Urinary Tract Infection In Women – Why it’s More Common In Pregnancy?

Urinary Tract Infection In Women – Why it’s More Common In Pregnancy?

Pooja got recently married and was enjoying her life. Her husband was very loving and she was well adjusting to her married life, but yet something was troubling her for a long time. She couldn’t understand why every hour and so she had to rush to the bathroom and relieve (urinate) herself and at times experience pain along with burning sensation doing the same.

Pooja was suffering from Urinary Tract Infection (UTI) which is sometimes called as Honeymoon Cystitis. This mostly occur post honeymoon since the high indulgence in sexual activity, hence the name. Like most of the Indian women, Pooja was completely unaware of what she was suffering from.

Doctors say that unlike earlier generations, UTI is now occurring more frequently and takes more time to get cured.

Urinary Tract Infections

A urinary tract infection is the infection that can occur in any part of the urinary system be it ureters, bladder, kidney and urethra. Most of the cases of infections occur in the lower urinary tract i.e. the bladder and the urethra.

What causes Urinary Tract Infections?

Typically, urinary tract infection occurs when bacteria get into the urinary tract through urethra and starts multiplying in the bladder. Though the urinary tract is designed to keep off this bacterial invasion, sometimes the defense system fails. This let the bacteria takes hold of the urinary tract and mature into full-fledged infection.

There are primarily two common types of urinary tract infection in women:

  1. Infection of the bladder (cystitis) – This type of infection is caused by E. Coli or Escherichia coli bacteria that is most commonly found in the gastrointestinal tract. However, there could be other bacteria responsible for the infection. Bladder infection or cystitis can also occur due to sexual intercourse.
  2. Infection of the urethra (urethritis) – When gastrointestinal (GI) bacteria spread from the anus to the urethra, it can cause infection. Moreover, since the location of the female urethra is near vagina, several sexually transmitted diseases such as herpes, chlamydia, gonorrhea, mycoplasma, etc. can cause urethritis.

Risk Factors - Why Urinary Tract Infection is common in women?

Many women are at risk of getting UTIs multiple times in their life. Here are some of the reasons or risk factors why women are three times more vulnerable of getting urinary tract infection as compared to men:

  1. Anatomy – Naturally, the urethra of woman is shorter than man. This also shortens the distance traveled by bacteria to reach their breeding ground i.e. bladder. Also, urethra is close to both anus and vagina, so bacteria that naturally occur around these organs can lead to infection in urinary tract.
  2. Sexual Activity – UTIs are common in women who are sexually active as compared to women who are not. Having multiple sex partners also increases their risk of getting UTIs.
  3. Some birth control methods – Diaphragms which is fitted over the uterine cervix can put pressure on urethra, decreasing the capacity to empty bladder completely. Spermicides can also cause skin irritation and increase the chances of bacteria entering the bladder. Same goes for non-lubricated latex condoms which may increase the friction, causing irritation during sexual intercourse.
  4. Menopause – The decrease in the level of estrogen after menopause can result in changes in the urinary tract. This makes women vulnerable to infection.

Others

  • Suppressed immune system due to diabetes and other diseases
  • Recent surgery or examination of urinary tract
  • Blockage in urinary tract due to kidney stones
  • Use of urinary catheters
  • Abnormalities in urinary structure from birth
  • History of UTIs
  • Pregnancy

Why urinary tract infection is common during pregnancy?

That’s a twofold blow for a woman. Urinary tract infection is more common in woman but it is more common in pregnancy as well. Here are some reasons.

  • The growing baby in the womb can put pressure on the bladder. This sometimes causes the urine to leak and trap the bacteria.
  • In pregnancy, fluid near the vagina is more as compared to non-pregnant woman. This increases the chances of infection.
  • Pregnant woman’s urine is more concentrated or thickened. It also contains certain hormones and sugar. This encourages bacterial growth and at the same time reduces the body’s ability to fight bad bacteria trying to invade the urinary tract.

Can urinary tract infection affect the fetus?

If UTIs is left untreated, it can spread to kidneys. Infection in the kidneys may cause early delivery of the baby or baby born with low birth weight. If the doctor is able to treat the infection early, it will not cause any harm to the child.

Symptoms of urinary tract infection in women

Urinary tract infection does not always show up signs and symptoms. But many women may feel:

  • Frequent urge to urinate
  • Burning sensation or painful urination
  • Urine that appears bright pink or red, a sign of blood
  • Pelvic pain
  • Urine that smells strong
  • Fever and chills
  • Nausea and vomiting

Why cases of urinary tract infection in Indian women increasing?

Health experts opine that thoughtless use of antibiotics in India has increased the cases of UTIs, which is a dangerous sign. As per Dr. Manohar T, Consultant Urologist at Columbia Asia Hospital, Bangalore, over 50 percent of women in India suffer from urinary tract infections. This is due to lack of adequate toilets in public places (that makes a woman hold urine for longer time) as well as unhygienic conditions of existing toilets that are contributing to infections.

