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Health Info, Policy Updates
8.24.24 Voter Empowerment Alert
August 26, 2024
The FAQ-style toolkit to help you feel confident leading up to Election Day.
Consumer Health Info, Health Info, Women’s Health FAQs
Publication Date: February 13, 2019
By: NWHN Staff
*Information updated in 2023.
Everything from bicycling to wearing sexy underwear (thongs) gets blamed for UTIs! [10] Most UTIs are caused by organisms that are fine elsewhere (such as in the vagina or the rectum) wrongly getting into the urethra and bladder. Although viruses and fungi can cause UTIs, the most common cause is that bacteria (E.coli) found in the stools in the rectum get into the urinary tract. [11] Up to 95% of UTIs are cause by E. coli bacteria.[12] [13]
Most cis and trans women know what UTIs are because they are so common and can be extremely uncomfortable and irritating in both how they feel and how they interfere with a woman’s life. UTIs are so common for girls and women throughout their lives that women can find themselves simultaneously making decisions about the best ways to identify and handle UTIs for themselves, for their children or grandchildren, and as caregivers for older loved ones.
Bacteriuria: presence of bacteria in urine. Bacteriuria without symptoms (asymptomatic bacteriuria) is no longer considered appropriate to diagnose a UTI
Girls’ and women’s anatomy is the key explanation for why UTIs are much more common in girls and women than in boys and men. In girls and women, the openings to the urethra, the vagina, and the rectum are very close together so it is easy for an organism to accidentally get moved from the anus or vaginal opening to the urinary opening. In contrast, try imagining the more difficult maneuvering it takes for bacteria from a man’s anus to reach the tip of his penis to enter his urinary tract. Proof that the short distance between women’s anal and urinary openings is key to explaining UTIs is demonstrated by the fact that the differences in distance between those openings in different women are useful for explaining the differences in UTI susceptibility in women: the distance from the female urethra to anus is significantly inversely proportional to the risk of developing a UTI. A woman with only 4.8 cm between her urinary and anal openings is more likely to develop a UTI than a woman with 5 cm between openings![14]
The fact that women’s urethras are ~ 5 times shorter than men’s urethras may also play some role in whether infectious agents can quickly ascend up the shorter urethra without getting flushed out, thereby being able to reach the bladder and quickly multiply.
*Most UTI’s in men are the result of problems that restrict normal urine flow, such as enlarged prostate.
The above female anatomy information explains why minimizing ways organisms can get from the anus or vagina to the urinary opening, flushing out the system (i.e. drinking water and urinating) regularly, and making sure the bladder is completely emptied (leaving no infectious organisms around to multiply) are key to minimizing UTIs.
UTIs have often been treated by antibiotics but, in this era of promoting a more responsible and cautious approach to antibiotic use, many women will be encouraged to find other ways of reducing UTI symptoms and to wait to see if the UTI resolves itself before resorting to antibiotic treatment. See “Urinary Tract Infections: Changing the Culture” in Rx for Change. (But please note: pregnant women and anyone with UTI symptoms accompanied by chills, fever, vomiting, and/or pain in the kidneys [near middle of the back] should not wait to contact their health provider.)
Because UTIs are very common, there is much money to be made from marketing UTI treatment products. The internet, including many web-sites specializing in medical information, is full of ads for such products. Even though many products will be helpful and safe, it is important to remember that good scientific trials proving effectiveness and safety have not been done for many of these products, the Food and Drug Administration may not regulate these products, and if something is powerful enough to be effective it is worth trying to figure out how it is working and how to safely use it and stop using it.
Many of the suggestions for preventing UTIs will also work to treat a UTI, especially good hydration and flushing out the system (with particular attention to completely emptying the bladder). Some women and some studies say cranberry and Vitamin C products are worth trying and over the counter drugs like Advil or Tylenol may help relieve pain. Warning: The drug phenazopyridine (manufactured under brand names such as Azo and Uristat), specifically designed to treat UTI pain is listed as a DO NOT USE drug by Worst Pills, Best Pills[15].
Probiotics seem a particularly promising way to maintain or restore a balanced community of microorganisms (microbiome).[16] [17] Many people are already aware of this and choose to consume live-culture yogurt. Probiotics contain live microorganisms, most of which are similar to beneficial bacteria that occur naturally in the human gastrointestinal tract. Studies have found mixed results in effectiveness of various probiotics in treatment and prevention of recurring infections of the gastrointestinal tract and the genitourinary tract.[18] [19] [20] While some results are encouraging in terms of UTIs, more research is needed to determine the best composition and use of probiotics. In some cases, vaginal application may work better than oral use.[21] Because there are not presently Federal standards for probiotics, tests have shown that products often do not contain the bacteria and the amounts claimed on the label. Even testing of many samples of the same product finds inconsistent composition.[22] Studies have shown few if any negative side-effects, which combined with a long history of safe use, means probiotics are generally considered safe.[23] [24] (It is recommended to consult your physician before starting on a regimen of probiotics.)
