Urinary Tract Infections - U.T.I. in Women

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Female Urinary Tract Infection

Urinary tract infections (UTI) are a serious health issue that affect millions of women each year. For this reason, women with a UTI should understand the causes and treatments for urinary tract infections. The cause of most female urinary tract infections is bacteria. Any part of your urinary tract can become infected, including the kidneys, ureters, bladder, and urethra. Bladder and urethra infections are the most common among women.

Accounting for approximately 8.3 million doctor visits each year, urinary tract infections rank as the second most common in all types of infection in the human body.1

The causes of UTI's in women

Normally, urine does contain some fluids, salts, and waste products, but is usually sterile and free of any bacteria, viruses, and fungi. An infection occurs when tiny organisms, typically bacteria from the digestive tract, adhere to the opening of the urethra - the tube that carries urine from the bladder to be expelled outside the body - and reproduce. Most infections are caused by Escherichia coli (E. coli) bacteria from the colon, beginning at the opening of the urethra.

The typical case occurs when bacteria first travels to the urethra and multiplies. An infection confined to the urethra is known as "urethritis." If the infection moves to the bladder, it is called "cystitis." If the infection is not treated immediately, bacteria could potentially travel farther up the ureters to infect the kidneys, which results in a kidney infection called "pyelonephritis."

Chlamydia and Mycoplasma, both microorganisms, are also known to cause urinary tract infections in women, but the trend of these types of infections is to remain limited to the urethra and reproductive system. Unlike E. coli, Chlamydia and Mycoplasma can both be sexually transmitted, requiring the treatment of both male and female partners.

The urinary system is biologically structured to help ward off infection. The ureters and bladder are designed to prevent urine from backing up toward the kidneys, and the flow of urine from the bladder is meant to wash bacteria out of the body. Despite these safeguards, infections can and do still occur.

During menopause, the drop in estrogen levels can affect the urinary system. Like the vaginal wall, the urethra (the tube that drains the bladder and is used for urination) undergoes changes as estrogen levels drop. The urethra's changes can lead to various urinary symptoms, including an increased susceptibility to urinary tract infections.

Pregnant women are not more prone to urinary tract infections than other women. However, when a UTI does occur during pregnancy, the infection is more likely to travel to the kidneys. Some reports say that about 2 to 4% of pregnant women develop a urinary infection. Some research suggests that hormonal changes and shifts in the position of the urinary tract during pregnancy make it easier for bacteria to travel through the ureters to the kidneys. Because of this, many doctors recommend periodic testing of urine during pregnancy. A pregnant woman who develops a UTI should be treated immediately to avoid premature delivery of her baby and other risks such as high blood pressure. It is important to note that some antibiotics are not safe to take during pregnancy. In selecting the best treatment, doctors consider various factors such as the drug's effectiveness, the stage of pregnancy, the mother's overall health, and the potential effect on the fetus.

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The Risk Factor for Woman

Some women are more prone to getting a urinary tract infection than others. Any anomaly of the urinary tract that obstructs the flow of urine (e.g., a kidney stone) increases the risk for an infection. A common cause of infection is catheters, or tubes, placed in the urethra and bladder. A woman who is unable to void or who is unconscious or critically ill might need a catheter that stays in place for a prolonged period. Some women, particularly the elderly and those with nervous system disorders that cause loss of bladder control, may need a catheter for life.

Women with diabetes have a higher risk of a UTI because of changes in the immune system. Any other disorder that suppresses the immune system raises the risk of a urinary infection. Urinary tract infections may occur in infant girls who are born with abnormal urinary tracts, which sometimes need to be corrected with surgery. The rate of UTIs increases with age in women, however scientists can't pinpoint why women have more urinary infections than men. One factor may be that a woman's urethra is shorter, increasing the risk of bacteria quickly accessing the bladder. A woman's urethral opening is near sources of bacteria from the anus and vagina. For many women, sexual intercourse seems to trigger an infection, although the reasons for this linkage are unclear.

According to several studies, women who use a diaphragm are more likely to develop a UTI than women who use other forms of birth control. Recently, researchers found that women whose partners use a condom with spermicidal foam also tend to have growth of E. coli bacteria in the vagina.

