A urinary tract infection (UTI) is an infection that can affect any part of the urinary tract, namely the kidneys, ureters, urinary bladder, and urethra. It is further classified as upper UTI if kidneys and ureters are affected and lower UTI if the urinary bladder and urethra are affected. It is one of the most common clinical bacterial infections in women. It accounts for around 25% of all infections[1]. Studies[1] have reported that around 50–60% of women will develop UTIs in their lifetime. Here’s more on UTI infection in women that you should be aware of!
UTI Infection In Women: How Is It Caused?
Urinary tract infections (UTIs) are some of the most common bacterial infections. Escherichia coli is the common bacteria that cause UTIs in most patients. Other common causative pathogens include Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, and Staphylococcus saprophyticus. Normally, the urinary tract is sterile, but bacteria may rise from the perianal region, possibly leading to UTI. Also, women have shorter urethras than men and therefore are more susceptible to UTI. If bacteria enter the bloodstream, they could cause severe complications, including septicemia, shock and, rarely even death.
According to a 2013 study titled “Recurrent Urinary Tract Infections Management in Women”[1], UTIs are classified into six categories. These are:
1. Uncomplicated infection: It is a condition in which a person suffers from infection even when there is no structural or physiological abnormality and any comorbidities that increase the risk of UTI such as diabetes, low immunity, etc.
2. Complicated infection: It is when a person has a structural or functional abnormality of the genitourinary tract or suffers from an underlying disease which can increase the risk of infection.
3. Isolated infection: An UTI infection in women is known as an isolated infection if it is the first ever episode of UTI or if you get a UTI infection which is at least months apart. Isolated infections usually affect 25–40% of young females.
4. Unresolved infection: This is when the therapy for UTI fails because of bacterial resistance or due to infection by two different bacteria with equally limited susceptibilities.
5. Reinfection: As the name suggests, reinfection can occur when there is no growth after a treated infection but you may get an infection post two weeks of the treatment. If the reinfection is due to the same bacteria and occurs after just two weeks of the first infection, it is termed as recurrent UTI. However, reinfection can occur due to different bacteria at any given point of time.
6. Relapse: In this, the same bacteria that causes an infection tends to again cause UTI within two weeks of therapy. However, distinguishing between reinfection and relapse is usually very difficult.
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UTI infection in Women: Why Are You At Risk?
There are numerous factors that can increase the risk of a UTI infection in women[2]. These include:
Female Anatomy: It plays a role in predisposing young women to recurrent UTI, especially those who do not have exogenous risk factors for these infections. The shortness of the urethra, with its close relationship to the anus, makes it easy for bacteria to ascend in the urinary tract.
Changes in Vaginal pH: Lactobacilli are the dominant bacteria in the vagina which possess antimicrobial properties. It regulates the bacterial load of other pathogens in the urinary tract by maintaining an acidic pH in the vagina and producing hydrogen peroxide. However, changes in the vaginal pH due to incomplete cure or recurrence of genitourinary tract infection leads trigger the growth of the bacteria which can lead to a UTI infection in women.
Menopause: The incidence of UTI in women increases with advancing age. According to a 2011 study in the International Journal of General Medicine[2], bacteriuria (presence of bacteria in the urine), which is a common sign of UTI, occurs in about 10%–15% of women aged 65–70 years and in 20%–50% of women aged over 80 years. This is because there is a significant reduction in estrogen secretion by the ovary post menopause. The lack of estrogen not only causes a change in the vaginal pH but also causes slackness of the ligaments of the genitourinary tract which further increases the risk of UTI in women.
Diabetes: Diabetes is correlated with the development of asymptomatic bacteriuria and recurrent UTI. This is attributed to the effects of uncontrolled blood sugar levels on the nerves. Diabetic neuropathy involving the urinary tract may be a potential mechanism for a high risk of UTI in diabetics as it may result in dysfunctional voiding and urinary retention, key symptoms of UTI infection in women.
Sexual activity: The incidence of UTI increases with age and sexual activity. The factors that put sexually-active pre-menopausal women at high risk of UTI include the onset of symptoms shortly after sexual intercourse, the use of spermicides for contraception, taking on new sexual partners, the age of the first UTI, maternal history of UTI and voiding dysfunction. The use of spermicidal contraceptives may irritate the vagina and urethra and facilitate the entry and colonization of bacteria within the urinary tract.
In addition to these common factors, there are few other risk factors for UTI infection in women. These are abnormalities of the urinary tract, poor immunity, blockage of the urinary tract (due to kidney stones, etc), use of a catheter, and any recent surgery of the urinary tract. Some studies suggest that a family history of UTI in a first-degree relative increases the risk of recurrent UTI and pyelonephritis in women[2].
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UTI infection in Women: When To Go To A Doctor?
Urinary tract infections usually do not cause any signs and symptoms. Moreover, these are often ignored or overlooked, especially in older women. Some of the common symptoms of UTI in women include persistent urge to urinate, burning sensation while urinating, frequent urination, cloudy urine, pelvic pain, changes in urine colour and strong smelling urine. If you experience any of these symptoms, consult your gynecologist at the earliest.
(The article is reviewed by Dr. Lalit Kanodia, General Physician)
Recommended Reads:
Top 12 Vaginal Hygiene Tips Every Woman Should Know
7 Effective Ways To Prevent Urinary Infections In Women
References:
1. Al-Badr A, Al-Shaikh G. Recurrent Urinary Tract Infections Management in Women: A review. Sultan Qaboos Univ Med J. 2013 Aug;13(3):359-67.
2. Minardi D, d’Anzeo G, Cantoro D, Conti A, Muzzonigro G. Urinary tract infections in women: etiology and treatment options. Int J Gen Med. 2011;4:333-43.
3. Tan CW, Chlebicki MP. Urinary tract infections in adults. Singapore Med J. 2016 Sep;57(9):485-90.
4. Bono MJ, Reygaert WC. Urinary Tract Infection. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan.
5. Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015 May;13(5):269-84.