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Everything you've wanted to know about urinary tract infections, but were afraid to ask. 2004-03-31 - 12:50 p.m. Ok, I promised to write out the knowledge I�ve accumulated over the years on urinary tract infections so here it is: How the heck does one get a urinary tract infection (UTI)? UTIs are caused by bacteria getting into the bladder, most commonly E. coli. Women are much more prone to getting them for the simple reason that our urethras are much, much, shorter than men�s so it�s a shorter distance for the bacteria to travel to get in there. (There are other factors involved but that�s the simple and most compelling explanation.) While there are some common-sense things that you can do to prevent them, like wiping front-to-back and drinking enough that you pee regularly, lots of women get them and there�s not a lot that they can do about it; it�s not their �fault�, that�s just the way it is. If you�re prone to them, drinking more water, and thus peeing more, will help, as will peeing after sex (sex can contribute to the onset of a UTI), and drinking before bedtime so you pee at least once during the night. I�ve also heard that waiting until you feel like you�re bursting before you go means that the bladder gets stressed by having to expand further than optimal and thus the possibility of an infection getting a foothold increases, but I haven�t found anything official to back this up so take it with a grain of salt. Common sense says go pee when you feel you have to; don�t force yourself to pee when you don�t feel you have to (that can contribute to urinary incontinence which is a whole other kettle of fish). Try to make sure that when you do pee, you empty your bladder completely so that everything is flushed out. The (in)famous cranberry juice remedy. Cranberry juice is used as a folk remedy for UTIs. I have heard a doctor say that it�s just the acidity of the cranberry juice that has an effect, and that you can get the same results with vitamin C; I have done my research and beg to differ. While there has been some published evidence that cranberries can inhibit the pilli of the bacteria from adhering to the bladder wall (the bacteria can�t stick to the bladder and are therefore flushed out more easily), and another study indicated that it may help prevent infections, there hasn�t been good medical evidence to actually prove that that it can cure a UTI once it has started. (You can feel free to do a search of PubMed to verify my info.) The bottom line for me though is that it can�t hurt. Look for unsweetened cranberry juice (it will probably need to be diluted and even then it tastes like �diluted sour� as my husband describes it). Cranberry �cocktail� doesn�t contain a lot of actual cranberry juice and does contain a lot of sugar and putting extra sugar in the blood when you�ve got a UTI means your supplying a food source to the bacteria. What do I do if I get a UTI? If you�ve had one before, you know it when you have one. If you haven�t had one before, the most common symptoms are urinary frequency (having to pee a lot), urinary urgency (feeling like you really have to pee; yes, even when you�ve just gone and you know damn well your bladder is empty), and painful urination (burning when you pee, particularly right at the end when your bladder is almost empty). If it goes untreated for too long you may have visible blood in your urine, and it can travel up one or both ureters to your kidneys which can be serious and you would feel as a pain in your lower back. Go to the doctor. If you�ve never had a UTI before the doctor should do a urine dip (she or he dips a special stick in the urine sample you provide) which determines if there�re white blood cells present (which indicates that your body is trying to fight off an infection). They�ll thump your back to check your kidneys for pain and poke at your belly over your bladder to check for pain/tenderness. They will then prescribe antibiotics but should also send your sample for culturing to make sure that the bacteria you�ve got aren�t resistant to that particular antibiotic. If they find that there is a resistance they should call you in and change your prescription. Take the antibiotics for as long as you are told to. This will usually be until they�re all gone. There is also the possibility the doctor want to check for STDs such as chlamydia, particularly if you�re male. A clinic is less likely to do this but your regular doctor might want to (right away if you go to them for the UTI or at your next scheduled visit � make sure you let them know that you�ve had trouble with UTIs). Women, there should be no need to have a Pap smear done for a UTI if you�ve been tested for STDs already and have had no new partners since then. Guys, you�re on your own with this one but a word to the wise, there is a urine test for chlamydia and you might want to ask about that instead of subjecting yourself to the extra-long swab. I hear it�s painful. If you�re a chronic sufferer of UTIs. You�ve had many of the damn things. You know how much they suck. You�re tired of running to clinics and dealing with different doctors who may or may not take your situation seriously. In addition to the usual stuff I mentioned above about prevention (peeing regularly and at strategic times, cranberry juice, etc.), there are medical options. You can take a low dose antibiotic for an extended period of time. This may give your bladder a chance to truly and fully recover, and a healthy bladder is a bladder less likely to let infection take hold. You can, if sex seems to precede the onset of infections, take a low antibiotic dose after you have sex as a preventative measure. You can also ask your doctor to supply you with several prescriptions for antibiotics at a time so that you have the prescription on hand when you need it and don�t need to be hotfooting it in to get one. It�s no fun to be in pain and feel like you shouldn�t be more than a 10-second dash to a toilet and then have to trek out to a clinic or doctor�s office. If you really have a lot of UTIs and/or if you�ve tried the low-dose/long-time antibiotic run and it didn�t work for you, you may be referred to a urologist. There are a number of things of various degrees of invasiveness that the urologist might recommend, but I�m not going to go into that here. Signs you need to change doctors. A doctor should be willing to discuss the above options with you. A doctor should take you and your condition seriously. A doctor should be willing to treat a UTI if you have already had a documented one, or more, before, even if the dip doesn�t show much in the way of white blood cells. Bodies can be more sensitive to infection than the tests, particularly in the early stages. Do not let them send you away without some sort of treatment. If you want to wait and see, you can always not fill or take the prescription if the symptoms go away on their own; you shouldn�t have to wait until you can �prove� that you�ve got an infection and then come back. Who the heck am I to be dispensing advice on this? I am not a medical doctor and this entry is not intended to be exhaustive or the last word on the topic. Treat it as you would any information on the internet and double check the facts with other sources. I do have a Master�s degree in science and my first job out of grad school was coordinating the clinical trial program for the Urology group at the Ottawa General Hospital. I know how to research and how to determine if a source is a respectable one or not � I check medical journal articles where possible. And as someone who�s suffered from a few UTIs over the years, I�ve had a vested interest and done a fair bit of research.
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A doctor should not treat your condition as trivial. They should not refuse treatment and tell you to come back only if the symptoms persist. They should understand that you�re an adult and you understand about antibiotic resistance (taking antibiotics, especially taking less than the full course prescribed, can result in resistance to that antibiotic in the strain of bacteria you�ve got) and you won�t take medication frivolously. As I�ve said before, grown women (and men) should not be held hostage to the paranoia or greed of the medical system.
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