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Urinary Tract Infections (UTIs)
Urinary Tract Infections are one of our most frequent topics 'round these parts!
A Urinary Tract Infection (UTI) is, not surprisingly, an infection of the urinary tract; it can include any infection from the kidneys, the urethra, ureters or the bladder.
Read on for useful information about recognizing and defeating the beast that is the UTI.
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What is a UTI and how do you get one?
What exactly is the urinary tract, you ask? Please see this diagram of the urinary tract in both men and women.
The New Our Bodies, Ourselves (OBOS) tells us that: Urinary tract infections (UTIs) are so common that most of us get at least one at some point in our lives. They are usually caused by bacteria such as Escherichia coli, which travel form the colon to the urethra and bladder (and occasionally to the kidneys). Though UTIs are not themselves sexually transmitted infections, trichomoniasis and chlamydia can also cause UTIs; low resistance, poor diet, stress and damage to the urethra from childbirth, surgery, catheterization, and so on can predispose you to getting them.
Often a sudden increase in sexual activity triggers symptoms ("honeymoon cystitis"). While this "sexual activity" is very often PIV sex, it can be anything that involves friction in the vulvovaginal area and might push bacteria into the urethra. This would include oral sex, manual stimulation (your own fingers or a partner's), and toy play.
Pregnant women are especially susceptible (pressure of the growing fetus keeps some urine in the bladder and ureters, allowing bacteria to grow), as are postmenopausal women (because of hormonal changes). Very occasionally, a UTI is caused by an anatomical abnormality or a prolapsed (fallen) urethra or bladder, most common in older women or women who have had many children.
Cystitis (inflammation or infection of the bladder) is by far the most common UTI in women. While the symptoms can be frightening, cystitis in itself is not usually serious. If you suddenly have to urinate every few minutes and it burns like crazy even though almost nothing comes out, you probably have cystitis. There may also be blood in the urine (hematuria) and pus in the urine (pyuria). You may have pain just above your pubic bone and sometimes there is a peculiar, heavy urine odor when you first urinate in the morning.
It is also possible to get mild temporary symptoms (such as urinary frequency) without actually having an infection, simply because of drinking too much coffee or tea (which are diuretics), premenstrual syndrome, food allergies, anxiety, or irritation to the area from bubble baths, soaps or douches. As long as you are in good health and not pregnant, you can usually treat mild symptoms yourself for twenty-four hours before consulting a practitioner. Cystitis often disappears without treatment. If it persists more than forty-eight hours, recurs frequently or is ever accompanied by chills, fever, vomiting or pain in the kidneys, consult a practitioner . These symptoms suggest that infection has spread to the kidneys (pyelonephritis), a serious problem that requires medical treatment. Some researchers estimate that 30 to 50 percent of women with cystitis symptoms also have silent kidney infections. Consult your practitioner if cystitis symptoms are accompanied by any of the following: blood or pus in the urine, pain on urination during pregnancy, diabetes or chronic illness, a history of kidney infection or diseases or abnormalities of the urinary tract. Untreated chronic infections can lead to serous complications, such as high blood pressure or premature births (if they occur during pregnancy).
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What are the symptoms?
Many doctors recommend that you get diagnosed by a health care provider the first time so that you'll know what you're looking for next time and don't repeatedly misdiagnose yourself (thus potentially making things worse). The Mayo Clinic tells us that "not everyone with a UTI develops recognizable signs and symptoms, but most people have some." They can include:
- A strong, persistent urge to urinate
- A burning sensation when urinating
- Passing frequent, small amounts of urine
- Blood in the urine (hematuria) or cloudy, strong-smelling urine
The Mayo Clinic also notes that "each type of UTI may result in more specific signs and symptoms, depending on which part of your urinary tract is infected." Here are the various types of infections and their typical symptoms:
- Acute pyelonephritis. Infection of your kidneys may occur after spreading from an infection in your bladder. Kidney infection can cause flank pain, high fever, shaking chills, and nausea or vomiting.
- Cystitis. Inflammation or infection of your bladder may result in pressure in the pelvis and lower abdomen and strong-smelling urine.
- Urethritis. Inflammation or infection of the urethra leads to burning with urination and sometimes pus in your urine. In men, urethritis may cause penile discharge.
It is important to have a UTI diagnosed by a health care professional as UTIs are generally treated with antibiotics. Your health care provider will test for a UTI by asking you to provide a clean catch or clean voided urine sample. This is done by cleaning the area first (usually with a prepackaged wipe), urinating a little bit (this prevents any bacteria that may be present in the genital area from contaminating the sample), and then collecting a urine sample using a sterile cup. The urine sample will be examined for evidence of blood, pus (or white blood cells), and possibly for presence of other elements (like ketones or protein). The sample may also then be cultured and examined microscopically in a laboratory to see exactly what kind of bacteria are present in your urine. All these things help your doctor to know what kind of antibiotic is best for you.
