Everything You Wanted to Know About Urinary Tract Infections, but Were too Afraid to Ask

1. What are common causes of UTIs? 

Intercourse, post-menopausal vaginal atrophy, kidney stones, sexually transmitted diseases, proximity to anus/GI tract for the most common bacterial cause, E. coli (wiping back to front, thongs, incontinence)

2. Are some people more prone to UTIs than others? If so, what are some risk factors? 

Sexually active women are more prone to UTIs, as are post-menopausal women due to vaginal tissue atrophy. Pregnant women are more prone to UTIs. Women with diabetes and other immune compromised states, vesicourethral reflux (condition that causes reflux of urine from the bladder into the ureter, then into the kidney), Multiple Sclerosis, spinal cord injuries and other neurological syndromes that cause bladder dysfunction, kidney stones or other blockages in the urinary tract can also be causes of UTIs. 

3. What steps can you take to help prevent a UTI from occurring in the first place?

Urinate and clean the genital area before and after intercourse (no cuddling right after intercourse until the bladder is emptied), empty the bladder frequently throughout the day, drink plenty of water to flush the kidneys and avoid urinary tract stones, wipe from front to back, wear cotton underwear, change incontinence pads or underwear when soiled, avoid anything that irritates the bladder and genital area (bubble baths, diaphragms, unlubricated condoms, perfumed feminine hygiene products and douching), shower instead of taking baths. Sometimes a low dose antibiotic is necessary when frequently recurring UTIs occur.

4. What are some of the earliest signs you might have an UTI? 

Needing to urinate more frequently than normal, getting up in the middle of the night to urinate when you usually don’t need to do so, pressure in the lower abdomen, bladder spasms, pain when urinating.

5. What about any other signs/symptoms? 

Fever, nausea and/or vomiting, and flank pain can be signs of a kidney infection, which is more serious since the kidneys filter the blood and can lead to urosepsis (bacteria in the blood from a kidney infection).

6. What should you do when you think or know you have an UTI? 

There are over-the-counter tests you can use to check if you have an infection. If this is positive, you should seek treatment from your physician, or you can seek medical attention at the first signs of infection and your physician will test your urine in the office. If you get frequent infections, it is advised that your urine is cultured to check for antibiotic resistant bacteria. Taking cranberry juice or a cranberry capsule does not cure a urinary tract infection. Similarly, taking AZO over-the-counter also does not cure an infection, but it can reduce the pain and bladder spasms associated with an infection.

7. What are common treatments? 

Antibiotic medication is the usual treatment for a bacterial urinary tract infection. AZO, pyridium or ibuprofen can be used to reduce pain. You should ensure plenty of water intake when you have an UTI to help flush the bacteria from the urinary tract. It is also necessary to complete the entire course of antibiotic to avoid creating antibiotic-resistant bacteria.

8. Do you always have to see a doctor, or can you identify and treat an UTI at home? 

There are kits you can purchase for home use to determine if there is an infection in the urinary tract; however, if your test is positive, you will most likely require an antibiotic. If you have a good relationship with your physician, you may receive an antibiotic, such as nitrofurantoin or trimethoprim/sulfamethoxazole.  In a randomized controlled study in 2015, some women with early, mild urinary tract infections were treated with ibuprofen and they recovered without antibiotic use. This is not advised if symptoms are moderate to severe or include fever and/or flank pain.

9. What treatments/steps should you avoid when you have an UTI? 

There is a lack of evidence that the tannin in cranberry juice is effective in preventing or treating urinary tract infections. Using a vaginal douche or taking baths with fragranced products should also be avoided.

10. What happens if you wait too long to go to the doctor or treat an UTI?  What are some possible consequences? 

The greatest risk of an untreated urinary tract infection is the infection spreading to the kidneys.  When a urinary tract infection involves the kidney, this is called pyelonephritis. This can be a very serious infection, requiring hospitalization and IV antibiotics when it has advanced to include systemic symptoms (such as fever, nausea, vomiting, weakness).

11. Anything else we should know? 

When there is a pattern of UTIs following intercourse, a treatment strategy can include taking one dose of antibiotic following intercourse to avoid an UTI.

In the elderly population, it is not uncommon for urinary incontinence to be the first sign of infection. Many elderly patients are also vulnerable to urosepsis, which may cause the patient to have not only urinary incontinence, but may also include difficulty in walking and delirium. Any evaluation of a fast change in an elderly patient’s mental status should include a urinalysis (urine dip test) to check for infection.

Young children should not have urinary tract infections and sometimes this is a sign there may be a structural or functional problem in the urinary tract. More than one UTI in a young child or infant usually triggers additional testing.