Urinary tract infections (UTIs), one of the most common bacterial infections, appear with a vengeance. The burning during urination is an unmistakable pain that can’t be ignored. Recognizing the symptoms and applying preventive measures can help ensure a path to health.
“A UTI almost always refers to a bladder infection, more so than a kidney infection,” said Hajar I. Ayoub, MD, a urologist at UT Physicians Urology — Texas Medical Center. “While the bladder, ureter, urethra, and kidney are all part of the urinary tract, most people refer to UTIs as bladder infections.”
When an infection spreads to the kidneys, it becomes a more serious condition called pyelonephritis. It can be classified as acute or chronic. Ayoub said not every UTI turns into a kidney infection, even if it stays in your body.
“You’d need other risk factors, like urinary tract abnormalities or stones that cause an obstruction, for it to turn into a kidney infection,” said Ayoub, an associate professor of urology at McGovern Medical School at UTHealth Houston. “They are serious and can escalate into sepsis pretty quickly.”
Symptoms to watch for
People with UTIs experience a range of symptoms, including burning during urination, frequent urge to urinate, bladder pain, pelvic discomfort, and cloudy or strong-smelling urine. Certain other symptoms, however, require immediate medical attention:
- Fever
- Dropping blood pressure
- Mental confusion, especially in older adults
- Blood in urine
- Back pain, indicating the infection may have reached the kidneys
Older adults may not experience typical UTI symptoms like fever or pain, making mental confusion often the first and most important warning sign.
“Their symptoms could be incontinence or burning, and they might be used to that,” Ayoub said. “If they have a change in mental status, they need to go to the emergency room.”
Why women are more susceptible to UTIs
Women face a higher risk of UTIs due to their anatomy and hormonal factors. About 60% of women (versus 12% of men) will have at least one UTI during their lifetime, according to the Urology Care Foundation. This is based on several factors:
Shorter urethra: Ayoub said the distance bacteria have to travel is a lot less in women. A woman’s urethra is 3-4 centimeters, while a man’s urethra averages 16-22 centimeters.
Hormonal changes: Women going through menopause are particularly vulnerable to bladder infections. Hormones cause a thicker vaginal wall and form more barriers that keep bacteria out. Ayoub said that as women lose hormones, these barriers weaken, allowing bacteria to attach easily to the bladder wall.
Proximity: The closeness between the urethra and anal area in women’s anatomy also contributes to bacterial spread, since most UTI-causing bacteria, like E. coli, originate from this area.
Men and UTIs
Men do not typically get UTIs, according to Ayoub. She recommends a more extensive investigation if they do. It can be a sign of not emptying the bladder, enlarged prostate or prostate infections, or an anatomical problem, such as a stone or fistula.
“Men should avoid sitting for long periods of time or cycling for long periods as that puts pressure on the prostate and could potentially cause issues,” Ayoub said.
Diagnosis and treatment
Providers use a urine sample to look for bacteria and yeast, which may be causing a UTI. Antibiotics are the common course of treatment. The specific antibiotic is based on the type of bacteria causing the infection.
“We have good bacteria and bad bacteria,” Ayoub said. “If a culture shows bacteria but you aren’t having symptoms, you don’t need antibiotics. We’d actually be doing harm to treat it because it builds up resistance to antibiotics.”
Knowing potential risks
While many people focus on hygiene habits, some lesser-known factors significantly increase the chances of getting a UTI.
“Constipation is a big one that could put you at a high risk of forming UTIs,” Ayoub said.
Not emptying your bladder regularly can also contribute to UTIs because it allows bacteria to multiply. Avoid holding urine in your bladder, as well, where it has the chance to stagnate.
Certain medications can also increase risk. Diabetes medications release sugar into urine, creating an environment where bacteria thrive. Hormone-suppressing medications and immunosuppressive drugs can also increase risk.
Tips for preventing UTIs
Natural prevention methods can be highly effective, according to Ayoub. D-mannose, a type of simple sugar related to glucose, is a supplement that may reduce the number of certain bacteria that cause UTIs. Ayoub suggests taking cranberry pills and D-mannose as a dynamic duo. With hydration, they can potentially clear out more than 70% of UTIs without taking antibiotics.
The right cranberry approach: Skip the juice and opt for pills. Ayoub said cranberry in juice form is a bladder irritant. The cranberry juice also may not have the correct active ingredient. Instead, opt for cranberry pills with 36 milligrams of proanthocyanidin (PAC).
Vaginal estrogen for postmenopausal women: This underutilized treatment can dramatically reduce UTI frequency. Ayoub said the decrease in UTIs just by adding estrogen is over 50% and up to 80%.
Recurrent UTIs
Some people experience multiple UTIs. Recurrent UTIs are defined as either two symptomatic infections within six months or three within a year. Ayoub recommended evaluation for those who experience recurrent infections despite following prevention strategies. Some of the following issues could be occurring:
- Bladder emptying dysfunction
- Kidney stones
- Urinary tract abnormalities
- Other underlying conditions
While UTIs are common and often manageable, they shouldn’t be ignored. Most importantly, listen to your body. If you’re experiencing symptoms, don’t hesitate to reach out to a health professional.
