Urinary tract infection (UTI)

What is a urinary tract infection (UTI)?

A UTI is an infection of your urinary tract – this can involve anywhere from your kidneys, ureters (tubes connecting your kidneys and bladder), bladder, and urethra (pipe connecting your bladder to the outside). Most commonly, UTI involves the bladder.

Adult women have UTIs more often than men as their urethra is shorter and nearer to the anus, making it easier for bacteria to enter. 

What are the symptoms of UTI?

• Painful urination
• Frequent urination (but little or no urine passed)
• Blood in your urine
• Pain in your lower pelvis 
• Fever

What are the risk factors for UTI?

• Menopausal changes (vaginal atrophy): low estrogen cause tissues in the genital region to be thinner and dryer resulting in higher risk of infection 
• Pregnancy: suppressed immune system 
• Sex (in some women)
• Bladder or kidney problems e.g. stones 
• Surgery (or having a urinary catheter placed)
• Not being to empty bladder completely (retention of urine): this may be more common in women who are elderly or have medical conditions such as diabetes, dementia, stroke, previous spine surgery 

What tests are needed to diagnose UTI?

You will be asked to produce a urine sample – clean your vaginal lips before passing urine and catch the middle portion of your urine stream. A microscopic analysis is first done to check for the presence of white blood cells in your urine sample, which indicates the possibility of a UTI. A urine culture is then performed over a few days to determine the bacteria in your urine (if any) and the appropriate antibiotics that kill the bacteria. 

If you have recurrent UTIs (≥2 UTIs in the last 6 months or ≥3 UTIs in the last 12 months which are culture confirmed), you will need to undergo further tests which may include:

• Ultrasound or CT of your kidneys and bladders
• Cystoscopy (scope to check the inside of your bladder)

What is the treatment for UTI?

Your doctor will prescribe a course of oral antibiotics, which you will need to complete. Sachets that alkalinize your urine e.g. citravescent can help. Drink lots of water to dilute your urine. Occasionally, if there are no suitable oral antibiotic options for your UTI, or if your UTI is severe/complicated, you may need to be hospitalised for intravenous antibiotics. 

If the issue is chronic retention of urine, urine catheters (tube to drain urine) may necessary in the short or long-term. Menopausal changes (vaginal atrophy) can be treated with topical vaginal estrogen (creams and tablets).

How do I prevent myself from getting UTIs? 

• Drink 7-8 cups of water every day  
• Drink at regular intervals (1 cup every 2-3 hourly) 
• Pass urine at regular intervals (every 2-3 hourly) – do not hold your bladder excessively 
• Avoid constipation
• After using the toilet, always wipe from front to back
• Avoid douching or feminine wash as it may irritate your vulva skin and increase the risk of infections
• Wear cotton underwear and loose fitting clothes 
• Keep your diabetes under control 
• Lubricate during sex
• Go to the bathroom before and as soon as possible after sex 
• Take a balanced diet and include probiotics (e.g. yakult, vitagen, yoghurt, cranberry juice etc)