UTIs can be dangerous if left untreated. The National Kidney and Urologic Diseases Information Clearinghouse says that you should see your doctor right away if you have any of these signs or symptoms:
- pain in your back or lower abdomen
- cloudy, dark, bloody, or unusual-smelling urine
- fever or chills
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How do I treat it?
There are essentially three ways to treat a UTI:
1. Prescription treatment from a doctor
Many argue this is the only way to cure the infection, although OTC and at-home methods can alleviate some symptoms) and OBOS tells us:
- For symptoms that are severe or indicate a kidney infection, medications are usually started immediately. For milder infections, many practitioners prefer to wait for culture results before prescribing a drug.
- Most UTIs respond rapidly to a variety of antibiotics. Drugs commonly used include antibiotics such as ampicillin, nitrofurantoin tetracycline or sulfonamides (see Hereditary and Other Types of Anemia, p. 608.) The medication may be given in a single large dose or may be spread out over three to ten days. If symptoms persist for more than two days after you start taking drugs, see your practitioner again.
- Antibiotics often cause diarrhea and vaginal yeast infections. Eating plain yogurt or taking acidophilus in capsules, liquid or granule form helps to prevent this diarrhea by replacing the normal bacteria in your intestines killed by the drugs. See pp. 604-7 for information on preventing and relieving vaginal infections; you can also click here to read more.
- For pain with UTIs, there is a prescription drug called Pyridium, a local anesthetic that relieves pain but does not treat the infection itself. It dyes the urine a bright orange, which will permanently stain clothing. Pyridium can cause nausea, dizziness and possibly allergic reactions. Self-help remedies are probably better.
- Have a follow-up urine exam when you finish taking the drugs (a culture if you have repeated UTIs) to be certain the organism is gone.
2. Non-prescription or over-the-counter (OTC) remedies such as AZO, etc.
It is possible to find the urinary analgesic phenazopyridine hydrochloride in over-the-counter products such as Uristat or AZO Standard at your local drugstore. While these products can alleviate the symptoms associated with UTIs, they do not treat the infection itself; if you have a UTI, it's still recommended that you seek professional medical attention in order to clear the infection from your system. Additionally, taking one of these products can discolor the urine so that it's bright or dark orange (a totally normal side effect of the medication) and can impede the accuracy of some diagnostic testing.
3. Natural, at-home methods
This is for mild infections only; please see your doctor if you are in serious pain or if you are experiencing recurring infections. If left untreated too long, UTIs can become extremely dangerous to one's health.
Many women choose non-medical methods for treating UTIS, because the cost of OTC methods are high, because they are unimpressed with OTC methods or simply because they prefer more natural methods. The following is a partial list of some 'at home' methods that may be helpful:
- Drink lots of fluid every day. Try to drink a glass of water every two or three hours. (For an active infection, drink enough to pour out a good stream of urine every hour. It really helps!)
- Urinate frequently and try to empty your bladder completely each time. Never try to hold your urine once your bladder feels full.
- Keep the bacteria in your bowels and anus away from your urethra by wiping yourself from front to back after urinating or having a bowel movement. Wash your genitals from front to back with plain water or very mild soap at least once a day.
- Though UTIs are not sexually transmitted diseases, any sexual activity that irritates the urethra puts pressure on the bladder or spreads bacteria from the anus to the vagina or urethra can contribute to cystitis. Make sure that you and your lover have clean hands and genitals before sex and wash after contact with the anal area before touching the vagina or urethra. To prevent irritation to the urethra, try to avoid prolonged direct clitoral stimulation and pressure on the urethral area during oral-genital sex or masturbation. Make sure your vagina is well lubricated before intercourse. Rear-entry positions and prolonged vigorous intercourse tend to put additional stress on the urethra and bladder. Emptying your bladder before and immediately after sex is a good idea. If you tend to get cystitis after sex despite these precautions, you may want to ask your practitioner for preventive tables (i.e., sulfa, ampicillin, notrofurantoin); a single dose of a tablet after sex has been shown effective in preventing infections and is usually not associated with the same negative effects as prolonged courses of antibiotics.
- Some birth control methods can contribute to or aggravate a UTI. Women taking oral contraceptives have a higher rate of cystitis than those not on the Pill. Some diaphragm users find that the rim pressing against the urethra can contribute to infection. (A different-sized diaphragm or one with a different type of rim may solve this problem.) Contraceptive foams or vaginal suppositories may irritate the urethra, or the dyes or lubricants may cause irritation.
- If you use sanitary napkins during your period, the blood on the pad provides a convenient bridge for bacteria from your anus to travel to your urethra . Change pads frequently and wash your genitals twice a day when you are menstruating . Some women also find that tampons or sponges put pressure on the urethra.
- Tight jeans, bicycling or horseback riding may cause trauma to the urethra. When you engage in sports that can provoke cystitis in you, wear loose clothing and try to drink extra water.
