UTIs: which women are affected?
Chances are if you’ve got a vagina you’ve had a UTI. You probably know the feeling of going to the loo and it being nigh on impossible and stinging so much you wonder if you will ever wee in comfort again. And then sitting back down at your desk only to go again after about five minutes, because you’re on your third litre of water of the morning, and are popping cranberry pills like smarties even though no one seems to know whether they actually work or not.
For most women, UTIs are things that pop up occasionally, no matter how hard you try to avoid them. You may religiously use the bathroom immediately after sex, and religiously drink more water than you thought was humanly possible, and still they keep coming. Despite their common nature, they’re not something widely discussed — and it’s unlikely that many of us can separate the myths from the truth.
So just how many people are affected by UTIs in the UK? What should you do if you have one? Why are some people more prone to UTIs than others?
The most common type of UTI is an infection of the bladder, known as cystitis, but UTIs can also affect the urethra. This, and cystitis, are known as ‘lower UTIs’. These cause the classic symptoms with which we are probably all familiar — needing to pee more often, pain when peeing, sudden urges to pee, feeling generally unwell. Other symptoms include pain low in the tummy, the feeling of not being able to actually empty the bladder, and urine that is cloudy, or foul-smelling, or even containing blood.
If the kidneys or ureters, which connect the kidneys to the bladder, are infected, then this is known as an upper UTI. As well as the classic symptoms above, these infections can also cause high temperature, pain in your sides and back, feeling sick, and confusion. Unlike lower UTIs, which are easily resolved, upper UTIs can be dangerous as they can damage the kidneys or spread to the blood stream. Generally, UTIs are treated with antibiotics, and symptoms should clear after about three days of the course. Upper UTIs may require intravenous fluid replacement, and if you’re showing symptoms of an upper UTI you should go straight to A&E.
UTIs are caused by bacteria entering the urinary tract. Normally, this is because bacteria from the gut get in through the urethra, which can occur easily — even just after having sex, for example. It’s not clear why it happens, but as the urethra, vagina, and anus are so close together in women, and as women’s urethras are much shorter, this would explain why UTIs affect women much more frequently than men.
Certain things can mean you are at increased risk of getting a UTI, including if you have difficulty emptying your bladder fully normally, or have a condition obstructing your urinary tract, such as kidney stones. A weak immune system, from having chemotherapy, for example, or HIV, can also mean you are at increased risk, as can using a contraceptive diaphragm, or condoms.
People with diabetes are particularly susceptible to UTIs because bacteria feast on the sugar in urine. A report from the American Diabetes Association showed that 9.4% of people with type 2 diabetes were diagnosed with a UTI in a year compared to 5.7% of those who hadn’t been diagnosed with diabetes. Recurrent infections were also more common in those who had had a type 2 diabetes diagnosis. Other factors making it more likely that someone with type 2 diabetes will contract a UTI include the fact that those with diabetes tend to have weaker immune systems and their circulation is also affected. This means the passage of white blood cells, which are required to fight infections, is blocked.
Some women may find they suffer from UTIs frequently even if they don’t have a medical condition causing this, and other women may find they have trouble getting rid of them. While there are numerous ways it is suggested you can mitigate the risks, it is unclear exactly how many of them actually work. Suggestions include avoiding perfumed bubble bath and having showers rather than baths, and peeing before and after sex. Wiping front to back hasn’t been proven to be a preventative measure but seems to always be included in standard advice, as does staying hydrated, and going to the toilet as soon as you need to pee.
Evidence of the benefits of probiotics and/or cranberry tablets or cranberry juice is sketchy. When it comes to cranberry there have been numerous studies that seem to either prove it works, or expose it as useless. Two recent examples of this are two studies conducted in 2016. One, published in the American Journal of Clinical Nutrition claimed cranberry juice is indeed ‘useful’ for women with UTIs, and even had The Telegraph claiming the fruit could reduce the global use of antibiotics.
However, although the study was conducted with 373 women who drank either a 240ml bottle of cranberry juice or a placebo every day for six weeks, it only seemed to reduce infections, rather than treat them, meaning that infected women would still need antibiotics and that starting drinking cranberry juice when you already have a UTI may not work. It is unlikely that the majority of women would want to drink the juice daily, considering it is high in sugar, and expensive. Finally, the study was funded by Ocean Spray Cranberries Inc, and two authors of the study work for the firm.
A second study, from Yale School of Medicine, found no evidence that cranberries can fight bladder infections. This one used a combination of genuine and placebo cranberry capsules on people in nursing homes, a group that is particularly vulnerable to UTIs. Over the course of one year, the cranberry made no difference to the presence of bacteria in urine. On top of that, there was no reduction in bladder problems.
The evidence for the benefits of probiotics is a tiny bit more compelling, although there still isn’t sufficient research for doctors to come to a firm conclusion. A 2011 study, published in Clinical Infectious Diseases found that replenishing naturally occurring bacteria that live in the vagina did limit recurrent UTIs in women. During the course of the study, seven of the 50 women who received an intravaginal suppository probiotic experienced a recurrence of UTIs, compared with 13 of the 50 women given a placebo. Nonetheless, a 2015 literature review found there was not enough evidence to prove success of probiotics in preventing recurrent infection compared with placebos, and not enough evidence to show whether or not probiotics were better than antibiotics at treating UTIs.
In short, there are no hard and fast rules or conclusions about what is the most effective preventive measure and why some women seem particularly susceptible to UTIs. The best you can do is eat a healthy, varied diet, and take regular exercise to ensure a good immune system, as well as maintaining good hygiene. If certain things trigger UTIs for you, it could be worth looking at those and seeing what changes you can make, or asking your GP for advice. If you’ve never had a UTI before and you get one, don’t panic — they’re very easily treatable.