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What You Should Know About UTIs

As women, there are three infections that are more common for us than men: urinary tract Infections (UTIs), yeast Infections and human papillomavirus (HPV). Today, let’s talk about urinary tract infections as they are twice as likely to happen to women than men1 and 50% of all women will get at least one2. If you are keeping up with the math here, that means roughly 40% of the population is going to have to deal with a UTI at some point, so it’s for the best that we understand them and most importantly, try to avoid them.

So, what exactly is an UTI? It’s an infection, typically caused by E. coli that originates from your or your sexual partner’s, stool, that infects your urethra and spreads throughout your urinary tract. Most of these infections stay in the lower urinary tract (bladder and the urethra) but they can become more serious if spread to our kidneys and where they could leave permanent damage.

UTIs are typically not difficult to treat and doctors use antibiotics to rid the body of them3.

What Are The Symptoms of a UTI?4

UTI’s do not always present symptoms, but you may have some indication by noticing your urination frequency, volume and color. Some common signs are consistently having strong urges to pee or having to habitually pee in small amounts. You may also feel pelvic pain in the center of the pelvis or a burning sensation along with a noticeable change in color. Infected urine may be cloudy or appear red, pink or brown, a sign of blood, and that comes along with a potent smell.  

Contact your physician if you are experiencing these symptoms.  When treated promptly, UTIs seldom lead to severe complications. Ignoring these symptoms and leaving them untreated can have serious consequences such permanent kidney damage or sepsis (blood poisoning) which can be life threatening5.

UTIs may be less symptomatic in older women than for younger women, making them dangerous as the UTI may cause unusual dementia-like symptoms. They may not know they have an infection, but there are usually signs of sudden behavior changes including confusion, agitation, or withdrawal6. These women should see a physician immediately.

Why Do Women Get So Many UTIs?

Let’s start by understanding the urinary tract. This is the body’s drainage system for urine, which is 95% water and 5% components filtered through your kidneys7. The urinary tract is consisting of 2 kidneys, 2 ureters that connect the kidneys to the bladder, where it is stored until it is time to urinate and exit the body through the urethra. Men and women have the same components to their urinary tracts, but a man’s urethra is approximately 4 times longer as it runs through the tip of the penis8.

Our shorter urethra allows for bacterial infections to be more common. When bacteria enter our body through the vagina, there is a shorter distance for the bacteria to multiply and reach the bladder9.  

Not only do anatomical differences make us more likely to have UTIs, but we have unique women-specific life events that increases our chances.

What Are The Risks of Getting a UTI?

While UTIs are common, they aren’t inevitable. We can take steps towards for prevention, especially if you are getting recurrent infections – experiencing two or more UTIs in a six-month period or four or more within a year10.

Let’s look at some common risks and preventions.

Pregnancy. In weeks 6 through 24 of pregnancy, women have an increased risk for infection as the womb is directly above top of the bladder. Each week as the baby grows its increased weight can block the urine drainage from the bladder, preventing bacteria from being flushed and allowing it to spread11.

The good news is that an UTI will not cause harm to your baby, but it can lead to kidney infection if not treated. Kidney infections are more serious because those can cause Mom to go into early labor and the infant may be born with a low birth weight12

Menopause. While this transition of losing our monthly periods is freeing from monthly physical and emotional discomfort, we also must adjust as our bodies stop producing hormones such as estrogen. Around 45, our bodies start to prepare for menopause by producing less estrogen as it’s no longer needed to help regulate our monthly cycles. Vaginal estrogen supports the “good” bacteria that fights the “bad” bacteria that can cause infections.  

If menopause cause you to consistently have UTIs there are vaginal estrogen options that come in low-dose creams and tablets, or rings that can be placed for a few months at a time13

Hygiene. Sometimes it’s the small things like washing your hands that can avert illness. For UTIs, how you choose to wipe can play a significant role in prevention. As we mentioned earlier women have a shorter urethra that runs through the end of our vaginal opening. That means that our urethra is also closer to our rectum (anus), a breeding ground for the infection causing bacteria14. So, doing something as simple as wiping from front to back after urination or bowel movements will help reduce the chances of an infection by pushing the E. coli AWAY from our urethra15. You can also avoid using the same tissue twice to reduce the risk even further.  

Holding Your Pee. We have all been there. Whether it’s, “2 more hours of back to back meetings, I think I can make it,” or “If I hold it a while longer, I’ll can ‘go’ at home, or “ I am NOT using this public restroom,” the real question is always the same, “How much longer can I hold off going to the bathroom?”

Hopefully, these situations are infrequent. Our bladders are impressive organs. They can hold up to 2 cups of urine, not requiring elimination for 3 to 4 hours16. While there is no research proving that holding your pee causes UTIs, many doctors recommend avoiding it, especially if a person has a history of frequent UTIs. The concern being that holding your pee causes your bladder muscles to tighten to prevent urine from leaking through your urethra. If you consistently hold for extended periods of time, you are not flushing out your urethra with urine, allowing bacteria to grow and infect the bladder.