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The Symptoms of UTI

Not every woman with a UTI is symptomatic, but most women display at least a couple of symptoms. Symptoms may include the need to urinate frequently and a painful, burning feeling in the vicinity of the bladder or urethra during the process of urination. It is not unusual to feel tired, shaky, or washed out, and to feel pain even when not urinating. Women often feel an uncomfortable pressure just above the pubic bone. It is common for a woman with a urinary infection to, despite the urge to urinate, pass only a small amount of urine. Once passed, the urine may appear cloudy or milky or even reddish if blood is present. Typically, a UTI in women does not cause fever if it is in the urethra or bladder. However, a fever may indicate that the infection has spread to the kidneys. Other symptoms of a kidney infection include pain in the back or side below the ribs, nausea, or vomiting.

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UTI Diagnosis

To determine whether you have a urinary tract infection, your doctor will test a sample of your urine for bacteria and pus. Usually, the doctor will ask for a "clean catch" urine sample, which is obtained by washing the genital area and collecting a "midstream" sample in a sterile container. This method of collection prevents bacteria around the genital area from contaminating the test results.

The sample is then sent to a laboratory where the urine is tested for red and white blood cells and bacteria. If found, the bacteria is then grown in a culture and tested against different antibiotics to see which drug will be most effective against it. Some microbes, like Mycoplasma and Chlamydia, can be detected only with specific bacterial cultures. A microbial infection is suspected when a woman displays symptoms of a UTI but a standard culture does not display any bacterial growth.

When a prescribed treatment does not clear up the infection and is traced back to the same strain of bacteria, the doctor may order more tests. One such test is known as an intravenous pyelogram, which requires X-ray images of the kidneys, bladder, and ureters. An opaque dye visible on X-ray film is injected into a vein and a series of X-rays are taken, which maps the urinary tract, and reveals even the slightest changes in the structure of the tract.

If infections recur, your doctor may also recommend an ultrasound exam, which creates images from the echo patterns of sound waves reflected from internal organs. Another useful test is a cystoscopy. A cystoscope is an instrument made of a hollow tube with several lenses and a light source, which allows the doctor to see the inside of the bladder through the urethra.

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UTI Treatment

The most popular treatment of urinary tract infections is the use of antibacterial drugs. The length of treatment and choice of antibiotic depend on the patient's medical history, as well as the urine tests that help identify the offending bacteria. The drugs that are most often used to treat routine, uncomplicated UTIs are trimethoprim/sulfamethoxazole (Bactrim, Septra, Cotrim), trimethoprim (Trimpex), nitrofurantoin (Macrodantin, Furadantin), ampicillin (Omnipen, Polycillin, Principen, Totacillin), and amoxicillin (Amoxil, Trimox, Wymox). A class of drugs known as "quinolones" includes four drugs that have been approved in recent years for treating UTI. These drugs include ciprofloxacin (Cipro), ofloxacin (Floxin), norfloxacin (Noroxin), and trovafloxin (Trovan).

If the infection is not complicated by an obstruction or other disorder, a urinary tract infection can be cured within one or two days of treatment. However, as a precaution, many doctors ask their patients to continue on their prescribed antibiotics for a week or more to ensure that the infection has been halted. Single-dose treatment is not recommended for certain patients – for example, those who neglected to seek out immediate treatment or who display signs of kidney infection, diabetic patients, or patients with structural abnormalities. A longer treatment is also necessary for women with infections caused by Chlamydia or Mycoplasma, which are typically treated with tetracycline, trimethoprim/sulfamethoxazole (TMP/SMZ), or doxycycline. Symptoms may vanish before the infection is fully cleared, so it is absolutely critical to take the full course of treatment. A follow-up urinalysis test may be conducted to confirm that the urinary tract is infection-free.

Severely ill women with kidney infections, which typically require several weeks of antibiotic treatment, may be hospitalized until they are able to take fluids and necessary drugs on their own. Researchers at the University of Washington found that two-week treatments with TMP/SMZ was as effective as six weeks of treatment with the same drug in women with kidney infections that did not involve an obstruction or nervous system disorder. In such cases, kidney infections rarely lead to any kidney damage or total kidney failure unless left untreated.

Several drugs are available to help relieve the pain of a urinary tract infection. A heating pad may help provide temporary relief. Most doctors suggest that the act of drinking more water helps purify the urinary tract of lingering bacteria. During treatment, it is beneficial to avoid alcohol, coffee, and spicy foods. One of the best things a smoker can do for his or her bladder is to quit smoking, as smoking is one of the leading causes of bladder cancer.

