Urinary Tract Infection

Many women have a urinary tract infection (UTI) at some point during their lives. Some women will have repeat infections and may have them often. Most UTIs are not serious. They are easy to treat with antibiotics, and symptoms can be relieved quickly. This pamphlet will explain

A Woman’s Urinary Tract

The urinary tract is made up of the following parts:

• Two kidneys, which produce urine
• Two tubes called ureters that take urine from the kidneys to the bladder
• The bladder, where urine is stored
• The urethra, which carries urine from the bladder out of the body

The urinary tract has a lower part and an upper part. The lower tract is made up of the urethra and the bladder. The upper urinary tract consists of the ureters and kidneys.

Types of Urinary Tract Infections

Most UTIs start in the lower urinary tract. Bacteria can enter through the urethra and spread upward to the bladder. This causes cystitis, a bladder infection. In some cases, urethritis, an infection of the urethra, occurs at the same time. Bacteria that have infected the bladder may travel up the ureters to the kidneys. This can cause pyelonephritis, a kidney infection. An infection in the upper tract may cause a more severe illness than infection in the lower tract.

Women are more likely than men to get UTIs because the urethra is shorter in a woman than in a man. That means bacteria can reach the bladder more easily.

Causes

There are many reasons why a woman may get a UTI. The most common causes include bacteria from the rectum and vagina, sex, or urinary tract problems.

Bacteria

Bacteria from the bowel live on the skin near the anus or in the vagina. These bacteria can spread and enter the urinary tract through the urethra. If they move up the urethra, they may cause infections in the bladder and, sometimes, in other parts of the urinary tract.

Sex

Women’s anatomy makes them prone to getting UTIs after having sex. The opening of the urethra is in front of the vagina (see figure above). During sex, bacteria near the vagina can get into the urethra from contact with the penis, fingers, or devices.

Urinary tract infections also tend to occur in women who begin having sex or have it more often. Using spermicides or a diaphragm also can cause more frequent UTIs.

Problems in the Urinary Tract

Infections also can occur when the bladder does not empty completely. This condition may be caused by

• blockage (a stone) in the ureters, kidneys, or bladder that prevents the flow of urine through the urinary tract
• a narrowed tube (or a kink) in the urinary tract
• problems with the pelvic muscles or nerves

Other Causes

Certain other factors increase your chance of getting a UTI. You are more likely to get an infection if you

• have had a UTI before
• have had several children
• have diabetes
• are obese

Menopause also increases the risk of getting a UTI. With menopause, the level of estrogen decreases. This decrease can cause changes in the tissues around the urethra that can lead to a UTI.

UTIs can occur during pregnancy. If you are pregnant and think you may have a UTI, be sure to tell your doctor promptly. If untreated, it may cause problems for you and your baby.

Symptoms

Symptoms of UTIs can come on quickly. One sign is a strong urge to urinate that cannot be delayed (urgency). As urine flows, a sharp pain or burning, called dysuria, is felt in the urethra. The urge to urinate then returns minutes later (frequency). Soreness may be felt in the lower abdomen, in the back, or in the sides.

Other signs may show up in the urine. It may

• have a strong odor
• look cloudy
• sometimes be tinged with blood

Blood in the urine may be caused by a UTI, but it also may be caused by other problems. Tell your doctor promptly if you see blood in your urine.

If the bacteria enter the ureters and spread to the kidneys, symptoms also may include

• back pain
• chills
• fever
• nausea
• vomiting

If you have any of these symptoms, tell your doctor right away. Kidney infections are serious. They need to be treated promptly.

Symptoms linked with a UTI, such as painful voiding, can be caused by other problems (such as an infection of the vagina or vulva). Tests may be needed to confirm the diagnosis. Be sure to let your doctor know if you have any of these symptoms.

Diagnosis

The key to treating a UTI is a prompt diagnosis. Your doctor may first do a simple test, called urinalysis, to find out whether you have a UTI. For this test, you will be asked to provide a urine sample. This sample will be studied in a lab for the presence of white and red blood cells and bacteria. Normal urine should not have bacteria or blood cells in it. If either of these shows up in the urine, you may have a UTI.

