Urinary Tract
Infections (UTIs)

Urinary tract infections (UTIs) may affect any part of your urinary tract, which includes your kidneys, ureters, bladder and urethra. Conditions in the upper urinary tract are typically more serious (albeit less common) than those in the lower tract.

UTIs occur more often in women than men, as women have a shorter urethra. A study by the National University Hospital of Singapore found that approximately 50–60% of women report at least one UTI in their lifetime. Moreover, 25% of these ladies have at least one recurrence of a UTI within six months of the first infection.

What are the risk factors of UTIs?

1) Diabetes mellitus

Having diabetes, especially if poorly controlled or suboptimal control, can predispose one to having more UTIs. Long standing diabetes can lead to neuropathy, which results in damage or dysfunction of the nerves supplying the bladder, in turn causing an inability to empty the bladder fully; a high residual urine volume left in the bladder yields a fertile ground for bacteria to infect and UTIs can arise from this. Other medical issues e.g. spine conditions can also result in incomplete bladder emptying and put one at increased risk of getting UTIs.

2) Urinary tract diseases

These can include urinary tract stones/calculi, which can be located either in the kidneys or the bladder. Occasionally, cancers of the urinary tract can also mimic the symptoms of UTIs.

3) Sexual activity

Intercourse with new partners, or even existing partners, with improper hygiene practices during or after intercourse can increase the risk of getting a UTI following sex. Another common scenario would be peri- or postmenopausal women having UTIs after sex due to changes in their genitourinary tissues from declining estrogen levels.

What are the Symptoms of a UTI?

You may have a UTI if you are experiencing one or more of the following:

  • Frequent and urgent urination
  • A burning sensation on passing urine
  • Bloody or cloudy urine
  • Urine with a strong or foul-smelling odour
  • Lower abdominal pain or discomfort
  • Fever

What are the Different Types of UTIs?

1) Acute UTIs

Acute UTIs are typically once-off infections that occur infrequently.

2) Recurrent UTIs

Recurrent UTIs are defined as having two or more proven UTIs in 6 months, or 3 or more UTIs within a year.

“Proven” UTIs refer to having a formal urine culture done, which 1) allows for isolation and identification of any microorganism (bacteria) of significant growth, and 2) check the bacteria for antibiotic resistance and allow for the selection of the most appropriate antibiotic treatment.

How are UTIs Treated?

If you experience any of the symptoms above, you should quickly seek medical help. A urine dipstick or microscopy is typically performed in the primary care setting (i.e. your family doctor) to quickly ascertain if there are any signs of infection in your urine if any acute UTI is suspected e.g. presence of white blood cells or bacteria. In the cases of recurrent UTIs, he/she will usually also perform a urine culture and sensitivity test. The most appropriate treatment option will then be recommended for you.

1) Antibiotics

UTIs are usually treated by oral antibiotics; in certain cases whereby the bacteria shows multiple antibiotic resistance, or in cases of severe/complicated UTI e.g. affecting the upper urinary tract system, intravenous antibiotics may be required. For those with complicated/multi-resistant UTIs, you may require prolonged treatment compared to someone with an acute, uncomplicated UTI.

2) Treatment of underlying conditions

In cases of recurrent UTIs, your doctor may recommend further investigations to delineate possible causes of your UTIs e.g. screening for diabetes or other medical conditions such as kidney stones. This is because in such cases, treatment and control of the underlying root cause (rather than just repeated antibiotic administration for UTIs) is important.

In cases of women experiencing UTIs after sex, a full sexual history is usually taken and measures to mitigate the risk of UTIs following intercourse can range from use of adequate sexual lubrication, voiding/washing up immediately after sex and topical vaginal estrogens particularly for peri- and post-menopausal women with evidence of atrophic vaginitis (where the vaginal skin becomes thin and dry due to reduced estrogen levelsm resulting in uncomfortable or even painful sex).

3) Preventive measures

The following measures can help prevent UTIs, benefit our general health, and are easy to implement into our daily lives.

  • Keep yourself well hydrated on a daily basis (1.5L to 2L daily, unless you have specific medical conditions that prohibit you from doing so)
  • Maintain basic perineal hygiene (always wipe front to back to avoid faecal contamination of your urethra)
  • Eat foods rich in probiotics, vitamins and minerals (this helps keep your vaginal and urinary flora in equilibrium)
  • Increase your fluid intake of water (and reduce caffeinated/alcoholic beverages) once you start having UTI symptoms
  • Pass urine regularly; avoid holding your bladder excessively
  • Explore ways to make sex more comfortable to avoid trauma to the region, especially if you typically have UTIs triggered following intercourse

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