TORONTO - It's not something most women want to talk about — well, maybe to their closest gal pals — but as medical conditions go, this one is pretty common and irritatingly so.
Urinary tract infections, or UTIs, can not only be painful, but also cause embarrassing and anxiety-provoking symptoms. They are a particular scourge for women, who for anatomical reasons are far more susceptible than men to developing the pesky disorder.
Indeed, about half of all women will experience a UTI at some point in their lifetime, and some women get them over and over again, making them more than just a nuisance.
Urinary tract infection is a non-specific term that refers to a bacterial infection in any part of the system responsible for removing urine from the body, including the bladder and kidneys, says Dr. Lesley Carr, a urologist at Sunnybrook Health Sciences Centre in Toronto.
UTIs typically start in the urethra, the narrow tube that runs from the bladder to the opening where urine is released. If the infection moves upwards to the bladder, it too can become infected, causing a condition known as bacterial cystitis.
Should the bacteria invade the kidneys, which are linked to the bladder by two long tubes called ureters, the infection is considered more serious. Left untreated, a kidney infection can lead in very rare cases to sepsis, an infection of the blood that can be fatal.
"The most common is bladder infection," says Carr. "It often irritates the bladder so there's increased frequency of having to void or urgency, having to get (to a bathroom) quickly.
"Often there's pain and that could be pain in the bladder area, felt above the pubic bone, and also what we call dysuria, which means pain during the actual act of voiding, often radiating down along the urethra."
That pain is often described as burning. And depending on the extent of the infection, it can be so excruciating that women will desperately try to limit how much they pee.
Other signs of a UTI can include foul-smelling and cloudy urine. "There could even be blood in the urine or blood on the toilet paper," Carr says.
Despite noticing some abdominal pain, Eileen Woods had no idea she was experiencing her first urinary tract infection three years ago. It wasn't until she went to the bathroom and spotted blood on a light pad she was wearing that she realized something was wrong.
"It panicked me a bit," admits Woods, 80, of Burlington, Ont., just southwest of Toronto. "It was frightening."
Woods went to the hospital emergency room, where doctors performed a number of tests and concluded she had cystitis.
She was immediately started on a course of oral antibiotics, the standard treatment for most urinary tract infections.
Some women with a UTI will get what Carr calls an overactive bladder — needing to urinate frequently and with an embarrassing out-of-the-blue and not-to-be-denied urge to go — but little pain.
And some women, typically those who are postmenopausal, will have no apparent symptoms at all. Often their infections are so low-grade, doctors don't actively treat them but ask women to keep an eye out for any sudden onset of symptoms.
"If they're getting fever, worsening pain, blood in the urine — that's a different story," says Carr. "They really should be on antibiotics at that point."
Urinary tract infections are usually caused by a strain of E. coli, a type of bacteria commonly found in the gastrointestinal tract that migrates to the urethra and up into the bladder.
Men get UTIs, but the incidence in females is 10 to 20 times higher due to the female anatomy — specifically, the close proximity of the anus to the urethra.
Sexual intercourse may also promote cystitis, and because the urethra is close to the vagina, sexually transmitted bugs like herpes, gonorrhea and chlamydia can also infect the urinary tract.
Postmenopausal women are often more prone to UTIs because diminished estrogen levels cause changes in the urinary tract that make it more vulnerable to infection. Doctors may prescribe a vaginal cream containing estrogen to reduce that risk.
"Sexual activity, regardless of age, increases the risk," says Carr. "It's probably multifactorial, but the act of intercourse will push the bacteria that are in the vaginal area up into the urethra.
"So that's why we often talk about behavioural strategies: drinking more and then voiding after intercourse to flush out any bacteria that got introduced into the urinary tract.
"But there's also some association with different forms of contraception. Spermacides can kill off the good, normal bacteria and change the makeup of the bacteria in the vagina. Things like diaphragms have been associated with UTIs as well."
Impaired bladder emptying, urinary incontinence, obstructed urine flow due to kidney stones in the urinary tract, diabetes and a suppressed immune system can also increase the risk of developing a UTI, as can the use of a urethral catheter, says a recent Mayo Clinic Health Letter.
Some women get repeated UTIs, and for a variety of reasons: an antibiotic may seem to stop the infection but not produce a lasting cure; an infection can recur when a woman is exposed to a different bacterium; and frequent sexual intercourse, especially with different partners, also increases the risk of recurrence.
The best treatment for urinary tract infections, doctors say, is to try to prevent them in the first place.
Carr said that means practising "healthy bladder habits," which includes staying well-hydrated by drinking lots of fluids and flushing out the system by urinating regularly — "so they're not holding for, let's say, more than about three hours during the daytime, and voiding after intercourse."
For women who get repeated UTIs, she suggests drinking a glass of unsweetened cranberry juice each day or taking a daily cranberry extract caplet.
Cranberries contain compounds called proanthocyanidins, which are thought to prevent bacteria from adhering to cells lining the urethra and bladder, so they can't get a foothold to cause infection. While there's no evidence that ingesting the tart fruit can treat an active UTI, studies suggest daily doses may prevent recurrence.
"For the majority, those simple behavioural strategies will help," says Carr.
Woods, who has now had a few UTIs, makes sure she drinks lots of water and takes a cranberry caplet daily to try to prevent another recurrence.
Because she has Parkinson's disease, which can affect the ability to fully void the bladder, Woods is at greater risk for the infections.
But Carr says that even sticking to the best bladder habits doesn't guarantee an end to this irksome infection.
"Some women do all the right things and they're still plagued with it. There is certainly genetic and other factors that we know that no matter how well they stick with those behavioural therapies, they still suffer a lot with them."