Curing urinary tract infections caused by an obstruction or other systemic disorder depends on diagnosing and fixing the underlying issue, sometimes even surgically. If the root cause of infection is left untreated, there is an increased risk of kidney damage. Such infections tend to stem from a wider range of bacteria, and sometimes infections can occur from more than one type of bacteria at a time.

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Recurrent Infections in Women

Approximately 50% of all women will experience at least one urinary tract infection in her lifetime, with many women suffering several infections throughout their lifetimes. Many women suffer from frequent UTIs. Nearly 20% of women who have one UTI will have another, and 30% of those will have yet another. Of the last group, 80% will have even more recurrences. Women who have had three urinary tract infections are likely to continue having them. Four out of five such women get another within 18 months of the last UTI. The latest infection usually stems from a strain or type of bacteria that is different from the infection before it, indicating a separate infection. Even when several UTIs in a row are due to E. coli, slight differences in the bacteria indicate distinct infections.

A woman who has frequent recurrences (three or more a year) can ask her doctor about one of the following treatment options:

  • Take low doses of an antibiotic, such as nitrofurantoin or TMP/SMZ, daily for six months or longer. If taken at bedtime, the drug remains in the bladder longer and may be more effective. NIH-supported research at the University of Washington has shown this therapy to be effective without causing any serious side effects.
  • Take a single dose of an antibiotic after sexual intercourse.
  • Take a short course (one or two days) of antibiotics when symptoms appear. Dipsticks that change color when an infection is present are now available without a prescription. The strips detect nitrite, which is formed when bacteria change nitrate in the urine to nitrite. The test detects approximately 90% of UTIs when used with the first morning urine specimen and may be very useful for women who suffer from recurrent infections.

Research funded by the National Institutes of Health (NIH) suggests that one factor behind recurrent UTIs may be the ability of bacteria to attach to cells lining the urinary tract. A recent study found that bacteria created a protective film on the inner lining of the bladder in mice. If a similar occurrence can be demonstrated in humans, the discovery may lead to new treatments that will be able to prevent recurrent UTIs. Another line of research indicates that women who are "non-secretors" of certain blood group antigens may be more prone to recurrent urinary tract infections. The cells lining the urethra and vagina may allow bacteria to attach more easily. Further research will help show whether this association is sound and proves useful in identifying women with an increased risk for UTIs.

Doctors suggest some additional steps that a woman can take on her own, to avoid an infection:

  • Drink plenty of water every day.
  • Urinate when you feel the need; don't resist the urge to urinate.
  • Wipe from front to back to prevent bacteria around the anus from entering the vagina or urethra.
  • Take showers instead of tub baths.
  • Cleanse the genital area before sexual intercourse.
  • Avoid the use of feminine hygiene sprays and scented douches, which may irritate the urethra.
  • Some doctors suggest drinking cranberry juice.
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Complicated Infections

Curing infections that stem from a urinary obstruction or other systemic disorders depends on finding and correcting the underlying problem, sometimes with surgery. If the root cause goes untreated, this group of patients is at risk of kidney damage. Also, such infections tend to arise from a wider range of bacteria, and sometimes from more than one type of bacteria at a time.

Liberator Medical is committed to providing you with the best catheter to help manage your condition, to help relieve any pain or discomfort associated with UTIs, and reduce the risk of catheter-caused infections. We offer the discreet and convenient SpeediCath Compact for Women, as well as The Cure Twist catheter, which are both pre-lubricated and compact enough to fit inside your pocketbook, and will provide you with convenience, portability, and privacy. If you've been treated for two or more UTIs within the last six months, you could also qualify for a Closed System Catheter. Closed System Catheters are pre-lubricated intermittent catheters that come in a complete kit, not requiring a toilet, with a collection bag, gloves, a drape, and a protective introducer tip. The protective introducer tip shields the catheter from bacteria, greatly reducing the risk of urinary tract infection.

Liberator Medical's Catheter Supply-Care Program* will find the best catheter supplies for your medical needs, and our Supply-Care Specialists will work with your physician and/or insurance company to make sure you get them! Contact Liberator Medical to speak with a representative today at 1-888-244-0789, and let us help reduce your risk of UTIs.

*Co-payments, deductibles, and conditions apply.

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The National Institute of Health
1Ambulatory Care Visits to Physician Offices, Hospital Outpatient Departments, and Emergency Departments: United States, 1999-2000. Vital and Health Statistics. Series 13, No. 157. Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention, U.S. Dept. of Health and Human Services; September 2004.

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