What doctors wish patients knew about UTI prevention

A strong urge to urinate that doesn’t go away, a burning feeling when urinating and any other discomfort or problem with urination, can be signs of a urinary tract infection (UTI), which is very common in the U.S. While most UTIs are not serious, some can lead to further complications such as kidney infections. That is why knowing the first signs of a UTI and what to do are key.

UTIs, which happen when bacteria get into any part of the urinary tract such as the kidneys, bladder or urethra, cause more than 8 million visits to the doctor annually. About 60% of women and 12% of men will have at least one UTI during their lifetime, according to the American Urological Association.

The AMA’s What Doctors Wish Patients Knew™ series provides physicians with a platform to share what they want patients to understand about today’s health care headlines.

For this installment, two physicians took time to discuss what patients need to know about UTIs and how to manage the symptoms. They are:

• Jennifer J. Bryan, MD, a family physician in Flowood, Mississippi, and a delegate in the AMA House of Delegates for the Mississippi State Medical Association.
• Laura L. Steers, MD, an ob-gyn in Iowa City at the University of Iowa Hospitals & Clinics, which is a member of the AMA Health System Program.

“Most women who are having symptomatic UTIs will present with burning with urination. So, all of a sudden, they have this onset of pain with urination,” Dr. Steers said. “The other kind of classic symptoms would be needing to go to the bathroom more frequently or urgently—so needing to get to the bathroom quickly.

“If those symptoms are new, that could be concerning for a urinary tract infection,” she added. “In older women, especially, sometimes urinary tract infections are a little bit more subtle, and they may not notice that burning with urination, but might notice more abdominal pain or they might just feel generally unwell—they might have fevers or chills, they might have malaise or nausea and vomiting.”

“If the infection has set up a little and has developed, it might be a little bit more serious—you might develop some back pain or even fever, chills, nausea, vomiting and just feeling bad in general,” Dr. Bryan said. “It’s important to pay attention to those symptoms and to seek care when they develop.”

“We think of urinary tract infections a lot of times as just being an infection of the bladder or urethra,” Dr. Steers said. “But when that urinary tract infection goes upwards up the urinary tract, it can start to climb up the ureter and enter the kidney.

“That’s called pyelonephritis. So, that would be an infection of the kidney. From there, it’s very easy for the bacteria to jump into the bloodstream and cause sepsis,” she added. “And from there, sepsis can cause multiple organ failure, kidney or lung problems—those kinds of things.”

“A UTI is often thought of as being a minor issue, but it can be life threatening,” Dr. Bryan said. “It’s not anything to take lightly. Even if the symptoms are minor, you need to get it taken care of.” 

There are times where symptoms may not show and it leads to a worsening condition, which is seen “more in our elderly patients or maybe somebody who lacks sensation. For example, if they have a neurologic issue where they can’t sense that they’re having symptoms,” Dr. Bryan said. “So, it’s important to know if you’ve had a history in the past because certainly we’ve seen those patients.”

“But know your body and listen. Pay attention and if something even begins to feel off to contact your doctor and get evaluated,” she said, noting “there are instances where people will have no symptoms and an infection can sneak up, but that would be the exception.”

“There seems to be an unfortunate genetic subset of people who have recurrent urinary tract infections,” said Dr. Steers. Those more prone to UTIs include “postmenopausal women, women who have prolapse, women with decreased immune response like diabetes or women who get kidney stones more frequently.”

“If you have urinary tract infections frequently, we call it recurrent urinary tract infections,” she said, noting that “women meet those criteria by either having two culture-proven urinary tract infections in six months or three within 12 months.

“And those women often will be synced up pretty closely with either a urogynecologist or a urologist and they will have more frequent antibiotics, and they might be on a daily prophylactic antibiotic,” Dr. Steers added.

“Hygiene in the bathroom is also a predisposing factor for UTIs,” Dr. Bryan said, which means it is important to “make sure that we cleanse from the front to the back to minimize the spread of bacteria.”

