Myths and Truths About Urinary Tract Infections

Urinary tract infections (UTIs) are one of the most common infections in women.

A UTI can occur anywhere along the urinary tract, including in the kidneys and along the tubes (ureters) that connect the kidneys to the bladder. More commonly, though, infections involve the lower urinary tract: the bladder (where urine is stored) and the urethra tube that empties urine.

Elodi J Dielubanza, MD, a Mass General Brigham urologist, addresses common myths and truths about UTIs.

What are the symptoms of a UTI?

For patients, the first question is when to see a doctor after feeling the initial symptoms. Typically, these symptoms are burning pain with urination, urgency and frequency of urination, and pain above the pubic bone.

“Our bodies sometimes can clear these infections on their own,” says Dr. Dielubanza.

But if symptoms do not get better within a couple of days, contact your primary care provider (PCP). Antibiotics may relieve symptoms shortly after you begin taking them.

When should you call your doctor about a urinary tract infection?

See a doctor right away if you have:

• Fever
• Flank pain (pain in your upper abdomen, side, or lower back)
• Flu-like symptoms or four-smelling vaginal discharge
  

These may be signs that your body may be fighting more than an uncomplicated UTI. Contrary to a common assumption among patients, the smell or appearance of urine by itself is not a reliable measure of infection, said Dr. Dielubanza.

UTI myth: Hygiene habits and clothing fit contribute to UTIs.

You may have heard that certain hygiene practices are risk factors for UTIs, particularly for women. But UTIs are not caused by how you wipe in the bathroom, by tampon use, or by failing to empty your bladder after sex. They’re also not caused by wearing tight clothes.

“A lot of women express concern about these,” says Dr. Dielubanza. “But studies have shown there is no association between these practices and UTIs.”

UTI fact: Having a vagina is the biggest risk factor for UTIs.

UTIs generally are caused by bacteria that live in the colon, especially the rectum. The short length of the urethra places its opening close to bacterial reservoirs (the anus and vagina), making women more vulnerable to infection.

“In truth, having a vagina is simply the strongest risk factor for UTIs,” says Dr. Dielubanza.

Another trigger particular to women is hormonal change with age. Until menopause, vaginal flora (microbes that normally live in the vagina) includes protective bacteria. But when estrogen drops during menopause, the pH of the vagina changes, and the good flora cannot thrive there as easily. Without these good bacteria, the “bad” bacteria can more easily flourish in postmenopausal women.

Men are not immune to UTIs, but they are less likely to have them. This is because their longer urethras present a challenge to bacteria entry. However, as men age and begin to empty their bladders less efficiently due to prostate enlargement, urinary tract infections can become more common.

A trigger for UTIs in both men and women is use of any medical instrument near the urethra, including a catheter to drain urine.

Some myth, some truth: Sexual activity

Sexual intercourse (or intercourse-like activity) indeed can be a strong trigger for a UTI, as can any activity that has the potential for putting infection-causing bacteria near the urethra.

“Your partner’s anatomy can act as a ladder for infection of the urethra with bacteria that usually live in the bowel,” says Dr. Dielubanza.

Use of spermicides with or without barrier contraceptives has been shown to increase the risk of urinary tract infections in sexually active women. Women may consider an alternative contraceptive regimen if they experience UTIs after sex.

UTI fact: Type of UTI test matters, especially for frequent infections

For patients with recurrent urinary tract infection (3 or more infections within 12 months, or more than 2 infections within 6 months), your doctor likely will culture your urine to determine the specific type of bacteria causing your infection. A culture is more informative than a dipstick urine test that reveals only whether an infection is likely to be present.

The right test is particularly important for someone who experiences recurring infections. “This is to be sure that your symptoms truly are due to infection and that the antibiotics usually used for these infections are appropriate for you,” says Dr. Dielubanza.

UTI myth: A long course of antibiotics is best.

Typically, antibiotics are prescribed for 3 to 5 days for symptoms confined to the lower urinary tract in patients who have no fever, flank pain, or flu-like symptoms.

“Longer courses do not increase the likelihood of clearing the infection,” says Dr. Dielubanza. “But they do increase the risk of antibiotic resistance, increase the risk of yeast infections, and increase the risk of infectious forms of diarrhea.”

A longer course may be required for someone who has more severe symptoms of an infection or if the infection is in the bladder. Always follow all instructions and take antibiotics for the number of days prescribed.

How to prevent UTIs

You may hear or read about prevention strategies for UTI, with cranberry supplements among the most popular. But the data is mixed about the role of cranberry to prevent UTI. Data thus far have shown no benefit or have been inconclusive.

The body’s best defense against urinary bacteria is adequate urine flow to wash away bacteria. Maintaining adequate hydration and avoiding urine holding are good strategies for prevention.

Increasingly, doctors are advocating probiotics via diet (yogurt, kefir, fermented foods) or supplements. While there is no evidence that probiotics alone offer sufficient protection against UTIs, they can be effective when used along with other prevention strategies by promoting healthy vaginal and bowel flora.

Women who experience recurrent UTIs can discuss possible medical prevention strategies with their doctor, such as low-dose antibiotics and vaginal estrogen replacement after menopause.