Urinary Tract Infections in Women
What Is a UTI?
Fifty percent of all women have at least one urinary tract infection (UTI) during
their lifetime. The urinary system is normally bacteria-free or sterile. When bacteria
enter the urinary system and multiply, infection occurs. Since the urethra in the
female is very short, it is very easy for such bacteria to enter the bladder and begin
an infection.
Urinary tract infections are often classified as upper or lower tract infections. A
urinary tract infection (UTI) may involve the bladder (cystitis), the urethra
(urethritis), or the kidneys (pyelonephritis). To explain these parts in brief:
 Kidneys filter blood to produce urine.
 The ureters are the tubes that carry urine to the bladder
 The bladder is a balloon-like storage area for urine
 The urethra is the tube or canal which leads to an outside opening and allows
you to urinate
Cystitis is the most common type of UTI in females and involves only the bladder.
It is typically caused when bacteria that normally inhabit the large intestine ascend
the urethra from the urinary opening, which is above the vaginal opening, and
enter the bladder.
Most commonly a UTI occurs following sexual intercourse, when bacteria can be
pushed into the bladder. Although it is frequently associated with sexual activity,
cystitis is not a sexually transmitted infection (STI).
Urethritis and vaginitis, which are both inflammations of the tube that carries
urine out of the body (the urethra), can cause burning with urination. Sometimes
urethritis is due to chlamydia or gonorrhea. Herpes can cause symptoms similar to
urethritis, because the genital sores can be irritated by urine.
Less commonly a UTI can lead to pyelonephritis, a more serious infection of the
kidneys. Because an untreated bladder infection can result in pyelonephritis, it is
very important that the symptoms of cystitis be recognized and treated promptly. It
is also important that individuals be made aware of the possible signs and
symptoms of pyelonephritis. If an infection moves to the kidneys (symptoms
include back pain, fever, chills, and/or nausea), it can become life-threatening.
Female Anatomy
What Are the Symptoms of a UTI ?
Cystitis
 Burning or pain with urination (dysuria)
 Feeling like you have to urinate all the time (urgency)
 Feeling of not being able to empty your bladder thoroughly
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Urinating small amounts frequently (frequency)
Getting up to urinate multiple times at night (if not a usual pattern)
Occasionally, you may pass blood in the urine (hematuria)
Discomfort in the middle of the lower abdomen and low back pain
Urethritis
Symptoms may be less severe than with cystitis, and may be intermittent
Pyelonephritis
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Symptoms of bladder infection (sometimes)
Back pain, usually on one side, located at about the level of the lower ribs
Fever greater than 101 degrees
Nausea and vomiting (sometimes)
Abdominal pain (sometimes)
Chills
How Is a UTI Diagnosed?
The diagnosis or detection of a UTI is made based on symptoms, physical exam,
and by a laboratory examination of the urine (urinalysis). Finding bacteria and
white blood cells in the urine is a strong indication of a UTI.
A urine culture may be done to identify the specific bacteria causing the infection,
and results usually take 48 hours to return. A pelvic exam may be required to
evaluate symptoms suggestive of vaginitis, urethritis, or herpes.
How Is a UTI Treated?
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An antibiotic will be prescribed if a UTI is diagnosed. The full course of
treatment should be taken as prescribed, even though symptoms may
resolve before treatment is completed. A small number of bacteria may
remain to cause a recurrence of the infection if the full course of antibiotic
treatment is not taken.
Drinking two to three quarts of liquid per day will make urinating less painful.
Treatment may also include the local anesthetic Pyridium (a prescription
drug) or Azo-Standard (a nonprescription medication). Both of these
medications are for comfort only and do not treat the infection itself. The
medication will turn the urine bright orange. The pain-relieving medication
may be stopped when symptoms improve, but the antibiotics must be
finished.
It is best to avoid caffeine and tea because they irritate the bladder.
It is advisable to refrain from sexual activity until treatment is completed.
How Can a UTI Be Prevented?
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Always wipe from front to back after urinating and after a bowel movement
to avoid contaminating the urethra with bacteria from the vaginal and rectal
areas.
Urinate frequently during the day. Do not hold urine when you feel the urge
to urinate. Urinating allows the body to dispose of bacteria in the urine
before an infection can develop.
Always urinate within ten minutes after intercourse if possible. Intercourse
causes a slight trauma to the urethra and allows bacteria into it. Urinating
helps flush these bacteria out. If this is not possible, drinking 10-12 ounces
of water immediately after intercourse will cause you to urinate later and
help flush the bacteria out.
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Drink at least eight glasses of liquids (preferably water, 6-8 ounces each) per
day, to increase urination and help flush out bacteria.
Avoid coffee, and tea. These substances irritate the bladder and cause a
slight amount of bleeding to occur. When bleeding occurs, bacteria may enter
the blood vessels more easily.
Drink fruit juices to acidify the urine as this will be helpful in reducing recurrent
infection. Several small studies have suggested that consuming pure
cranberry juice may be helpful in prevention of UTIs. In the laboratory,
cranberry juice appears to decrease the ability of bacteria to stick to the
inner wall of the bladder. Further research is needed to confirm this effect.
Prevention of cystitis
Appropriate hygiene and cleanliness of the genital area may help reduce the
chances of introducing bacteria through the urethra. Females are especially
vulnerable to this, because the urethra is in close proximity to the rectum. The
genitals should be cleaned and wiped from front to back to reduce the chance of
dragging E. coli bacteria from the rectal area to the urethra.