“That’s because the bacteria that cause a urinary tract infection usually comes from stool or just being colonized there sometimes from e coli and other bacteria found in the gastrointestinal tract,” she explained. “Attention to general hygiene can reduce the risk of UTIs.” 

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“Sexual activity is definitely a predisposing factor in urinary tract infections,” Dr. Bryan said, noting that sexual intercourse itself does not directly cause UTIs, but it can increase the likelihood.

This is because “bacteria in the genital or anal region can enter the urethra during sex, so urinating before and after sex can definitely decrease the risk of a UTI,” she said. “Fully showering and bathing before and after sex can help too.”

“Pregnant women oftentimes don’t know that they are at increased risk for urinary tract infections, or they may not be aware of the risk of progression of UTIs,” Dr. Steers said.

“While they are common for women and mild for most women outside of pregnancy, they can be quite dangerous in pregnancy,” she added, emphasizing that “pregnant women need to present to the doctor sooner than nonpregnant women and get treated for a UTI.”

“Just like any infection, there’s more bacteria that are present in the hospital because there are lots of sick people around,” said Dr. Steer, noting “the biggest risk to developing a UTI in the hospital is having some sort of catheter in your bladder during the hospitalization or having some sort of procedure near your urethra.”

To prevent a hospital-acquired urinary tract infection, “the biggest thing would be minimizing the amount of time the catheter is in place,” she said. “From my perspective as a gynecologist, there are a lot of times where we need the catheter in your bladder, but then we try and remove it as soon as possible.”

“From the patient perspective, if you’ve had some sort of surgery, the quicker you can tolerate being out of bed and trying to go to the bathroom on your own, that helps us get the catheter out sooner,” Dr. Steer explained.

“Holding your urine can definitely increase your risk for a lot of different issues, and a urinary tract infection is one of those,” Dr. Bryan said. “Your body is giving you an alarm there and telling you that if you need to go to the bathroom, you need to go.”

“For people who have minor symptoms, it’s reasonable to try and treat by trying to flush out the bladder, so increasing water intake and going to the bathroom more frequently,” Dr. Steers said. “We recommend somewhere in the ballpark of going to the bathroom every two to three hours.

“You’re just trying to flush things through and that is an important part of treatment regardless of whether or not you need antibiotics,” she added.

“The biggest thing for prevention is drinking a lot of water and keeping your bladder empty,” said Dr. Steers. “Increasing the amount of water that you drink dilutes out that bacteria and then by going to the bathroom more frequently, you’re not letting that bacteria sit in that pool of urine and populate.”

“We recommend about eight glasses of water a day, unless you have other reasons why you’re not supposed to be drinking that much fluid,” she said. 

“Other things that people have looked into would be vitamin C supplements and probiotics,” Dr. Steers said. “The idea behind probiotics is that there are good bacteria and there are bad bacteria.

“And if you can keep the good bacteria around, that helps fight off the bad bacteria,” she added. “So, certain people advocate for probiotics and then some other supplements like D-mannose or there is a medication called methenamine salts and those seem to be helpful as well.”

“Postmenopausal women who have a lot of vaginal atrophy—thinning, drying and inflammation of the vaginal walls that may occur when your body has less estrogen—might need other forms of prevention,” Dr. Steers said. “We know that by using topical estrogen or vaginal estrogen that can help prevent urinary tract infections.

“It helps boost the genital urinary health and helps keep the good bacteria around,” she added, noting “that vaginal estrogen is really important for postmenopausal women.”

“General overall health is so important. If you’ve got other medical conditions, tend to those,” Dr. Bryan said. “If your diabetes is out of control or you’ve got some inflammatory disorder or something that’s not controlled, take care of your general health.”

That means “getting plenty of rest, making sure that you’re getting plenty of nutrients in your diet, take a multivitamin, exercise, get a good night’s sleep, stay hydrated,” she said. “Take all those things into account when you try to prevent getting infected with something. It’s just about being healthy.”