Woman's World

On Urinary Tract Infections

By Jean Talbert, M.D.
Although urinary tract infection (UTI), one of the most common types of infection, can occur in anyone–men, women or children—women appear to be the most susceptible.

Approximately half of all adult women will experience a UTI at least once during their lifetime and 8.3 million doctor visits per year in this country are related to urinary tract symptoms. Most infections are confined to the bladder, but more serious kidney infections also can occur.

The urinary tract—kidney, ureters, bladder and urethra—normally are sterile. UTIs occur when bacteria migrate up the urethra and begin to multiply. Women are probably more susceptible as they have a short urethra in close proximity to the rectum, the source of most urinary tract pathogens. Many women find that they develop symptoms following sexual intercourse.

Men and women with insulin-dependant diabetes, urinary tract obstruction, kidney stones, incomplete bladder emptying and suppressed immune systems have a higher risk for UTIs. Children may be at risk if they are born with ureteral reflux, a congenital abnormality of the urinary tract.

The most common symptoms of UTIs are painful urination, urinary frequency, urgency, pelvic pain and blood in the urine. Fevers, flank pain, nausea or vomiting suggest a more serious kidney infection and need to be treated more aggressively. Life threatening sepsis can occur if the bacteria spread to the blood stream.

Elderly women, in particular, can develop signs of sepsis (high fever, low blood pressure, confusion) without first having the classic urinary tract symptoms.  A diagnosis of UTI usually is based on symptoms confirmed by a urinalysis. (A pelvic exam may be needed to rule out other conditions. An over-the-counter dipstick for nitrites can detect about 90 percent of true UTIs.

Treatment generally involves a short course of oral antibiotics although increasing antibiotic resistance is becoming a serious problem. Intravenous treatment may be necessary if fever or significant illness is present. Urine cultures with testing for sensitivity of the bacteria to various antibiotics should be done for any persistent or recurrent infection.

A hot pack to the lower abdomen and over-the-counter medications such as phenazopyridine, acetominophen and ibuprofen can help to ease the symptoms before the antibiotic has had full effect. We also recommend avoiding bladder irritants such as caffeine, alcohol and tobacco.

Several herbal products such as Goldenseal root and Uva ursi have been found to be useful in treating UTIs and are available in a variety of formulations (dried herbs to be made into tea, tinctures or capsules). These can be taken safely under the direction of a naturopath or other specialist in herbal medicine. Herbal treatments may not be adequate in all cases and antibiotics should be used if symptoms do not resolve after two or three days.

Here are some ways to prevent UTIs: take plenty of fluids (6-8 glasses per day); void regularly; avoid bubble baths, feminine hygiene sprays and douches, and void after intercourse. Vaginal estrogen (available by prescription) in the form of a ring, tablet or cream can lower the risk of UTIs in post-menopausal women. Extracts of cranberry juice (non-sugar sweetened) have been shown to inhibit the adherence of bacteria to the urethra and bladder. Consuming 16 ounces a day may discourage bacterial growth. Alkalinizing the pH of the urine with calcium or magnesium citrate (500 mg/day) also may be helpful.

Women with recurrent urinary tract infections should be evaluated for the presence of an abnormality in the urinary tract such as an obstruction or a stone. Long term, low-dose antibiotics may be prescribed as a preventive measure. Women who experience UTIs related to intercourse are often prescribed antibiotics to take prophylactically after intercourse. Researchers are currently investigating a vaccine for use in high risk cases.

Although most UTIs respond readily to treatment, serious complications can develop. Seek medical attention for severe or persistent symptoms to confirm the diagnosis and obtain additional treatment.

(Dr. Talbert is a board certified OB/GYN specialist practicing with Cape Obstetrics, Midwifery & Gynecology in Falmouth and Sandwich, 508-457-0088.)