Your risk for UTIs

URINARY tract infections (UTIs) are considered to be the most common bacterial infections in humans and they account for the vast majority of visits to the physician and also a significant number of hospitalisations annually.

According to urologist Dr Gareth Reid, UTIs are so common that a third of women will experience symptoms of a UTI requiring treatment by the age of 24, and about half of all women will experience a UTI during their lifetime. He said most UTIs are caused by bacteria that originate from the bowel as a result of the bacteria E Coli and most enter the urinary tract originating from the anus and perineal area.

“The bacteria E Coli is by far the most common cause of UTIs accounting for 85 per cent of community-acquired and 50 per cent of hospital acquired UTIs. Most bacteria enter the urinary tract originating from the anus and the perineal area (the area between the anus and the vagina) and ascend through the urethra (the tube that transports urine from the bladder to the outside) into the bladder,” Dr Reid said.

He explained that once in the bladder, these bacteria can multiply and if they are able to overwhelm the body’s natural defences, then this can lead to a UTI.

Moreover, the urologist said women are more prone to UTIs because the urethra is much shorter and is closer to the anus and the perineal area than in men, allowing for easier access of bacteria into the urinary tract.

Dr Reid said the causes of UTIs will vary according to the person’s age and any other medical conditions that can affect their ability to mount or fight off any bacteria within the urinary tract.

“Young premenopausal women who are sexually active are at increased risk of developing UTIs, because there is a greater potential of introducing bacteria into the bladder at that time,” he explained.

However, Dr Reid said passing urine after sexual intercourse has been shown to reduce the risk of developing a UTI.

Other causes in the young female, according to Dr Reid, is the use of spermicides or the use of diaphragms for birth control. He further explained that in the post menopausal or elderly female patient, there is also an increased risk of developing a urinary tract infection.

“This is due to a lack of circulating oestrogen, which can lead to a condition known as atrophic vaginitis, where the lining of the vagina becomes very thin and dry. This can lead to increased bacterial adherence to the area and allow for easier access of bacteria into the bladder,” Dr Reid explained.

Dr Reid said other conditions for UTIs include:

1. Any condition that can block the urinary tract such as a kidney stone.

2. Medical conditions that can weaken the immune system such as diabetes or HIV/AIDS, or those who are on chemotherapy.

3. Medical conditions that can cause incomplete bladder emptying (for example spinal cord injury).

4. Urinary tract abnormalities can also predispose to UTIs. This can be seen in babies and infants in whom there is some structural abnormality that affects the drainage of urine from the kidneys, or there is reflux of urine from the bladder back in to the kidneys.

5. The use of a catheter can also increase the risk of an infection. Catheters are used in patients who are unable to pass urine on their own.

Symptoms of a UTI include burning when passing urine, passing urine very frequently, and increased urge to void, lower abdominal cramping and pain, as well as the passage of foul smelling urine or blood in the urine.

Dr Reid added that in the upper urinary tract, patients may experience fever, flank pain and vomiting if the kidney is infected (a condition called a pyelonephritis).

The urologist said urinary tract infections are treated using antibiotics.

He added that historically it has been suggested that reduced fluid intake as well as personal hygiene behaviours, for example wiping from back to front after defecation, douching, and wearing occlusive underwear have been associated with an increased risk for UTI. However, he explained that studies exploring these risk factors have consistently shown a lack of association with recurrent UTIs.

He also said cranberry juice or cranberry tablets has long been discussed as a good prophylactic agent but evidence does not support the claim.

“The theory behind its use is that it contains substances that prevent bacteria from attaching to the cells in the urinary tract, therefore preventing infection. The studies supporting its use have been mixed with regards to its preventative properties and currently the best evidence available suggests that its use does not prevent recurrent UTIs,” he said.

Dr Reid said women with simple, uncomplicated recurrent UTIs, may be prescribed specific antibiotics to prevent an infection, where they are given a low dose of antibiotics for three to six months to prevent the development of an infection.

He said if these recurrent UTIs are associated with sexual intercourse, then a doctor may prescribe antibiotics immediately following sex.