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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 Iíve 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 menís so itís a shorter distance for the bacteria to travel to get in there. (There are other factors involved but thatís 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 thereís not a lot that they can do about it; itís not their ďfaultĒ, thatís just the way it is. If youíre 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. Iíve also heard that waiting until you feel like youíre 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 havenít 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; donít force yourself to pee when you donít 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 itís 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 canít stick to the bladder and are therefore flushed out more easily), and another study indicated that it may help prevent infections, there hasnít 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 canít hurt. Look for unsweetened cranberry juice (it will probably need to be diluted and even then it tastes like ďdiluted sourĒ as my husband describes it). Cranberry ďcocktailĒ doesnít contain a lot of actual cranberry juice and does contain a lot of sugar and putting extra sugar in the blood when youíve got a UTI means your supplying a food source to the bacteria.

What do I do if I get a UTI?

If youíve had one before, you know it when you have one. If you havenít 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 youíve 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 youíve 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 thereíre white blood cells present (which indicates that your body is trying to fight off an infection). Theyíll 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 youíve got arenít 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 theyíre all gone.

There is also the possibility the doctor want to check for STDs such as chlamydia, particularly if youíre 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 Ė make sure you let them know that youíve had trouble with UTIs). Women, there should be no need to have a Pap smear done for a UTI if youíve been tested for STDs already and have had no new partners since then. Guys, youíre 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 itís painful.

If youíre a chronic sufferer of UTIs.

Youíve had many of the damn things. You know how much they suck. Youíre 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 donít need to be hotfooting it in to get one. Itís no fun to be in pain and feel like you shouldnít be more than a 10-second dash to a toilet and then have to trek out to a clinic or doctorís office. If you really have a lot of UTIs and/or if youíve tried the low-dose/long-time antibiotic run and it didnít 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 Iím 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 doesnít 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 shouldnít have to wait until you can ďproveĒ that youíve got an infection and then come back.
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 youíre 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 youíve got) and you wonít take medication frivolously. As Iíve said before, grown women (and men) should not be held hostage to the paranoia or greed of the medical system.

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 Masterís 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 Ė I check medical journal articles where possible. And as someone whoís suffered from a few UTIs over the years, Iíve had a vested interest and done a fair bit of research.

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