Urinary tract infections, or UTIs, are one of the most common problems doctors see in women. According to the National Institute of Diabetes and Digestive and Kidney Diseases, 40 to 60 percent of women will have a UTI at some point in their lifetimes, and one in four women will have an infection that comes back after initial treatment.
But even those high numbers may be under-reported. Many women have UTIs and never talk about them with their doctors. Some may not even realize they have an infection. I often don’t see patients until they’ve had multiple UTIs, when they’ve started missing work and are having trouble dealing with the symptoms.
It’s important to know the facts about UTIs. Let’s discuss who’s at risk for UTIs and symptoms to watch for, as well as myths and tips about UTI prevention.
Listen to Dr. Andrew Sokol discuss UTIs further on this Medical Intel podcast.
What’s a UTI, and who’s at risk?
Anyone can develop a UTI. They’re caused by bacteria, particularly bacteria from the bowel. Women have a higher risk for UTIs than men on average. That’s because, compared to men, the female urethra (the tube through which urine, or pee, passes on its way out of the body) is shorter, which makes it easier for bacteria to enter the urinary tract.
A UTI can involve any part of the urinary tract, which goes from the kidneys through the urethra. The most common form of UTI is a bladder infection. Put another way: All bladder infections are UTIs, but not all UTIs are just bladder infections. Infection could also involve the kidneys.
All bladder infections are #UTIs, but not all UTIs are just bladder infections. via @MedStarWHC
UTIs often are linked to sexual activity, which can spread bacteria from the anus to the vaginal opening, which increases a woman’s risk of developing a UTI.
Younger women tend to have UTIs that are mild or uncomplicated. The risks for UTIs increase as a woman enters menopause, because a lack of estrogen lowers a woman’s defenses against infection in the urinary tract. Older women may have more UTIs that are more likely to come back after being treated. We call these recurrent infections.
Common UTI symptoms and when to see a doctor
No matter where in the urinary tract a UTI develops, the symptoms are similar. Women who have a UTI may experience:
- A burning feeling with urination, called dysuria
- An urgent need to urinate
- Blood in the urine
- Cramping or pain in the pelvis
- Having to urinate more often than normal
Older women may not necessarily experience these symptoms. They may feel fatigued or show changes in their behavior, such as confusion or irritation, instead of having the classic symptoms of a UTI.
Most women are fairly accurate at diagnosing themselves with a UTI, particularly if they have common symptoms. A primary care doctor or gynecologist often can prescribe antibiotics to treat a UTI after an in-office urinalysis (a test of the patient’s urine).
However, UTI symptoms are similar to those of other conditions, including:
That’s why women who have symptoms that don’t go away on their own or that come back repeatedly need to see a urogynecologist like me. A urogynecologist specializes in problems of the female urinary system and pelvic floor. We can determine if these symptoms are due to a UTI or some other condition, such as a physical issue that makes a woman more likely to develop UTIs.
Request an appointment with one of our urogynecologists if you have UTI symptoms that keep coming back.
The most common question I hear from women about UTIs is how to prevent them in the first place. Unfortunately, there are many commonly held beliefs about what women can do to treat or avoid UTIs which are not supported by scientific evidence.
Myths about avoiding UTIs
Some women, and even some doctors, say cranberry juice or tablets can lower a woman’s risk. But recent research indicates that cranberry tablets may not make a difference in a woman’s risk for developing a UTI.
One of the suggestions I hear most often is that women should increase the amount of water they drink to increase how often they have to urinate and flush out any bacteria. That hasn’t been proven to work very well, but the “eight-glasses-of-water-a-day” myth persists despite no scientific evidence supporting its benefits.
Drinking too much water can lead to having to urinate more often, a greater urgency to urinate and other symptoms similar to those of a UTI, making women think they have an infection when their bodies are just getting rid of the excessive fluid they’re drinking. This is especially true in women who consume excessive amounts of caffeine (such as by drinking coffee, tea and soda).
Tips to prevent a UTI
There are many commonly shared strategies for lowering the risk of UTIs. For women who develop UTIs after having sex, I often suggest urinating after sexual intercourse, as well as washing with soap and water afterward. Some women are more likely to develop UTIs if they use certain methods of birth control, including spermicidal jellies, diaphragms or even condoms in some cases. If that’s the case, I may recommend changing the method of birth control a woman uses in addition to urinating after sex and washing with soap and water.
Wiping from front to back whenever going to the bathroom is another important tip. The idea here is to lower the chance of spreading bacteria from the anus to the vaginal opening, where bacteria could enter the urethra. Unfortunately, there isn’t much data on this, but it’s a common-sense strategy for women to try.
If simple behavioral modifications such as cleaning with soap and water and urinating after sex fail, some women are candidates for prophylactic antibiotics—drugs used to prevent an infection, rather than to treat an infection that already exists. If a patient tests positive for two UTIs within six months or three within a year, she may be a candidate for preventative antibiotics which can be taken after sex, daily, or if symptoms develop.
When a woman experiences UTI symptoms, it’s natural for the mind to go to the worst-case scenario. It can be scary to see blood in the urine or feel a burning sensation during urination. But UTIs usually aren’t cause for great concern. And if a woman has symptoms that keep coming back or that don’t get better, seeing a specialist can ease her fears and point her toward the right course of prevention and care.