We spoke to Dr Tlaleng Mofokeng, a medical doctor and an activist for sexual reproductive health rights about the causes, symptoms and prevention of urinary tract infections.
A urinary tract infection (UTI) is an infection affecting one or more parts of the urinary system, namely the kidneys, ureter (the duct through which urine passes from the kidney to the bladder), bladder and urethra. Although the most common and simple infections involve the bladder and the urethra, located in the lower urinary tract, serious illness can occur if a UTI spreads to the kidneys. This applies to everyone, even children can have UTIs, however it is uncommon for men to get a UTI.
The signs and symptoms of urinary tract infections (UTIs):
(Not all urinary tract infections cause symptoms but these are the most common ones)
- An urge to urinate, even small amounts of urine result in this persistent urge
- A burning sensation when passing urine
- Passing frequent, small amounts of urine
- Urine that appears cloudy
- A sign of blood in the urine such that it appears red, bright pink or cola-coloured
- Strong-smelling urine
- Pelvic pain, in women, especially in the centre of the pelvis and around the area of the pubic bone.
What causes UTIs?
Some women have recurrent UTIs and some sexually transmitted diseases can share symptoms similar to a UTI such as lower abdominal pain, burning urine and frequent or painful urination. Cystitis, an infection in the bladder, is usually caused by Escherichia coli (E. coli), a type of bacteria commonly found in the gastrointestinal tract. Sexual intercourse may lead to cystitis, but you don’t have to be sexually active to develop it. The short urethra, which is normal for women, means that the urethral opening and distance from the urethra to the anus, versus the distance between the urethral opening of a penis and the anus, make UTIs common in some women.
Pregnancy, diabetes, kidney stones and other conditions affecting the flow of urine can predispose one to UTIs. The bacteria that is sometimes isolated during a laboratory urine test is called E.coli, a bacteria commonly found in faeces. Urethritis is an infection in the urethra and because the female urethra is close to the vagina, sexually transmitted infections such as herpes, gonorrhoea and chlamydia can cause urethritis.
Some risk factors for the development of a UTI include urinary tract abnormalities, which often show up in infancy because they are congenital. These can include kidney stones and an enlarged prostate that can trap urine in the bladder and decrease emptying thereby increasing the risk of UTIs. Diabetes, and other diseases that impair or weaken the immune system, as well as catheter use by those who can’t urinate on their own, have an increased risk of UTIs. Any urinary tract procedure or surgery that involves medical instruments or devices such as the placement of a urinary catheter or chronic use of an in-dwelling catheter, can increase the risk of developing a urinary tract infection.
Fortunately, UTIs are easy to diagnose and treat. Common UTI disorders caused by E.coli and staphylococcus bacteria respond well to treatment and the antibiotic course is short. Some recurrent or persisting issues may be an indication of other illnesses being present.
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What is interstitial cystitis?
Interstitial cystitis is an example of a urinary tract disorder than can impact social life, exercise and sleep. The inability to work or enjoy sex is what often prompts more diagnostic tests and specialised management. Interstitial cystitis is a condition that affects sexual pleasure the most and carries other symptoms such as pressure in the bladder, pain in the vulva and vagina, lower abdominal back, pelvis or urethral pain. In men the pain can be located in the scrotum and testicles, with pain experienced during orgasm or after sex. The symptoms can vary weekly or be recurrent for months or even years.
Urinary urgency and frequency are also common. The bladder pain can range from a dull ache to piercing pain. Some causes include nerve problems, douching, an auto-immune disease or another condition such as diabetes that can cause inflammation and also affect the bladder.
Common bedside tests to diagnose recurrent UTIs and interstitial cystitis can be done as well as laboratory or imaging tests such as consultation with the urologist, a cystoscopy (an instrument inserted into the urethra for examining the urinary bladder) can be ordered and when necessary, a bladder and and urethra biopsy can be obtained.
Treatment for interstitial cystitis is mainly about symptom control. It takes trial and error to find the right combination of treatments and it usually takes weeks or months to calm the symptoms. The first stage of treatment of interstitial cystitis is to try to avoid triggers and make lifestyle changes that may help ease symptoms. Smoking may worsen pain and contributes to bladder cancer.
Foods to avoid – common bladder irritants
- Carbonated beverages
- Caffeine in all forms (including chocolate)
- Citrus products
- Food containing high concentrations of vitamin C.
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How to minimise your urinary tract infection (UTI) risk:
- Wash your genitals before and after sex; both you and your partner
- Drink at least five to eight glasses of water every day to flush toxins out of the bladder
- Drink 100% cranberry juice. Its acidity helps to stop E. coli from implanting in the bladder
- Urinate before and after sex; as well as throughout the day
- Wipe the vagina from front to back to keep bacteria away from the urethra (the urine pipe in women is short therefore it is easy for bacteria to reach the bladder)
- Take showers, not baths, so you’re not sitting in water that may contain bacteria
- Avoid douches, spermicides, and diaphragms, all of which may irritate the genitals and increase your risk of infection
If you have recurrent or persisting UTIs, try different sex positions, use cushions to change the angle of penetration and apply lubricants to the vulva to avoid excessive friction and dryness.
Dr Tlaleng Mofokeng is the author of Dr T: A Guide To Sexual Health & Pleasure published by PanMacmillan.