A doctor explains everything you need to know about UTIs

Words by Christina Karras

From cranberry juice to peeing after sex.

Most of us have had a urinary tract infection (UTI) at least once before. Maybe you’ve had a big day, night or weekend of fun – even worse, maybe you’ve done absolutely nothing at all – and you get that feeling. A burning sensation when you go to the toilet, so painful it seems straight from hell itself.

After you’ve cursed your body and wondered what you could’ve possibly done to deserve this personal torment, you consult Dr Google and send someone to get copious amounts of cranberry juice. Maybe you try to soldier on and go about your day but to no avail.

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Having a urinary tract infection is a huge pain – literally. And if it all sounds a bit too familiar, it’s because on average 40 per cent of women will have at least one UTI episode in their lifetime, according to urogynaecologist and pelvic reconstructive surgeon Dr Ruchi Singh.

To make matters worse, there’s still plenty of myths and stigma around UTIs that make the already terrible experience even more isolating. A consultant at Knox Private Hospital, The Royal Women’s Hospital and several others around Melbourne, Dr Singh helps break down everything you need to know about UTIs.

Does sex cause UTIs?

“Being sexually active can predispose you to having a urinary tract infection. Unfortunately, women are four times more likely than men to have a UTI,” Dr Singh explains.

“The probability of having a UTI increases with a new sexual partner, during pregnancy or when you are menopausal. The reasons for this are mainly the anatomy of the female urethra, which is short, and the bacteria that commonly cause the infection like escherichia coli live around the anus. Hence the proximity of the urethra, vagina and anus coupled with the reduced distance the bacteria need to travel to cause an infection (compared to males), increases the risk of a urinary tract infection.”

But it’s important to note you can’t ‘catch’ a UTI from having sex. Unlike sexually transmitted diseases, UTIs are not contagious.

Can you get a UTI from a swimming pool or spa?

“Public swimming pools that do not undergo proper maintenance have a disproportionately higher number of bacteria in the water including E. coli, streptococci and staphylococci which live on the skin and other surfaces of the body,” says Dr Singh.

If the pool doesn’t have enough chlorine to kill this bacteria and the water is contaminated, this can contribute to a UTI.  She says it’s best to change out of wet swimsuits as soon as possible, have a shower after swimming and maintain vulval hygiene by wiping front to back to reduce the risk of infection.

Can you get a UTI from holding in your pee?

“Not necessarily, but stasis or stagnation of urine may be implicated as a risk factor in developing urine infections as it may allow the germs to multiply and overwhelm your body’s natural defences,” she says.

“This risk is increased in women with diabetes and immunosuppressive conditions like lupus. Women with prolapse or incomplete bladder emptying often develop urinary tract infections. It is recommended that you urinate when you experience the urge and commonly most women urinate between four to six times a day.”

Why is it recommended women pee after sex?

“Sexual activity causes inoculation of the bacteria from the anus closer to the urethra or the tube that comes from the bladder. Peeing after sex can help flush out the bacteria and avoid an infection,” Dr Singh notes.

“Other strategies are to use lubricant during sex which reduces urethral irritation and avoid sharing sex toys which reduces risks of cross-contamination.” It’s not the end of the world if you don’t or can’t pee after sex, but it is an easy way to help minimise the risk of a UTI.

Can cranberry juice cure UTIs?

This one is a classic we all know and it’s hard to tell whether it’s just an old wives’ tale or if it actually works. While cranberries have been used widely for several decades for the prevention and treatment of UTIs, Dr Signh says there is no high-quality evidence supporting this.

“Cranberries comprise nearly 90 per cent water, but also contain various organic substances such as quinic acid, malic acid and citric acid as well as glucose and fructose. Research suggests that cranberries prevent bacteria from adhering to uroepithelial cells that line the wall of the bladder,” she explains.

But she explains drinking cranberry juice or products with a PAC (proanthocyanidins, the micronutrient full of antioxidants that helps flush bacteria out) of less than 36 mg per day, will not significantly reduce the risk of repeat symptomatic UTIs compared to a placebo or even receiving no treatment, according to a 2012 study. So ultimately, it’s more important to maintain a healthy daily water intake over chugging litres of cranberry juice.

What are some other UTI myths?

“‘If the UTI returns it means that the antibiotic did not work’. This is likely to be untrue as 25 per cent of women with UTIs are likely to have a recurrence within six months. UTIs occur in clusters,” Dr Singh explains.

She also warns against the use of douches, powders and some “feminine hygiene” products as they can change the PH of the vagina and cause irritation. So let nature, and the actual medication, take its course.

What should people do if they suspect they have a UTI?

“Drink more water – at least eight glasses per day to dilute the urine. Use urinary alkalisers like Ural, which are available over the counter to reduce the discomfort associated with the UTI,” Dr Singh suggests. It’s also imperative to visit your doctor as soon as possible for a urine sample and to start antibiotics.

“Antibiotics remain the mainstay of treatment for urinary tract infection,” she says. “If you see blood in your urine or have a high fever then you may need to attend the hospital emergency for an urgent assessment and intravenous antibiotic treatment.”

There’s still some shame and stigma around UTIs, for example, suggestions of bad hygiene. What’s something you think people should know about UTIs?

“Urinary tract infections are common and can be debilitating. Repeated infections can cause a urethral stricture and in older and immunosuppressed women, there is an increased chance of sepsis; hence, prompt treatment is recommended,” Dr Signh says.

“(Untreated UTIs) can spread to the kidneys and cause a more serious infection. All the strategies described above may be useful but sometimes you may not be able to avoid it completely – and shame or stigma should not prevent you from seeking treatment.”

For more on UTIs, try this.

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