Urinary Tract Infection (UTI) Fact Sheet
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What is the urinary tract?

The urinary tract is a system of organs composed of the kidneys, ureters, bladder and urethra. The purpose of the system is to filter waste products from the blood and dispose of them in the form of urine. Normally, the system is sterile. It is free of bacteria, viruses and fungi.

What is a urinary tract infection (UTI)?

If the urinary system is contaminated with bacteria an infection can develop. Urinary tract infection or “UTI,” is a general term that refers to an infection anywhere in the urinary system. Often we use more specific terms that identify the location of the infection. Infections occur most commonly in the “lower tract” (a bladder infection or cystitis), but occasionally may spread upward into the “upper tract” (a kidney infection or pyelonephritis).

What causes UTI’s?

Women’s bodies have a design flaw. The urethral opening, (part of a sterile system), has, as two close neighbors, the vagina and rectum, both normally full of bacteria. Because of their proximity to the urethral opening, it is fairly easy for their germs to get into the wrong place and contaminate the urethra, which is how most UTI’s start. E. coli, bacteria normally found in the digestive system and around the rectal opening, is the most common cause of bladder infections. Once in the urethra, the germs can “ascend” or move upward into the bladder, causing a bladder infection. The mechanics of sexual intercourse seem to encourage this process, and many women have their first infection after becoming sexually active, although bladder infections are not considered a sexually transmitted infection. Inadequate lubrication or excessive friction during sex can irritate the area around the urethral opening, making it easier for bacteria to take hold. Once in the bladder, the infection can ascend up the ureters into the kidneys, causing a more serious infection.

Other risk factors for developing UTI’s include:

• A habit of ignoring the urge to urinate and holding urine for long periods
• Use of a diaphragm, spermicides or spermicidally lubricated condoms
• Anything that impedes the flow of urine, such as a kidney stone
• Any condition that weakens the immune system, such as diabetes
• Family history of UTI’s in mother or sisters (currently under study is the theory that people with certain blood types may be more prone to UTI’s)

College age men rarely develop UTI’s. One reason is the fact that their urethras are longer, making it more difficult for bacteria to reach the bladder. They can, however, develop inflammation in the urethra which is usually caused by sexually transmitted infections (STI’s). Any man with symptoms of a bladder infection should be checked for STI’s.

What are the symptoms?

Most women with a bladder infection have at least some of the following symptoms:

• Pain or burning during urination
• More frequent urination of smaller amounts than usual
• A change in the appearance of the urine-it may look cloudy or even bloody
• Foul smelling urine
• Pressure or pain over the bladder
• Fatigue or a generally sick feeling
• Mild fever

If the infection moves upward into the kidneys, women may experience additional, more severe symptoms:

• Low back pain, usually on one side
• Fever and chills
• Nausea and vomiting
• Dizziness

How is a UTI diagnosed?

A woman who experiences any of the above symptoms should come to the Student Health Center as soon as possible for an evaluation to determine if she has a UTI. Be sure to let the receptionist know that you are experiencing symptoms that may indicate a UTI so you can be scheduled for an appointment as soon as possible. The sooner treatment is started, the better the chance of controlling the infection while it is still in the bladder (before it moves upward into a more serious kidney infection). If you develop symptoms at a time when the Health Center is closed, you should seek urgent care. (What to do when the SHC is Closed)

During the appointment, you will be asked about your urinary symptoms, any vaginal or abdominal symptoms, any past history of UTI’s, sexual activity, birth control method, date of last period, current medications and any history of significant medical problems. Temperature and blood pressure will be checked. You will be examined by a medical provider who will check for back and abdominal pain. You will be asked to provide a “clean catch” urine specimen, a method of first washing the outside of the skin around the urethral opening to prevent contamination of the urine sample with normal skin and vaginal bacteria. This sample will be examined under the microscope by the medical provider to see if there are signs of an infection. If an infection seems likely, a sample of the urine will be sent to an outside lab for “culture” to see how many and what specific kind of bacteria are causing the infection. It takes about three days to get the results back but you will be started on presumptive treatment the same day you are examined.

