Urinary Tract Infection (UTI)

A urinary tract infection (UTI) is a very common cause of pelvic pain and discomfort. It is caused by bacteria entering the urethra, which can also travel up to reach the bladder and kidneys. This results in a number of symptoms, including; burning or pain when you urinate, you may need to urinate more often, and you may feel generally unwell.


Types of UTI

  • Cystitis - When only the bladder is infected.
  • Urethritis - When only the urethra is infected.
  • Kidney infection - When one or both kidneys is infected, which can lead to serious kidney damage if left untreated.
  • Lower UTI - When both the bladder and urethra are infected.
  • Upper UTI - When the bladder, urethra and one or both of the kidneys are infected.

The urinary tract stores urine for long periods of time. When it is healthy it has a tight barrier of epithelial cells which prevent the toxins from your urine entering the blood stream. These cells secrete antibacterial agents and pro-inflammatory substances to prevent bacteria from growing. The urethra is often exposed to bacteria, but is able to resist infections through this natural immune response. The rest of the urinary tract is usually sterile, protected by the bodies natural mucus secretions.

UTI's most commonly develop as a result of Escherichia coli bacteria, from the bowel, reaching the urethra. UTI's usually stay within the urethra and pass within a few days as your bodies natural immune response deals with the infection. However, they can develop into significantly more dangerous conditions; including the formation of pelvic abscesses, sepsis (if the bacteria enters the blood stream), kidney dysfunction and pyelonephritis (inflamed kidneys) if the bacteria reaches higher. This can occur if the immune defences has broken down, or if the bacteria are considered 'opportunistic' and cling to healthy cells which are travelling upwards. As these conditions can be fatal, the development of any UTI should be monitored. If you are worried, a visit to your GP can prescribe a short course of antibiotics which can usually easily treat the infection.

UTI's are non-contagious and relatively common. They can affect men and women of all ages but are 8 times more common in women as their anus and urethra are closer together, and they have a shorter urinary tract for bacteria to travel up. Around 50-60% of women develop UTI's in their lifetime, accounting for 25% of all types of bacterial infections experienced by women.


What are the Symptoms of a Urinary Tract Infection?

  • Stinging and irritation when you urinate
  • A more frequent urge to urinate than normal
  • The urge to urinate is more sudden than normal
  • Smelly or cloudy urine
  • Blood in your urine - Visit your GP if this occurs even once.
  • Pain in your lower abdomen
  • Tiredness
  • In older people it can cause confusion and agitation
  • In children it can cause them to:
    • wet themselves as they deliberately don't go to the toilet as it stings
    • be irritable
    • appear generally unwell
    • babies may not feed and have a fever of 37.5°C (99.5°F)

A UTI can be a symptom of a more series condition. Seek urgent healthcare if you have suffered from a UTI for longer than a week, or if you also have any of the following symptoms which suggest the UTI has developed into a kidney infection:

  • Pain in the sides of your lower back
  • A fever
  • Vomiting or feeling very sick
  • Diarrhoea

What Causes a Urinary Tract Infection?

A UTI is caused by bacteria entering the urinary tract through the urethra. This can happen from:

  • Not fully emptying your bladder - The urine that remains allows bacteria to multiply.
    • If you have weak pelvic floor you will not have the control needed over your bladder and can often have urine remain after urinating.
    • Bladder or kidney problems can prevent full bladder voiding.
    • In children, constipation can prevent full bladder voiding.
    • In men, an enlarged prostate gland can prevent full bladder voiding.
  • A weakened immune system - As is the result of many conditions, including; type 2 diabetes, HIV and going through chemotherapy.
  • Faeces reaching the urethra - 80% of UTI's are caused by the bacteria Escherichia coli which is found in faeces and the bowel. This can occur from poor hygiene, diarrhoea, or wiping back to front.
  • Pregnancy - Pregnancy increases the pH of your urine. It also weakens your pelvic floor and dilates your renal pelvis (in the kidneys).
  • Kidney stones - Blocking the urinary tract and allowing urine to pool within it.
  • Urinary catheters - The most common cause of UTI's that develop in hospital. Urine pools allowing bacteria to grow.
  • Bacteria from the vagina reaching the urethra - The proximity of the vagina and urethra often allows bacteria to travel between the two. Bacteria can grow in the vagina as a result of:
    • A drop in oestrogen, as often seen during the menopause, reduces the vagina's normal protective flora, which can allow bacteria to grow in the area.
    • Spermicidal lube contains Nonoxynol-9 which suppresses the growth of normal vagina flora, and encourages bad bacteria to grow.