Many Indian women suffer the condition in silence; they feel embarrassed to discuss such topics. Gynecologist Ranjana Das says that tight clothing that traps moisture increases chances of UTI. “We see a lot of young college-going girls complaining of UTI. Wearing tight-fitting jeans that go unwashed for days is a big culprit because it does not allow ventilation and makes a conducive environment for bacterial growth. Using unclean washrooms is another reason,” the doctor said.

What complications can a woman face following urinary tract infections?

If left untreated or not treated properly, urinary tract infections can render serious complications such as:

  • Increased chances of recurrent infections
  • Risk of permanent kidney damage following acute or chronic kidney infection
  • Increased chances of a pregnant woman delivering premature or low weight babies
  • Risk of getting sepsis, a severe complication resulting from infection, especially when the infection reaches the urinary tract or kidneys

How urinary tract infection is diagnosed?

If you suspect of urinary tract infection, meet the gynecologist who will perform physical examination. For confirmation of UTI, the doctor would be performing a few tests. They are:

  1. Clean catch urine sample – This urine sample will be taken midstream, means the sample will be taken in the middle of urination. This is to avoid contamination from bacteria or yeast. The doctor will actually be looking the presence of large amount of white blood cells which can indicate infection.
  2. Urine culture – The doctor can also suggest urine culture for testing bacteria and fungi. This will also help the doctor to determine the right treatment plan for you.
  3. Imaging tests - For frequently occurring UTIs, the doctor can also conduct ultrasound test to display images of the urinary tract organs on to the monitor.
  4. Intravenous Pyelogram (IVP) – This type of test uses an X-ray to highlight structure of the urinary system. A dye is injected into the body that travels through the urinary tract and highlights these parts on an X-ray.
  5. Cystoscopy – For recurrent urinary tract infections, the doctor may also use cystoscopy to determine the cause of infection. A long thin tube with a camera (cystoscope) is inserted through the urethra and up to the bladder to check for infection. The doctor may also take a sample of the bladder tissue to rule out whether the cause of symptoms is inflammation or cancer.

How urinary tract infection in women is treated?

The treatment of urinary tract infections will primarily depend on the cause and your health condition. Mostly, antibiotics are given as the culprit behind infection in most of the cases is bacteria. In some other cases, fungi and viruses can also cause infection. The medication can be given depending on the severity of the condition.

  • For simple infection, antibiotics such as ceftriaxone, fosfomycin, cephalexin are recommended. You may be advised to complete a 7 day course of these antibiotics.
  • For frequent infection, you might be recommended low-dose antibiotics for a period of 6 months and longer. If the reason of infection is related to sexual activity, you may also be advised to take a single dose of antibiotic after sex. For postmenopausal women, vaginal estrogen therapy might be recommended.
  • In severe cases of urinary tract infection, which happens mostly in the upper tract, antibiotics can be given intravenously.

Can we prevent urinary tract infection?

Yes, right to some extent and the results are promising.

  • The most easy and safe way to prevent urinary tract infection from occurring is to drink a lot of water, according to a study led by Thomas M. Hooton, Clinical Director of the Division of Infectious Diseases at the University of Miami. The survey was conducted on 140 healthy pre-menopausal women. The researchers found that women who consumed less water were 3.1 times more affected as compared to women who increased their water intake. The group which consumed more water was affected from UTIs by just 1.6 times, almost reducing the chances to half. So drink 8-10 glasses of water everyday.
  • One should avoid drinks that may irritate the bladder. These include soft drinks, caffeine and alcohol. These liquids will trigger the urge to urinate frequently. So until the infection is cleared, avoid these drinks.
  • Maintaining a good hygiene might also keep off urinary tract infection to some extent. Empty your bladder often and do not hold urine for longer times.
  • Urinating after sexual intercourse can flush out bacteria passed on during sex.
  • Avoid using feminine products such as perfumes or deodorants that might cause chemical imbalance in the vagina.
  • No matter how much you are tempted towards those sexy looking synthetic underwears, try sticking to the cotton made panties, especially during the summer.
  • Avoid tight fitting pants
  • Practice good hygiene especially after bowel movements by wiping from front to back. This prevents the bacteria in the anus from entering the vagina or urethra.

These are some of the matters women don’t openly discuss and sometimes end up in developing infection. So don’t be reluctant and just remember, doctors have seen several such cases, and yours case is not the new one. If you are not feeling comfortable going alone and talk about the problem, take your spouse or female relative or friend to go with you and discuss the condition with the doctor.

Sources
1. Curtiss N, et al.(2017, September).Urinary tract infection in obstetrics and gynaecology read more
2. Bono MJ and Reygaert WC (2017, December 12).Urinary Tract Infection read more
3. Al-Badr A and Al-shaikh G (2013). Recurrent urinary tract infections management in women read more
4. Urinary tract infection (2015, April 17). CDC read more
5. Urinary tract infections (UTI) (n.d.). Pubmed Health
read more