Sometimes, vaginal infections can cause symptoms very similar to UTI symptoms. Yeast infections, for example, can cause so much external vaginal irritation that a woman may experience discomfort with urination. If the provider suspects a vaginal infection may be the cause of symptoms, she may do a pelvic exam to investigate further.

How are UTI’s treated?

UTI’s are treated with antibiotics. After checking if you have any medication allergies, an antibiotic will be chosen based on which ones will eliminate the bacteria that usually cause a UTI. In the case of an uncomplicated bladder infection, a three day course of antibiotics is usually adequate to eliminate the infection. You will usually feel much better by the second day but it is essential to take all the pills to insure the infection is completely eliminated. Stopping the medicine early puts you at risk for re-developing the infection and encourages antibiotic resistance. If the provider suspects a more serious infection, you may be treated for up to two weeks. Rarely, women with serious kidney infections may require hospitalization for intravenous fluids and antibiotics.

You will be asked to return at the end of treatment to re-check the urine to make sure the infection has cleared. At that time, the urine culture results will be available and will be discussed with you. Occasionally, the infection may be resistant to a particular antibiotic. There is no way to predict this ahead of time. It doesn’t happen too often, but if your infection is resistant, you’ll probably notice that you don’t feel better after one or two days of taking the antibiotic. If this happens, you should notify the provider or make an appointment to be seen as soon as possible so your medicine can be changed.

Women who take birth control pills who are started on an antibiotic for a UTI or any other infection need to know that the antibiotic can weaken the effectiveness of the pill for that cycle. You should continue taking your pill daily but will be advised to use a “back up” method of birth control (condoms) if you have sex during the cycle you are on the antibiotic.

Other measures that help increase comfort during treatment:

• Drink lots of fluids (enough to make urine look light or almost clear) but avoid caffeine and alcohol that can irritate the bladder

• Cranberry juice helps in two ways: it makes it harder for bacteria to grow by making the urine more acidic and it makes it harder for E. coli to stick to the bladder walls
• Avoid sex while you are healing
• A heating pad over the lower abdomen may help
• Over the counter pain relievers may help

What about self treatment?

You may have heard about an over the counter medicine called Uristat. Uristat is a urinary anesthetic--it helps to reduce pain while urinating but does nothing to eliminate the infection. It may even cause a woman to delay evaluation and treatment. It also turns the urine a bright orange color which can stain clothing and, more importantly, interfere with lab testing done to determine if a woman has a UTI. The Student Health Center does not recommend the use of Uristat for these reasons.

How can UTI’s be prevented?

Here are some ways you can help prevent UTI’s:

• Drink plenty of fluids each day (enough to keep the urine a light yellow or almost clear color)
• Urinate as soon as you feel the need-don’t ignore the urge and hold urine
• Drink cranberry juice- a study showed that drinking 10 oz. each day helped to prevent UTI’s caused by E. coli- the most common bacteria responsible for UTI’s
• Make sure you have plenty of lubrication during sex. Avoid excess friction which can irritate the urethra and vagina-wait until you (not just your partner) are fully aroused before penis-vagina contact to ensure lots of natural lubrication. Water based lubricants such as Astroglide or Replens may be helpful.
• Avoid putting anything that has had contact with the rectal area into the vaginal area
• Urinate shortly after sex-this helps flush out any bacteria before they have a chance to start an infection
• Avoid anything that irritates the urethral/vaginal area: bubble baths, feminine hygiene sprays or douches, deodorant sanitary pads or deodorant tampons, soap in the urethral/vaginal area (plain water is best), tight clothing and scented detergent or dryer sheets.
• Wiping front to back after urinating or having a bowel movement (to help avoid dragging digestive tract bacteria to the urethral area) is a good habit, although it has not been proven to be a significant factor in preventing UTI’s

What about recurrent UTI’s?

If a woman experiences frequent UTI’s despite practicing good preventive habits, additional measures may be necessary. She may be referred to a urologist, a doctor who specializes in diseases of the urinary tract, for further evaluation, or she may be started on small doses of daily “suppressive” antibiotics. If sexual intercourse seems to be a factor in triggering UTI’s, she may be advised to take a single dose of an antibiotic each time after sex.