can be a cystocele (a protrusion of the bladder into the vagina), caused by a weakening in the vaginal wall. A diverticulum in the urethra (a pouching out of the wall) can trap bacteria and become a reservoir of infection.

What are the symptoms of a urinary tract infection?

Painful urination — stinging or burning — is the classic symptom. Often women with Urinary tract infections feel an intense urge to urinate frequently, even though there is not much urine in the bladder. The pain may be greatest when the bladder contracts after urinating: it hurts most just as the flow ceases.

What symptoms suggest that a urinary tract infection has spread to the ureters and kidneys?

Sometimes it is difficult to distinguish between upper urinary tract infections and those that involve only the bladder and urethra; the symptoms maybe the same. However, if you have fever, or flank pain (pain in the side of your midback), you might suspect an upper tract infection. Another suspicious sign is frequent or recurrent infection. Nausea and vomiting can also be associated with a kidney infection.

What causes repeat infections?

If the bacteria that caused the original problem were not all killed by antibiotic therapy, they can flourish again once the antibiotics are stopped, causing what seems to be a repeat infection. But sometimes repeat infections are caused by bacteria different from those that caused the first episode.

How long should you wait before calling the doctor if you think you have a urinary tract infection?

Sometimes Urinary tract infections will go away on their own or respond to self-help measures, but if your symptoms continue for more than two days, call your doctor. If you have fever, chills, back pain, or nausea — symptoms of a possible upper tract infection — call your doctor right away If you have recurrent infections, two or three within a year, even though they are not accompanied by fever or back pain, you should be checked out.

If you suspect you have a urinary tract infection, it is reasonable to give your regular physician a call. If the problem is easily cleared up, so much the better. If you have frequent or recurrent urinary tract infections, then you should probably be referred to a urologist, who specializes in urinary tract problems.

How can you prevent urinary tract infections?

First of all, follow your mother’s advice about not “holding” urine; go to the toilet often, whenever you feel the urge (if it is convenient). Wipe yourself from front to back after urinating and especially after a bowel movement so that you do not spread bacteria from the rectum to the urethra. Change sanitary napkins frequently during your period. Every time you have intercourse, be sure to get up and urinate afterward, even though falling asleep may be more comfortable. You want to rinse out the bacteria that are trying to climb up your urethra.

If you are prone to Urinary tract infections, you probably should not wear panty liners all the time. You might not want to use a diaphragm, spermicide, or condoms (provided you and your partner are monogamous and you do not need protection from sexually transmitted diseases). Some women find that avoiding bubble baths and chlorinated hot tubs or swimming pools cuts down on the frequency of Urinary tract infections.

Try to drink plenty of water, as much as eight to ten glasses daily. Don’t wear tight-fitting jeans or all-nylon underwear (which may create an environment that also contributes to vaginitis and yeast infections). Some women find that it helps to cut their intake of coffee, other caffeinated beverages, alcohol, and spicy or highly acidic foods; these may cause bladder irritation. Avoid using perfumed toilet paper, perfumed bath products and powders, or scented soaps, which can be irritating.

Self-Help Methods

Testing for Recurrent Infections

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