Urinary Tract Infections in Women
Urinary tract infections are a common and distressing complaint in women. Most women would have suffered from at least one episode of urinary infection; many will continue to suffer from many repetitive episodes of UTI. This article reviews the causes, and management of UTI.
Before we proceed to examine the causes we will look at the anatomy of the female uro-genital system. The urinary system consists of the kidneys, ureters, bladder and urethra. The anatomy is similar in both men and women till the bladder, but from the bladder onwards, the uro-genital system attains different characteristics in the female that predispose to UTI. Firstly the female urethra is only 2.5 cm long compared to 4 cm in men. This allows easy access of the bacteria to the bladder. Secondly the urethra opens in the vagina, and hence is easily injured during sexual activity. These injuries allow bacteria to invade deeper tissues due to the breach in protective epithelium of urethra and bladder. Thirdly the vitality and strength of the tissues supporting the urethra, bladder and vagina are estrogen dependent. After menopause the hormonal stimulus is lost and these tissues shrink and devitalise leading to repeated infections. And lastly the female urethra is in close proximity to the anal canal; hence gastrointestinal bacteria can gain access quickly.
There are many factors predisposing to UTI. As mentioned in the afore paragraph, female sex is one important predisposition. Others include any form of obstruction due to stones, strictures etc, menopause, immune-suppression, diabetes, urinary tract abnormalities and sexually transmitted infections.
UTI is most commonly caused by the gut bacteria E.Coli. It is the most commonly isolated bacteria in cases of uncomplicated UTI. Other organisms that can cause UTI include Chalamydia, Gonococci, Herpes Virus, and Proteus.
UTI is classified in to upper and lower UTI. Upper UTI in women will refer to any infection in the kidneys or the ureters. Lower UTI refers to infection of the bladder and urethra. It is the lower UTI which is very common in women; the incidence of upper UTI is almost similar in both men and women.
Lower UTI most commonly presents with painful burning micturation. Women might have a constant urge to urinate and may pass small amount o f urine at frequent intervals. The urine may have a cloudy appearance which implies infection. A red or pink or cola coloured urine is inactive of blood in urine. Other than these, women may also suffer from deep pelvic pain and fever.
Upper UTI typically presents in a sudden fashion with shaking chills and rigors. High temperatures are typical and women may complain of flank pain and pain while urinating. Urine is similarly cloudy or cola coloured.
Normal UTI are innocuous and should clear up in a few days. Drinking lots of water and use solutions that alkalise urine are helpful. However if the symptoms become to bothersome or are impairing your quality of life you should consider seeing a doctor.
Before you see your doctor, make a list of all your complaints, this way you will not forget anything there. Also make a list of all your doubts and question you would like answered. You should also inform your doctor about any drugs you are currently using and any other diseases you suffer from.
During the consultation the doctor likely to ask a few questions about your problem like how frequently do you suffer, how long each episode lasts, any relation to sexual activity, any fevers, any blood or pus in urine and so on?
He will then perform a physical exam and order some tests. When you go with complaints of UTI you may expect to give a urine sample. Urine sample is usually collected in a wide mouth container (will be available with your doctor’s office). Before you collect urine in the container, wash the area around the urethra with just plain water. Then start urination and wait for few seconds. Then collect the sample for dew seconds and discard the rest. You should try to collect the urine in mid stream. Once collected give it to your lab immediately so that it can be processed without delay.
The urine collected by this method is subjected to culture and a microscopic and chemical examination. Culture is done to grow the offending organism and is usually positive in 24-72 hours. Chemical and microscopic exam involve looking for nitrates, crystals, blood and pus cells in urine.
In uncomplicated lower UTI, there is no necessity for imaging of the urinary tract. However in cases of upper UTI and complicated UTI’s your doctor may want to look at your urinary system by means of a ultrasound or CT scan. In some rare cases your doctor will look inside your bladder through a flexible scope.
Treatment of uncomplicated UTI is simple but marred by frequent relapses. UTI are commonly treated using antibiotics. Most doctors will prescribe an antibiotic for 3-5 days. Commonly prescribed antibiotics include sulphamethaxazole-trimethoprim, ampicillin, ampicillin-clavulanate, doxycycline and ciprofloxacin. Your symptoms should clear up within a few days of antibiotics.
Women who suffer from UTI after sex can be advised to take antibiotics after sexual intercourse. Post-menopausal women may benefit from local application of estrogen creams.
Cranberry juice has been proven to reduce symptoms in women who have frequent episodes of UTI, but conclusive proof is lacking. There is little harm in consuming cranberry juice if you like it. Also ensure to drink plenty of water and avoid drinks like alcohol and sodas, also avoid any caffeinated products. You can apply a warm water bottle to your lower abdomen to relieve bladder pain and irritation.
There are some general lifestyle measures that are known to help. While urinating or after bowel movements, wipe from front to back, this will prevent gut bacteria from gaining access to urethra. Avoid using deodorants and vaginal douches. Drink plenty of water. Also pass urine before and after sex. Following this measure will help you a great extant in controlling recurrences of UTI.