Urinary tract infections in women

Woman's hand reaching for toilet paper

Photo: Dr. Les Spevack, Urologist at North York General Hospital

A urinary tract infection (UTI) is an infection of the urinary system (kidneys, ureters, bladder and urethra) causing an inflammatory response. The Pulse sat down with Urologist Dr. Les Spevack to discuss the most common UTIs in women — bladder infections. Any person can get a UTI, but women are at greater risk of developing one.

“The bacterial environment of the vagina and shorter urethra are the reason infections are much more common in women,” says Dr. Spevack.

Urologist Dr. Les Spevack, North York General Hospital

NYGH Urologist Dr. Les Spevack

An infection in a woman occurs when bacteria from the intestinal tract replaces the normal bacterial flora of the vagina. The bacteria can then travel through the short urethra to the bladder to cause a bladder infection (cystits) and can further ascend to the kidney to cause a kidney infection (pyelonephritis).

Complicated or uncomplicated UTIs

When a doctor is considering treatment, they will first determine whether the UTI is complicated or uncomplicated. Dr. Spevack explains that an uncomplicated UTI is an infection of the bladder or kidney in the absence of any structural abnormalities of the urinary tract. Complicated UTIs include infections during pregnancy, patients with kidney stones, indwelling (inside the body) catheters, obstruction of kidneys, neurologic diseases affecting bladder function, and recurrent kidney infections.

Some women also suffer from recurrent UTIs, which are defined as two or more symptomatic episodes in six months or three episodes in one year.

Common symptoms

Common symptoms of bladder infections include:

  • urgency to urinate frequently.

  • burning with urination

  • blood in urine

  • cloudy urine

  • pelvic/back pain

  • low grade fever

If the infection makes its way to the kidneys, symptoms may also include:
  • flank pain (discomfort in your upper abdomen or back and sides)

  • high fever

  • chills

  • fatigue


Risk factors

Risk factors specific to women for UTIs include:

  • Menopause — declining levels of estrogen make the vaginal tissues more susceptible to infections

  • Sexual activity — can facilitate the ascension of vaginal bacteria to the bladder

  • Certain types of birth control may put patients at higher risk such as diaphragms and spermicides which can disrupt the normal vaginal bacterial flora

  • Pregnancy

Other risk factors for UTIs include:

  • Suppressed immune system such as from diabetes or other chronic diseases
  • Kidney stones, indwelling catheter, obstruction of kidneys, neurologic diseases affecting bladder function and recurrent kidney infections

Treatment and prevention

Bladder infections are typically diagnosed by history, urinalysis and culture. Antibiotics are usually the first line of treatment. The drug of choice and duration of therapy depend on the clinical picture for that patient. Uncomplicated UTIs can typically be treated with a short course, often of only one to three days. Complicated UTIs require a much longer treatment.

One dose of an antibiotic within two hours of intercourse can be given as a preventive strategy if there is a clear association between sexual activity and infection.

In a patient with recurrent UTIs, taking a daily low dose of antibiotics for 3 to 12 months can be effective.

In some women who are able to recognize their UTI symptoms, an option would be for them to self-treat with a short one- to three-day course of antibiotics at the first sign of infection without getting a urine test.

Asymptomatic bacturia (bacteria in urine without symptoms) typically does not require treatment, exceptions include the patient that is pregnant or suffering from a condition that compromises the immune system.

We've all heard the old wives tale “You have a UTI, drink cranberry juice,” but as Dr. Spevack explains there is conflicting evidence to support this and no clear benefit has been drawn. “Probiotics also show little evidence to date that they aid in treating or preventing UTIs,” he says.

For a patient who experiences menopause, estrogen-topical creams (as opposed to oral estrogen) have shown benefit.

“Other factors that have been looked at in studies including wiping patterns, douching, use of bubble baths, hot tubs have shown no correlation to UTI activity,” explains Dr. Spevack. “However there is some limited data that adequate hydration, urinating after intercourse, avoidance of delaying urination and good personal local hygiene can help prevent bladder infections. As well, limiting the use of prolonged broad spectrum antibiotics and good glucose control in diabetics has also been beneficial.”

If you think you may have a UTI please contact your health care provider.

This article first appeared in the May 2019 issue of The Pulse.

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