Managing recurrent urinary tract infections in women - Edith Declan

A Urinary Tract Infection is an infection of the urinary system (vagina, bladder, urethra, kidneys) leading to an inflammatory response. UTIs occur when the normal flora (the microorganisms that live on another living organism (human or animal) or inanimate object without causing disease) of the area surrounding the urethra are replaced by the microorganisms in the lower gastrointestinal tract in humans. These go further into the urinary tract to cause a bacterial inflammation of the urinary tract and bladder. A recent survey suggests that by 24 years of age, 1 in 3 women would have been diagnosed and treated for a UTI, and over half of these women will remain infected throughout their lifetime.

Generally, symptoms of a UTI include burning or painful urination, increased frequency and urgency of urination, cloudy urine, foul smelling urine, bloody urine, waking up very frequently at night to urinate, lower back pain, lower abdominal (pelvic) pain.

However, the location of the infection can enable a differentiation for proper diagnosis and treatment. Infections in the kidney present more often with back/flank pain, fever, nausea, vomiting, chills or shaking. Infections of the bladder (Cystitis) present with symptoms such as lower abdominal discomfort or pain, frequent and painful urination, bloody urine. Burning or painful urination, and vaginal discharge are symptoms of Urethral infection (Urethritis).

There are several factors that expose a woman  to UTIs. The shorter urethra in the females enables bacteria to reach the bladder very quickly.  Increased sexual activities, and multiple sex partners can increase a woman’s chances of acquiring a UTI, and the use of the Diaphragm (a type of birth control) may increase a woman’s risk of getting a UTI. Some other factors that may contribute to an increased risk for UTIs in women include urinary tract abnormalities, any kind of obstruction in the urinary track, a suppressed immune system, certain medications, the use of indwelling urinary catheters, a recent surgical procedure involving any part of the urinary system.

Poor hygiene is also a major contributor to UTIs; wiping from the anus to the vagina can introduce bacteria into the urinary tract.

Recurrent UTIs are the most common complaint women report to their providers and urologists, and occurs due to bacterial reinfection or bacterial persistence. A reinfection is a recurrence with either a different organism, the same organism in more than two weeks, or a sterile intervening culture. Persistence occurs when the same bacteria continues to show up in the urine after two weeks of sensitivity-adjusted treatment.

Recurrent UTIs can be either complicated or uncomplicated.  An uncomplicated UTI is one that occurs in a healthy woman who has no structural or functional abnormality of the urinary tract. Recurrent uncomplicated UTIs may be defined as the occurrence of three or more uncomplicated UTIs in 12 months. Recurrent UTIs are common in women and are associated with long term health complications. Recurrent UTIs have been largely reported in post-menopausal women (women no longer have menstral periods) with a history of UTI before menopause, urinary incontinence, and hormonal imbalances. Several studies have shown that estrogen deficiency plays an enormous role in the development of bacteriuria. One of these studies showed that the use of estrogen cream decreased new episodes of UTI by reducing vaginal pH and restoring lactobacillus. The American Association of Family Physicians suggests that topical estrogen may reduce the incidence of recurrent UTIs in postmenopausal women.

In order to prevent UTIs, women are encouraged to practise good body hygiene. Ensure to shower in the morning upon waking up, and at night before sleep (at least every 12 hours). Avoid douching as this rids the vagina of its normal flora, thereby creating an ideal atmosphere for bacterias to flourish. Women should take showers instead of baths; baths can introduce soaps and chemicals into the vagina, altering the vaginal Ph. When washing or wiping, clean the genital area first, then the anus. This prevents the introduction of infections from the anus into the vagina.

Avoid using harsh “antiseptic” soaps, scented soaps or pads, scented tampons or perfumed bath oils, as these can irritate the linings of the vagina, alter PH and promote bacterial growth.  After urinating, wipe from front to back. When possible, ensure to wash the anus and genitals with water after stooling. Doing so prevents the introduction of bacteria from the anus to the vagina. Regardless of sexual orientation, ensure to use condoms during intercourse. This will maximally prevent the transmission of bacteria during vaginal intercourse. Avoid condoms that are not lubricated, or lubricants meant to kill sperm cells, as these may irritate the vaginal tissues, and trigger vaginal inflammation. During sex, ensure that your partner is not going from anal to vaginal, even with a condom. This introduces faecal matters and bacteria from the anus into the vagina, causing UTIs. Also ensure that your partner practises good oral hygiene if you have to engage in oral sex. The use of Diaphragms as contraceptives has been known to promote growth of bacteria like E.Coli. Wear underwear that gives your genitals some breathing room. Synthetic underwear traps and retains moisture, thereby creating the perfect breeding environment for infection. Finally, ensure to drink lots of water.

Ms Declan is a Family Nurse Practitioner and Health Literacy Specialist based in Texas, United States of America

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