- Caffeine and alcohol irritate the bladder. If you don't want to stop using them, try to drink less of them and drink enough water to dilute them.
- Women use a wide variety of herbal remedies to prevent or treat UTIs. Drinking teas made of uva ursi, horsetail or shavegrass, barberry, echinacea, cornsilk, cleavers, lemon balm or goldenseal may be beneficial to the bladder. You may want to consult an herbalist.
- Vitamin B6 and magnesium-calcium supplements help to relieve spasm of the urethra that can predispose to cystitis . This is especially helpful for women who need to have their urethras dilated repeatedly.
- For temporary relief, try putting a hot water bottle or heating pad on your abdomen and back.
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Can men get UTIs too?
Yes! The National Kidney and Urologic Diseases Information Clearinghouse and the Men's health website note that even though urinary infections in men—especially boys and young men—are less common than in women, it is still important to recognize the symptoms and get treatment quickly. Infections of the urinary system (the kidneys, ureters, bladder and urethra) can be very serious—even life threatening. Men with abnormalities of the urinary tract, such as kidney stones or an enlarged prostate, are more prone to infection, as are men who have a catheter or tube placed in the bladder. Men with diabetes or any disease that suppresses the immune system are also more prone to UTIs.
The first step is to identify the infecting organism and the drugs to which it is sensitive. Usually, doctors recommend lengthier therapy in men than in women, in part to prevent infections of the prostate gland, although men can also try some of the at-home remedies listed here. Prostate infections (chronic bacterial prostatitis) are harder to cure because antibiotics are unable to penetrate infected prostate tissue effectively. For this reason, men with prostatitis often need long-term treatment with a carefully selected antibiotic. UTIs in older men are frequently associated with acute bacterial prostatitis, which can have serious consequences if not treated urgently.
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Recurring UTIs: Why?
Sometimes UTIs become chronic because of problems with the immune system, damage to part of the urinary system, sexual intercourse (which seems to trigger UTIs in some women), or poor hygiene (such as wiping from back to front after a bowel movement or not changing underwear often). If you experience recurring UTIs, see your doctor for help. S/he might prescribe mild preventative antibiotics or in very serious situations, s/he might even recommend surgery. To improve your odds, see the next section on UTI prevention.
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How do I prevent future UTIs?
OBOS and Prevention tell us that:
- Some women find that routine use of unsweetened cranberry juice, cranberry concentrate supplements or vitamin C to make their urine more acid helps to prevent urinary tract problems . (If you have an infection, try combining 500 milligrams of vitamin C and cranberry juice four times a day; you can substitute a half a cup of fresh cranberries in plain yogurt for the juice.) Whole grains, nuts and many fruits also help to acidify the urine. Avoid strong spices (curry, cayenne, chili, black pepper). You can read more about why cranberry juice is effective in UTI prevention here.
- Diets high in refined sugars and starches (white flour, white rice, pasta, etc.) may predispose some women to urinary tract infections.
- Keep up your resistance by eating and resting well and finding ways to reduce stress in your life as much as possible.
- Avoid using feminine hygiene sprays and scented douches. They also may irritate the urethra.
- Urinate when you feel the need; don't resist the urge to urinate.
- Wipe from front to back to prevent bacteria around the anus from entering the vagina or urethra.
- Take showers instead of tub baths. Use only water (or an extremely gentle and unscented soap) to wash your vulva.
- Cleanse the genital area before sex.
- Use plenty of lubrication during sexual intercourse; insufficient lubrication can aggravate the urethra.
- Always urinate after sex. This helps purge the urethra of UTI-causing bacteria.
- Wear underwear with a cotton crotch.
- Drink plenty of water. Many health care professionals recommend 6 to 8 soda-can sized glasses of fluids--especially water--every day to help flush out the kidneys and wash out germs from the urinary tract.
- Kegel exercises can help prevent future infections.
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Can I have sex while treating a UTI?
Because sex can often aggravate (and cause) UTIs, most health care professionals, including those at the University of Wisconsin-Madison University Health Services, recommend that patients refrain from any sexual activity that can irritate the urethra--this may include manual masturbation and cunnilingus in addition to PIV sex--until the treatment is completely finished.
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Can I treat my UTI while on my period?
Sure. However, as previously mentioned, if you use pads during your period, the blood on the pad provides a convenient bridge for bacteria from your anus to travel to your urethra. Change pads frequently and wash your genitals twice a day when you are menstruating. Some women also find that tampons, menstrual cups and/or sponges put pressure on the urethra, although they may offer fewer opportunities for bacteria to travel to the urethra.
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NOTES AND DISCLAIMERS: This FAQ (and VP) is no substitute for medical care. Much of the information above has been adapted from the indicated sources. Click on the links to see their original text or to get more information. Any non-quoted items come from the VP Team's personal experience, which, again, is no substitute for medical care. As always, there is a limit to the information internet resources can provide; if you require additional assistance, it's best to contact an appropriate professional.