Specific subgroups of women are at increased risks for UTIs. These include women with spinal cord injuries, diabetes, multiple sclerosis, acquired immunodeficiency diseases, underlying urologic abnormalities, and women who use catheters.[25]
In addition to issues related to adjusting to changing anatomy for someone transitioning, there are societal attitudes, such as hostility to transgender people using public bathrooms, which may add to the complexities of preventing UTIs. Results from a 2015 survey of transgender people in the U.S. found that in the previous year 59% had avoided public restrooms due to fear of confrontation and 31% had avoided eating or drinking so that they would not need to use a public restroom.[26] These behaviors are obviously not healthy, particularly in preventing or treating UTIs. As some laws bar transgender people from using their bathroom of choice and many have faced verbal or physical violence in bathrooms, public attitudes and policies need to change in order to make bathrooms accessible and safe.
Genital surgery itself may cause problems with urination, possibly increasing UTIs. [27] Tucking, which is a method used by some trans women (and also some cis men) to hide the crotch bulge of the penis and testes, if used regularly or for long periods of time, can cause a build-up of bacteria that can cause UTIs.[28] Many transgender people have difficulty finding a healthcare provider with whom they are comfortable enough to come out and discuss their concerns in an open way. Many providers do not have enough good training in working with transgender people, so the providers themselves may be very uncomfortable, too.
Babies and young children, especially girls, are commonly affected by UTIs but a fever is often the only symptom in young children, so good communication with a health provider is especially important. The use of antibiotics for UTI treatment in children is receiving particular attention both because antibiotics have a questionable benefit to children and because recent studies show that childhood exposure to antibiotics may have particular negative effects.[29] Of course, childhood is the crucial time for helping little girls learn about their anatomy for UTI prevention and lots of more interesting things.
Pregnant women are especially susceptible to UTIs because the weight of the growing fetus in the uterus can prevent the complete emptying of the bladder. As UTIs increase the risk for kidney infection, preeclampsia, premature delivery, and fetal mortality, screening for and treating UTIs is especially important in pregnant women.[30] [31]
Post-menopausal women may experience UTIs for the first time in their lives or have more recurrent UTIs because of their lowered estrogen levels and the accompanied changes in the vagina, urethra, and bladder. Post-menopausal women can try prevention suggestions above, paying particular attention to the importance of hydration and completely emptying the bladder regularly. Some sources suggest the use of estrogen creams, tablets, or rings.[32] While the NWHN has warned women about the effects of long-term estrogen as menopause hormone therapy (MHT) the NWHN says that low dose vaginal estrogen does not increase the risk of many problems associated with MHT. (See “I’ve Got a Question.”)[33]
Very promising are new understandings about how the lowered estrogen in post-menopausal women relates to the changes in vaginal flora so that “good” (lactobacillus) bacteria which control acidity are reduced making women more susceptible to infections. Better understanding of how to promote and restore a healthy balance of organisms (see probiotics above) will be of particular benefit in reducing post-menopausal UTIs.[34] [35]
All UTI issues and controversies are intensified in relation to older women because older women are the most susceptible to UTIs and rUTIs, because UTIs in older women are often connected to other issues (including urinary incontinence, difficulty or pain in urination, increasing aging and disability issues, changing ability to have control over their bodies and their lives), and because this is the population (especially in community living and institutional settings) where the misuse and overuse of antibiotics, the dangerous levels of bacterial resistance and resulting life-threatening diseases, receive the most attention.
Asymptomatic bacteriuria is common in older and elderly women (incidence increasing from 3.5% in the general population to 16-18% in women older than 70 years, with some longitudinal studies reporting it affects 50% of older women) [36] so medical journals are full of articles emphasizing that asymptomatic bacteriuria in older women should not be treated with antibiotics.[37] [38] [39] [40]
Because so many factors come together and come together differently for different older women, it is difficult to know or prove which quality of life issues are sufficiently related to possible UTIs to be tested for and treated. A Journal of the American Medical Association (JAMA) article described that “there was a significant association between laboratory confirmed UTI and acute dysuria (difficulty or pain in urination), change in character of the urine, and change in mental status” but went on to recommend that “symptoms such as dizziness and confusion alone should not be attributed to UTI.” [41]
Organizations specializing in quality care for older people and individual caregivers taking care of elder loved ones who have witnessed how UTIs can impact older people have urgent work to do in ensuring that the new emphasis on minimizing antibiotic use does not reduce the vigilance in identifying and managing UTIs. A Place for Mom says, “A sudden change in behavior is, in fact, one of the best indicators of a urinary tract infection in older adults… Falls, confusion, new onset of incontinence in someone who had been getting to the bathroom, decrease in appetite, any of these can be a sign of a urinary tract infection. It really requires a detective-like index of suspicion from the caregiver.” [42] Supporting older women staying hydrated when they are trying to manage incontinence and ensuring that good hygiene is manageable are as important as teaching little girls about their anatomy.