The urine sample also may be grown in a culture (a substance that promotes the growth of bacteria) to see which bacteria are present. The sample also may be tested with different antibiotics to see which one destroys the bacteria best. This is called a sensitivity test.

When an infection does not clear up with treatment, you have had several UTIs in a row, or you have pain, fever, and chills, your doctor may need to examine your urinary tract more closely for signs of a more serious problem. He or she may use one of these tests:

• Intravenous pyelogram (IVP)—A special dye is injected into the body. As it passes to the urinary tract, X-ray images of the bladder, kidneys, and ureters are taken.
• Ultrasound exam—Images of the urinary tract are shown on a monitor.
• Cystoscopy—A thin, lighted tube with a lens at the end is passed through the urethra to check for any abnormalities of the urethra or bladder.
• Computed tomography (CT)—Small X-ray beams rotate around the body and transmit images of body tissues in cross sections into a computer.
• Cystourethrography—A dye is put into the bladder and X-ray images are taken as you void.

Treatment

Antibiotics are used to treat UTIs. The type, dose, and length of the antibiotic treatment depend on the type of bacteria causing the infection and on your medical history.

In most cases, treatment is quick and effective. Most symptoms go away in 1–2 days. Be sure to take all the medication even though your symptoms may go away before you finish your prescription. If you stop treatment early, the infection may still be present or it could come back after a short time.

For more severe infections, such as a kidney infection, you may need to stay in the hospital. These infections take longer to treat and you may be given medication intravenously (through a tube in a vein).

Recurrent Infections

If you have more than two UTIs in a year, you have a recurrent infection. The first step in treatment is finding the cause. Factors that increase the risk of recurrent infection are

• frequent sex
• young age at first UTI
• spermicide use
• diaphragm use
• a new sexual partner

Recurrent infections are treated with antibiotics. A week or two after you finish treatment, a urine test may be done to see if the infection is cured. Changing your birth control method also may be recommended. If you often get UTIs through sexual activity, you may be given an antibiotic to take in single doses after you have sex.

Prevention

There are a number of ways to prevent UTIs:

• After a bowel movement or after urinating, wipe from front to back.
• Wash the skin around the anus and the genital area.
• Avoid using douches, powder, and deodorant sprays.
• Drink plenty of fluids (including water) to flush bacteria out of your urinary system.
• Empty your bladder as soon as you feel the urge or about every 2–3 hours.
• Try to empty your bladder before and after sex.
• Wear underwear with a cotton crotch.

Unsweetened cranberry juice and cranberry pills may decrease the risk of getting a UTI. The exact amount of juice or pills needed and how long you need to take them to prevent infection are being studied. Treatment with an estrogen cream or pills is being studied as a way to prevent UTIs in women past menopause.

Finally…

Urinary tract infections are common and can be painful. If you have symptoms of a UTI, see your doctor right away. With prompt, proper treatment, these infections can be treated with success.

Glossary

Antibiotics: Drugs that treat infections.

Anus: The opening of the rectum on the outside of the body.

Bladder: A muscular organ in which urine is stored.

Dysuria: Pain during urination.

Estrogen: A female hormone produced in the ovaries.

Kidneys: Two organs that cleanse the blood, removing liquid wastes.

Labia: Folds of skin on either side of the opening of the vagina.

Menopause: The process in a woman’s life when ovaries stop functioning and menstruation stops.

Rectum: The final part of the large intestine that connects to the anus.

Recurrent Infections: Infections that occur more than once, usually within a short time, although they may be spread out over several months.

Spermicides: Chemicals (creams, gels, foams) that inactivate sperm.

Ureters: A pair of tubes, each leading from one of the kidneys to the bladder.

Urethra: A short, narrow tube that carries urine from the bladder out of the body.

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.

Vulva: The external female genital area.