Urinary Tract Infections (UTIs) in women

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What is a UTI?

Most UTIs involve the lower urinary tract — the bladder and the urethra.  A UTI can affect any part of your urinary system:  kidneys, ureters, bladder and urethra. Women are at greater risk of developing a UTI than men because their urethra is so short.

What causes UTIs?

Urinary tract infections are usually caused by bacteria normally found in the gastrointestinal system. Bacteria enter the urinary tract through the urethra and begin to multiply in the bladder.

When bacteria from the gut spread from the anus to the urethra it can cause an infection in the urethra (urethritis). Sexually transmitted infections, such as herpes, gonorrhea and Chlamydia, can also cause urethritis. Women who use catheters are more likely to get a UTI. Some older women are also more prone to UTIs. Having sex with a new partner or having sex for the first time in a while may also provoke a UTI.  A woman who has had more than three UTIs is more likely to keep getting these infections.

What are the symptoms?

Five to nine per cent of women with UTIs show no symptoms. Typical symptoms are:

• strong, constant urge to urinate
• small amounts of urine with a sensation the bladder is not empty
• burning sensation when urinating felt inside vagina or felt as pain deep inside
• cloudy urine
• urine that appears red, bright pink or brownish
• strong-smelling urine
• pelvic pain

 Painful urination may be mean cystitis (bladder infection), vaginitis, urethritis or a kidney infection.

Some symptoms depend on where the infection is located. For example, if it has settled in the kidneys, there could be upper back and side pain, high fever, chills, nausea or vomiting.  With any of these symptoms, a woman must go to the hospital immediately because she may need intravenous antibiotics.

 What tests need to be done?

Some health care providers write a prescription for antibiotics on the basis of signs and symptoms alone.  If there is every reason to believe it is a UTI and it clears up with antibiotics in 24 – 48 hours, that’s what it was.  Other health care providers may spend more time asking questions like:

“Do you think you have a UTI? Do you have pain when you urinate? Is your vagina irritated?”

Your health care provider may want to dip the urine for signs of infection as well as send a urine sample for analysis. If they treat you for a UTI and the laboratory result shows the correct antibiotic was used, that’s the end of it.

 If there is a possibility of an STI, some health care providers will do an internal examination (with two fingers in the vagina and the other hand pressing on the belly) to ensure that the pain is coming from the bladder and not the uterus. If you were at risk for an STI, some health care providers will also either do a swab or order a second urine sample for a specific test to rule out gonorrhea or Chlamydia. If there is discharge from the urethra or the vagina, they may suspect chlamydia. Or if the symptoms came on slowly, that is another reason to consider Chlamydia. Your health care provider may also want to check for symptoms of herpes and mycoplasma.  There are specific treatments for each of these infections. If you have had unprotected sexual activity that may have exposed you to any of these bacteria, it is important to tell them.

What is the treatment?

The antibiotic used depends on the bacteria causing the infection. It is important to take all your medication for the length of time prescribed. While waiting for the medication to work, some women find relief taking sitzbaths in very hot water, or peeing in the bathtub. Although it may be tempting to avoid drinking water because you will have to urinate more frequently, it is important to flush out the bacteria. The ideal is one good flow per hour.

What if you don’t get treated?

Aside from ongoing pain, a UTI can infect the kidneys causing permanent damage.  It is four times more likely to travel to the kidneys in pregnant women, so it needs to be treated even if there are no symptoms.

How can you prevent UTIs?

• Wipe from the vaginal area towards the anus.
• Urinate before and after any sexual activity involving the genital area.
• Drink water after sexual activity to flush out the urethra.
• There is some evidence that for women who get frequent UTIs, drinking unsweetened cranberry juice may help to prevent them.

It can be distressing, painful and even embarrassing to get a UTI, but in most cases, with treatment it clears up quickly. UTIs are very common.

This FAQ may provide medical information, but is not meant to be a substitute for medical advice. When you have questions about your health, it is always advisable to ask a health care practitioner.

Created October 2013.