Urinary Tract Infection in Women
Urinary tract infection (UTI) is the most common bacterial infection in women in both pre- and post-menopausal setting. Though infection can occur in any part of the urinary tract, urinary bladder is most commonly involved and presents as cystitis. It is often seen in young sexually active women. Usually, the UTI in women is classified as “uncomplicated UTI” since there is no obstruction to the flow of urine. In women who are pregnant, who have risk factors such as diabetes, immunocompromise or neurological disease or urinary tract obstruction, UTI is classified as “complicated UTI” as it may be more difficult to treat. Some women have frequently recurrent or chronic UTIs which is conventionally defined as an occurrence of 3 or more episodes in a year.
What are the risk factors?
More than 50% of women suffer from UTI in their lifetime and out of these about 25% will have recurrent episodes. The risk factors for developing UTI in young women include sexual activity, use of spermicides and diaphragm and pregnancy. Poor hygiene of the genital area (in particular wiping back to front) can promote the growth of bacteria which results in ascending infection. Any previous UTI increases the chances of its occurrence again. Inadequate intake of fluids results in dehydration and reduced production of urine. This results in reduced flow and increased likelihood of infection. Any associated obstruction of the urinary tract leads to complicated UTI. The causes include stones, tumor, stricture or narrowing of the ureter or urethra, incomplete emptying of the bladder, nerve injuries leading to incontinence of urine and neurogenic bladder. Any manipulation or procedure on the urinary tract is associated with a risk of an infection. Examples include cystoscopy, passing a catheter, ureteroscopy or treatment of kidney stones. In perimenopausal women falling levels of estrogen result in loss of epithelium of the urinary tract making it more prone to infections.
What causes UTI in women?
Most cases of UTI are caused by bacteria which come from the bowel. E. coli is responsible for about 80% of cases of uncomplicated cystitis. Other bacteria include Staphylococcus saprophyticus (15%), Klebsiella, Proteus, Enterobacter, and Pseudomonas. Candida (fungus) is associated with hospital-acquired infections and is associated with prolonged use of broad-spectrum antibiotics.
What are the symptoms of UTI?
The common symptoms include fever with chills, burning during urination, pain, blood in urine, urgency, frequency, and sensation of incomplete bladder evacuation. At night also, one has to get up many times to pass urine. There is a cramp-like pain over lower abdomen and is associated with the passage of foul-smelling turbid urine. Sexual intercourse can be painful.
How is UTI diagnosed?
History of symptoms and local tenderness over the lower abdomen is usually diagnostic. A few tests are usually done to gather more information for better treatment. Analysis of urine is done which shows a presence of pus cells, bacteria, and red blood cells. Dipstick kits are also available commercially and aid in rapid diagnosis. Urine is also sent for culture of bacteria and testing their sensitivity to particular antibiotics. Treatment based on culture is more effective and is especially used in complicated UTI. In suspected complicated UTI imaging in the form of ultrasonography or computed tomography (CT) scanning provides structural and functional details
What is the treatment of UTI in women?
The treatment of uncomplicated UTI is simpler. Antibiotics such as fluoroquinolones, nitrofurantoin or TMP-SMZ are given for one to 7 days. UTI during pregnancy should always be treated after culture and sensitivity. In post-coital (post-intercourse) UTI, a single dose of cephalexin helps. Complicated UTI associated with diabetes, immunosuppressed person, recurrent UTI require culture and sensitivity based antibiotic. Any medication should be taken under medical supervision. People find pyridium (phenazopyridine) helpful for relief of urinary burning. Peri-menopausal women may require estrogen- therapy orally or vaginally in the form of a vaginal cream.
What additional advice is given?
One should maintain good hydration by consuming 3 to 4 liters of water. It increases urine output and clears the infective material from the bladder. A good hygiene of the genital area is essential. During an active infection, a sexual intercourse should be avoided. About 25% of women with uncomplicated UTI develop a second episode of infection within 6 months. So they should take adequate preventive measures to prevent recurrent UTI.
Dr. Alex Shteynshlyuger is a board-certified urologist in NYC who specializes in treating men and women with frequent urinary tract infections (UTI).