by Elissa Sonnenberg
For women with painful urinary tract infections (UTIs), understanding and avoiding certain activities can lead to a happier and healthier life.
According to the National Kidney Foundation, up to 10 million women a year experience the burning and discomfort of UTIs. Statistics show that once you have a UTI, you are more likely to suffer repeat episodes.
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 10-20 ounces of urine at a time and triggers the urge to urinate when it's about half full.
When bacteriatypically E. colimakes its way from the rectum and 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 generally need to be treated with antibiotics. If left untreated, the infection may spread to the kidney.
Symptoms of UTIs include:
Painful, burning urination
Constant urge to urinate, even for small amounts of urine
Cloudy or foul-smelling urine
Fever, chills, or nausea*
* These symptoms indicate a possible kidney infection and should be reported to a doctor immediately.
Experts agree that several key factors contribute to UTIs. These include:
Many women begin their struggles with UTIs when they become sexually active. According to Dr Gillespie, while it's natural for some bacteria to make their way into the bladder during intercourse, it doesn't have to lead to infection. Dr Gillespie wrote You Don't Have to Live with Cystitis. She points out that UTIs result when the bladder is not emptying properly or 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).
Women who don't drink enough fluids might be more susceptible to UTIs because their bladders are never full enough to empty completely.
Women who go to the bathroom infrequently may also be 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 and can empty more efficiently. Women are also encouraged to wipe from front to back to avoid the spread of bacteria.
Snug-fitting jeans, underwear and pantyhose with nylon crotches, and other apparel that continually rub against the perineum and labia might cause abrasions on the tender tissue where bacteria can latch on, adds Dr Gillespie. Leaving tampons in while urinating could partially obstruct the bladder neck; additionally, 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: What to Do and What to Avoid
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. Roberts warns that women who use these medications to mask symptoms without treatment might develop a kidney infections.
Get cultured: Many doctors now prescribe antibiotics to women with recurrent UTIs without seeing them in the office each time. However, some physicians believe that it is essential to stress the importance of taking "clean" urine samples to ascertain which, if any, bacteria is present. Any woman who suffers five or more UTIs per year needs a complete urologic evaluation to see if she has other physical problems.
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 also fills the bladder, which can then empty more completely. While cranberries contain a substance that appears 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.
Take your medicine:Evidence suggests that for uncomplicated bacterial UTIs three days of antibiotics are generally enough. Cases that quickly recur and kidney infections might require longer-term antibiotic use. Kidney infections are much more serious and may need to be treated with intravenous antibiotics. For women who experience UTIs after intercourse, some doctors recommend using prophylactic antibiotics before or after sex. Staying the course with treatment can help keep future infections at bay.
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.
"It is your body," she writes. "Only you can choose how to live and manage your illness."
National Institute of Diabetes and Digestive and Kidney Disease
National Kidney Foundation
Canadian Family Physician
Canadian Urological Association
Blumberg E, Abrutyn E. Methods for the reduction of urinary tract infection. Curr Opin in Urol. 1997;7:47-51.
Jepson R, Craig J. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD001321.
Katchman EA, Milo G, Paul M, et al. Three-day vs longer duration of antibiotic treatment for cystitis in women: systematic review and meta-analysis. Am J Med. 2005;118:1196-1207.
Miller LG, Tang AW. Treatment of uncomplicated urinary tract infections in an era of increasing antimicrobial resistance. Mayo Clin Proc. 2004;79:1048-1053;
Last reviewed March 2008 by Adrienne Carmack, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.