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UTIs in women: causes, symptoms and prevention
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UTIs in women: causes, symptoms and prevention

Women are more prone to urinary tract infections because of their anatomy
urinarytractinfection
Photo by Anantha Subramanyam K

Urinary tract infections (UTIs) are caused by microbes (bacteria) affecting both the upper (kidney ureters) and the lower (bladder and urethra) urinary tract. Infection in the upper urinary tract is rare but is a more serious condition compared with lower UTIs. Women are more prone to UTIs because of their anatomy since the urethra lies in proximity to the vagina and the anal canal.

Dr Govardhan Reddy, lead consultant, urology and uro oncology, Aster CMI Hospital, Bengaluru, told Happiest Health that UTIs are caused by microorganisms or germs, usually bacteria. “However, some are caused by fungi and in rare cases by viruses,” he said. “When they enter the urinary tract and multiply, they can cause a UTI. Women, babies and old people generally get UTIs.”

Dr Chetan JV, a urology consultant at Manipal Hospital, Bengaluru, said UTIs occur in the elderly since ageing slowly deteriorates the body’s immune system. People living with HIV and diabetes are also prone to UTIs because of their weak immune system. It is important to maintain cleanliness and hygiene to protect oneself from these infections.

Dr Chetan said there are anatomical and physiological causes for UTIs.

The anatomical causes include obstruction to the flow of urine, abnormal architecture of the urinary system (narrowings in the urinary tract), stricture urethra, BPH (benign prostatic hyperplasia) and posterior urethral valves. Stricture urethra is abnormal narrowing in the tube which hinders the flow of urine. In BPH, the enlargement of prostate gland blocks the flow of urine. Posterior urethral valves are obstructive membranes that develop in the urethra. The valve can obstruct or block the outflow of urine through the urethra.

The physiological causes are the inability to completely empty the bladder (urinary retention) and neurogenic bladder (where a person lacks bladder control due to a weak neuron system).

What causes UTI are inadequate intake of water or dehydration and honeymoon cystitis. The latter occurs when a woman has sex for the first time or after a long gap. Thus, all women are at the risk of getting honeymoon cystitis because of their anatomy.

UTI is also caused by Escherichia coli (E. coli), a type of bacteria commonly found in the gastrointestinal tract (the digestive system’s passageway that connects the mouth to the anus). Sometimes these bacteria can get out of the anus and into the urethra, and from there they can travel up to the bladder. If the infection isn’t treated, it can affect the kidney.

UTI (Urinary Tract Infections) symptoms

The urinary tract infection symptoms depend on the part of the urinary tract that has got infected. UTIs are classified as lower UTI and upper UTI.

The symptoms of the lower-tract (urethra and bladder) UTI include a burning sensation while passing urine, increased frequency and urgency of urination, bloody or cloudy urine with a strong odour, and pelvic pain.

UTIs that affect kidneys are associated with symptoms such as pain and tenderness in the upper back and sides (flank), chills, fever, nausea and vomiting, said Dr Reddy.

Types of UTI

Urethritis (infection of the urethra), cystitis (infection of the bladder), pyelonephritis (infection of the kidneys) and vaginitis (infection of the vagina) are the types of urinary tract infections, according to Dr Reddy.

Some doctors classify the infections into simple and complicated UTI. People with a normal urinary tract get a simple UTI (most women are prone to this). People with an abnormal urinary tract (or when the bacteria causing infection cannot be treated) are prone to a complicated UTI.

Under simple UTI one can have symptoms like frequent visit to the washroom, a burning sensation while urinating and blood in the urine (haematuria).

A person having complicated UTI experiences weakness, fever with severe chill and low blood pressure or septic shock. A complicated UTI can sometimes be fatal if not detected or treated early.

Meanwhile, genitourinary tuberculosis (GUTB) is a special type of UTI in which a patient is infected with the TB bacillus rather than regular bacteria. The symptoms are more or less the same but can be severe, recurrent and difficult to treat. A person with GUTB tends to lose weight.

A CT scan, a urine examination for a special strain like Zn stain (used to identify tuberculosis bacillus) and a gene expert test (used to identify tuberculosis particles) help in detecting GUTB. This type of UTI can be treated by anti-tubercular therapy, said Dr Chetan.

UTI prevention measures

Dr Reddy said since constipation can also lead to UTI, one needs to eat healthy food that is rich in fibres and exercise daily. Simple tricks that help in prevention are not to hold the urge to urinate and to use a clean toilet for urination. One can carry a wet tissue to clean the seat before using it in public toilets.

However, Dr Reddy said toilet seats are not a common means of infection transmission to humans — and there is minimal chance of bacteria or microbes entering the body because of contact with toilet seats.

In this regard, Dr Chetan said though no randomized controlled trial study has been done, observational studies have concluded that it might be one of the factors for UTIs. He said the urethra does not typically touch the toilet seat and many organisms can only survive for a short time on the surface of the seat, but no conclusive evidence for or against has been found regarding toilet seats as a cause for UTI.

To prevent UTI, one should increase fluid intake, control and manage the sugar level, maintain genital hygiene and improve general health, said Dr Chetan.

Also, wiping from the front to back after urinating and bowel movement helps prevent bacteria in the anal region from spreading to the vagina and urethra. One should empty their bladder soon after intercourse and drink a full glass of water since it helps to flush the bacteria. As a birth-control measure, one should avoid using diaphragms or unlubricated or spermicide-treated condoms since they contribute to bacterial growth. All these measures can go a long way in helping keep UTIs at bay.

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