Sexual Activity. Have you ever heard of “The Honeymoon Disease”? It’s actually the most common bladder specific UTI. It got its name because it’s more common with 20-year-old women having sex with men or older women who start dating and having sex again17.

When you have sex with a man, his penis can introduce bacteria by pushing it up the urethra and into the bladder during penetration. This is why it’s not just an old wives’ tale that it’s a good idea to urinate before and after sex. Urine flushes out the urthera, reducing the number of bacteria introduced to the bladder during intercourse.

Women who wear diaphrams have an increased chance of getting an UTI as the diaphragm presses next to the urethra, making emptying your bladder more difficult. Urine that stays in the bladder is more likely to grow bacteria and spread18.

How to Prevent UTIs

We have already discussed a few tips to reduce your risk of getting an UTI like wiping from front to back and urinating before and after sex to clean to keep the urethra free of bacteria like E coli that cause infections.  Here are some other healthy tips that can prevent infection.

Drink Plenty of Water. Water is important because our bodies use it to absorb key minerals, vitamins, amino acids, and glucose into cells and tissues to flush out toxins as well as regulate temperature19. As we flush toxins through our kidneys through urine, we are flushing the urethra ridding it of bacteria.   

Staying hydrated throughout the day will make you pee more frequently, flushing out your urinary tract, so DON’T HOLD IT. Women should drink around 2.7 liters (91 ounces) a day20 which is roughly 8 glasses.

Avoid Douching. Douching is a method of washing your vagina with a mixture of water and other solutions like vinegar or antiseptics, often with fragrances added. The mixture is delivered by using a bottle or bag that sprays the solution into your vagina. Between 20% to 40% of American women ages 15 to 44 use a vaginal douche, even higher in teens, African-American, and Hispanic women. Women who use douche say it makes them feel fresher by getting rid of unpleasant odors and removing menstrual blood after their period.21

But, health experts find douching is not effective and while it may wash out the bad bacteria that could cause a UTI it also washes out lactobacillius, the good bacteria. This affects the pH balance in the vagina which actually makes it easier for more of the bad bacteria to grow and spread into the urethra.22

Cleaning your vagina is obviously still important, but try this alternative to douching23:

  • Use a non-fragranced soap/wash
  • Gently hold the outer folds of your vagina back and rinse or splash with water
  • Do not scrub the area or get soap/washes inside your vagina
  • Rinse thoroughly afterward
  • Gently pat dry with a clean towel

Also, if you get UTI’s frequently, you should avoid baths and try switching to showers. Bath water can collect bacteria from your skin and allow for easy entry into your vagina and urethra.24

Loose and Cotton Pants. Athleisure clothing has gained in popularity over the past decade – and continues to grow year over year. We have never had so many comfortable options of leggings, sweatpants and underwear that we can wear to the gym and also suitable for school, work and day-to-day living.

You may prefer your yoga pants over your khakis because they keep everything in place and are way more relaxing, but you should consider more breathable fabrics like cotton if you are worried about an UTI. Skin-tight clothes trap moisture and creates a warm environment ideal for UTI-causing bacteria 25 Opt for cotton, or clothes with cotton crotches, in loose-fitting fabrics for underwear and pants.

While brands have continued to invest in this market, engineering fabrics that are more breathable and water-proof, you should always quickly change from wet or sweaty clothing to dry clothes at the gym or pool. This will reduce the chance for bacteria to flourish in our underpants and migrate to our urethras26.

Cranberries? “To prevent UTIs, you should drink cranberry juice”. Is that another wives tale or science? It may be a little bit of both. Scientifically the thought behind this is treatment is that E.coli causes about 85% of UTIs27. Some researchers believe that chemicals in cranberries prevent the E coli from attaching to the urinary tract, reducing your chance of getting an UTI.28 Other researchers cannot conclusively agree, but cranberries are a low-risk option and they do offer other benefits like anti-oxidants and a boost to your immunity.

Probiotics. As we mentioned, losing estrogen means you lose the support for the “good bacteria” that fights the UTI causing bad bacteria. This also happens after you have been treated with antibiotics that doesn’t discern between the types of bacteria it kills.  We can increase the amount of our good bacteria by incorporating more probiotics into our diet. Probiotics are live bacteria and yeasts that promote good digestive health29 and some studies show that it keeps the bad bacteria from growing in the vagina30. You can buy probiotics supplements or find it naturally in fermented foods like Greek yogurt, kombucha, sauerkraut, pickles, kimchi, sourdough bread and some cheeses (like Gouda and Gryere)31

Food is a way to help prevent UTI’s, it is NOT a method of treating a UTI.

For more nutritional information for women check out our article : Seven Nutrition Hacks for a Healthy Pelvis

Just Remember: UTI’s are Preventable! Stay dry, wipe from front to back, eat right and be mindful of how your body feels. Keep an eye out for the older women in your life that may be showing drastic changes in their behavior.

If you do feel you have a UTI, or find that you are getting UTIs frequently, contact your primary care physician. Your family doctor, nurse practitioner or other health care provider can treat most urinary tract infections. The sooner you get treated the faster you’ll have relief from pelvic and urination discomfort and reduce the chances of an infection spreading, causing more serious damage.  

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