Urinary tract infections (UTIs) are some of the most common conditions that we see in our office every day. Almost every woman will have an infection at some point in her life. UTI is a catch-all term that means an infection anywhere in the urinary tract, which in women could mean kidneys (pyelonephritis, characterized by fever) or bladder (also called “cystitis”, with typical painful urination, frequency, urgency). We often use “UTI” and “bladder infection” interchangeably.
They seem to occur at times of hormonal or sexual change: a young teen starting her period is more prone, a honeymooner beginning to be sexually active, a woman going through or who has gone through menopause. The vaginal pH is very sensitive to estrogen and when that pH is out of whack, the bacterial balance gets off kilter and a UTI is more likely to occur.
UTIs also occur when the body is stressed, either physically or mentally. The immune system is weakened and the normal barriers to infection are not as strong. We see this a lot: after surgery, when a husband dies, or work is super-busy patients are more likely to get infected.
But usually they occur for no good reason at all. As women, we have naturally short urethras (the tube that goes from the bladder to the outside), and bacteria are always getting in there. If we are flushing them out and the local area is healthy, then we don’t get infected. When there is a compromise in the system, we tend to get infected.
What are the natural immune barriers? Well, first of all, if you are overall healthy and exercising, not smoking and taking care of yourself in general, then the blood flow to your pelvis is good and that makes the whole area healthier and able to function normally. Drinking plenty of water to stay hydrated and to flush the bladder regularly will wash out any bacteria that are trying to take an opportunity in the bladder. The bladder itself has a natural layer of glycosaminoglycans that protects the bladder wall from infection. These are the fundamental blocks to infection.
When a patient comes in with recurrent UTIs, we will ask about their fluid intake, sexual correlation, other health issues, surgeries in the area, and menopausal status. We will do a thorough examination of the pelvic area, including measuring how much urine is left behind after voiding to make sure the bladder empties well. And we will look at the urine under the microscope.
If someone has more than 3 UTI in a year, then we will look more in depth: renal ultrasound to look at the kidneys, x-ray to look for stones and a bladder scope (cystoscopy) in the office to evaluate the bladder wall. Sometimes we will order a CT scan if there has been blood in the urine.
Some other causes of recurrent UTI that we are looking for: urinary stones, urinary obstruction, and although unlikely, bladder tumors. In thousands of scopes for UTI, I’ve found two tumors, but I sure wouldn’t want to miss one.
So drink your water, exercise to keep that blood flowing and to help manage stress, and eat lots of fruits and veggies. And hopefully you will be able to stay away from the urology office!