Understanding and treating UTIs, which affect about 50% of women

Autumn Edenfield, M.D., helps women deal with what can be a really uncomfortable but common problem: urinary tract infections. “About 50% of women in their lifetimes will have a UTI,” the MUSC Women’s Health urogynecologist said.

 

Those women – and some men, although a far smaller number for anatomical reasons – may feel like they need to urinate all the time and feel pressure in the groin area – just a couple of the symptoms a UTI can cause. The symptoms depend on where the infection is.

“Most commonly, it’s going to be the bladder, but it can be anything from the urethra all the way up to the kidneys. A kidney infection is going to be much more severe and less common than bladder infection. Most people, when they throw around the term UTI, they mean a bladder infection.”

And usually, they’re talking about UTIs in women. “Men can get urinary tract infections, but it's much less common. The female urethra is much shorter. So there's a much shorter distance from the outside world where bacteria get to the bladder.”

Risk factors for UTIs

There are multiple factors that raise the risk for getting a UTI. A big one: age. “We see an uptick when women are postmenopausal. There's a lot of interplay with estrogen in the vaginal tissues and the vaginal flora and even the lower urinary tract. So low estrogen changes in the lower urinary tract and urogenital tract are probably the biggest risk factor that I see for UTIs.”

Another risk factor is being sexually active. “It's just mechanical. There's more ability for the bacteria to get moved or flushed up the urethra. It's not considered a sexually transmitted infection, but a lot of women can have UTIs after intercourse.”

Edenfield said medical conditions can play a role, too. “Anything that suppresses the immune system. That means people who are on different immune suppressive drugs. Poorly controlled diabetes, that's a big risk factor. There are certain diabetes medications that can slightly increase the risk of UTI or even yeast infections.”

Other risk factors for UTIs include having had one before, being pregnant and poor hygiene that might occur in kids who are potty-training.

UTI treatments

The good news is there are plenty of pathways to relief, Edenfield said.

“Typically, you want to drink more fluid to flush out the bladder. And then there are some over-the-counter bladder pain relievers. The most common one is the name brand AZO. It's phenazopyridine. And so that can help with the discomfort.”

But if the symptoms don’t go away in 24 hours, Edenfield said it’s time to see a health care provider to get antibiotics. It doesn’t have to be in person. “Through MUSC, for example, you can do telemedicine visits for UTIs. And that's appropriate in certain populations. You don't necessarily need to come in and have a urine test unless you're someone who has recurrent or frequent UTIs or symptoms are unclear or not necessarily consistent with a typical UTI.”

Preventing UTIs

There are some steps people can take to try to prevent UTIs. They include urinating after sex, wiping front to back, drinking plenty of fluids and taking showers instead of baths.

Edenfield said there are also supplements that may help. “Probably the one people know the best is cranberry, more so the cranberry tablets or supplements, compared to the juice. There's also some evidence on a supplement called D-mannose, which is carbohydrate. It doesn't increase blood sugar, so it's safe in diabetics.”

She explained the idea behind the supplements. “They keep the bacteria from sticking to the bladder cells and then creating a biofilm that creates the infection to begin with. So that's the idea. Both slightly different mechanisms, but that's the idea behind both cranberry tablets and D-mannose.”

When it comes to postmenopausal women, Edenfield said low-dose vaginal estrogen has been shown to be more effective than OTC supplements and safe for nearly all women. “It helps to promote the good bacterial flora in the area, the lactobacillus that we want in that area. That then lowers the pH and makes the whole environment less hospitable for bacteria.”