To read about other causes of pelvic pain, visit the Causes and Diagnosis of Pelvic Pain page.


How to Treat a Urinary Tract Infection

If your UTI does not naturally go away in a few days, your GP can help you treat it. If you have a severe UTI you may stay in hospital during your treatment. This is more likely for men and children.

If your UTI comes back, it is likely that the bacteria has combined within epithelial cells, allowing them to rapidly grow once any treatment has stopped. Your treatment will now be more intense, with a longer cause of antibiotics.

  • Antibiotics - Not suitable for pregnant women. The symptoms should improve within 2 days in children, and 5 days in adults. It is essential that you finish the entire course, even if you feel better.
  • Paracetamol, warm baths and ice packs - To relieve discomfort whilst the bodies natural immune system clears the infection.
  • Drink plenty of fluids - To help flush the bacteria out of your body.
  • Elimination diet - If you frequently suffer from UTI's you may consider an elimination diet to see if any food or drink is assisting the infection. Stop consuming bladder irritants such as acidic foods and drinks such as citrus fruits, caffeine and alcohol, and then reintroduce them back into your diet one at a time. Consider permanently eliminating any foods that lead to a UTI developing on reintroduction. Elimination diets are most successful when supported by a Nutritionist, and in combination with a bowel regime and lots of fluids.
  • Baking soda and potassium citrate - To make your urine more alkaline and reduce pain when urinating. Often available in tablet form in pharmacies.
  • Bladder training - To reduce the risk of urge incontinence developing.
  • Vaginal oestrogen topical cream or vaginal ring - If you have low oestrogen levels your vagina is less defended against bacteria infections. Taking oestrogen vaginally can boost its immune defence.

To read about other treatments available for pelvic pain, visit our pelvic pain treatment page.


12 Tips to Prevent a Urinary Tract Infection

There are many things you can do to reduce your risk of developing a UTI.

  1. Do your Kegels (pelvic floor exercises) - A strong pelvic floor is essential in having control over your bladder. If you are struggling to fully empty your bladder, it is usually down to a weak pelvic floor.
  2. Wipe front to back after being on the toilet - Reducing your risk of the bacteria Escherichia coli, from the bowel, reaching your urethra.
  3. Fully empty your bladder each time you go - To prevent bladder growing in stagnant urine.
  4. Drink plenty of water - To flush bacteria out of the body.
  5. Shower rather than bath - To prevent bacteria sitting around your urethra.
  6. Wear loose cotton (breathable) underwear - To keep you fresh.
  7. Urinate straight after sex (for women) - To prevent bacteria from the vagina reaching your urethra.
  8. Change your child's nappy frequently - To prevent bacteria sitting around the urethra.
  9. Avoid spermicidal lube (for women) - Spermicidal lube contains Nonoxynol-9, which promotes the growth of bad bacteria and suppresses good bacteria in the vagina.
  10. Avoid scented skincare products - Which can irritate your urethra.
  11. Be aware of foods and drinks that irritate your bladder - Try cutting down on carbonated drinks and citrus fruits.
  12. Have regular bowel movements - There are lots of benefits to staying regular, avoiding a UTI is just one.

7 Myths About Urinary Tract Infection's

  1. Cranberry juice helps clear UTI's - Wrong! It is true that cranberry juice contains proanthocyanidins (PAC's), which help prevent bacteria collecting on the lining of the bladder. However, an impractically large volume of cranberry juice would need to be drank to consume enough PAC's to make a difference.
  2. Probiotics help clear UTI's - Not definitively! Although studies show probiotics have a small positive effect by preventing bacteria moving up the urinary tract, studies show that overall there is no significant improvement in patients with UTI's. Instead, taking too many probiotics has been connected to diarrhoea, constipation and vomiting.
  3. Only women suffer with UTI's - Wrong! Men and children can suffer with UTI's as well. They are increasingly common in men over the age of 50.
  4. You must be unclean to get a UTI - Wrong! Your bodies natural immune defence can be affected by many factors.
  5. You can't get a UTI if you do not have sex - Wrong! Sex is only one risk factor for developing UTI's. The most common cause is not cleaning correctly after having a bowel movement.
  6. If you have cloudy smelly urine, you have a UTI - Not definitively! Other conditions can lead to cloudy smelly urine. The change in your urine may be related to how hydrated you are.
  7. If it stings when you urinate, you must have a UTI - Not definitively! Other conditions can lead to discomfort. If you often suffer with uncomfortable urination, visit your GP.


Sources

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