What Factors Increase The Risk of UTI in Women?

Urinary Tract Infections (UTI) are one of the commonest causes that prompt women to visit a doctor and almost 1 out of every 5 women who get a UTI, is likely to have recurrent UTI’s. 

Recurrent UTI is defined as the occurrence of UTI at least twice in 6 months or at least thrice in a span of 1 year.

UTIs  may affect the any one or more parts of the urinary tract :

• Urethra (the external opening of the urinary tract from which the urine is passed out).
• Urinary bladder ( It is the storage organ where urine is stored in the body before being passed out through the urethra).
• Ureters (These are the tubes which carry the urine from the kidneys to the urinary bladder).
• Kidneys (The organs in the body where urine is filtered & produced).

Symptoms of lower UTI (urethritis or cystitis) include

• Burning or painful urination (dysuria).
• Waking up more than once in the night to pee (nocturia).
• Increased frequency of urination.
• Persistent urge to pee even though you have just passed urine.

 Upper UTI (pyelonephritis) causes

• Fever.
• Chills & shivering.
• Nausea.
• Pain in abdomen & flanks/lower back. 

UTIs are classified into

• Uncomplicated UTI: Infection in women who are otherwise healthy with no structural or functional abnormality of urinary tract & no other medical illness.
• Complicated UTI: Infections in women who have a structural or functional abnormality of the urinary tract or those who have other medical illness which increases the risk of adverse outcomes with UTI. 

Let’s look in detail at how these risk factors contribute to UTI

• Female anatomy: Women have a shorter urethra which is placed in very close proximity to the vagina & anus, this makes it easier for the bacteria from anus or vagina to enter into the urinary tract. Female urethra is 4cm long while the urethra in males is 18-20cm long. 
• Sexual activity: UITs are more common in sexually active women. During sexual intercourse, the organisms from the genital area come in contact with the urethra which increases the risk of UTI. The vaginal dryness during sexual intercourse causes very small abrasions /tears in the lining of the area, making it more susceptible to infection. 

To prevent infection after sexual intercourse, you should pee before and after sex, use water based lubricants and avoid using vaginal sprays and soaps, drink plenty of water to flush out the bacteria

• Use of certain birth control options: Birth controls like diaphragms along with spermicides alter the vaginal pH which disrupts the normal vaginal flora. They also allow for the growth of organisms responsible for UTI, further causing infection. Using vaginal douches, sprays, scented products also increase the risk of UTI. Avoid using vaginal douches, perfumes or sprays or any other artificial chemicals in the area.
• Pregnancy: In pregnancy, the increased size of the uterus leads to pressure over the urinary bladder and incomplete emptying of the bladder during urination. Additionally, the movement of urine through the urinary tract becomes slower under the influence of progesterone. This leads to a stagnation of urine in the urinary bladder & tract , as well as increased growth of the bacteria. All these factors predispose a woman to a condition called asymptomatic bacteriuria (ABU). It is a condition where there is significant number of bacteria in the urine but no signs and symptoms of infection. It is advisable to do pelvic floor exercises, Kegel’s exercises to facilitate better control over  urinary voiding and also seek medical help promptly for any urinary symptoms so that any infection can be treated properly. Also, make sure that you consume at least 2-3 litres of fluids in a day.
• Menopause: After menopause, the levels of estrogen circulating in the body decrease significantly and the vaginal pH & flora also get altered which makes women more susceptible to UTI. It is important to maintain hygiene, ensure adequate fluid intake, consume a balanced diet and wear cotton undergarments to avoid any genital or urinary infections. 
• Genital prolapse: Prolapse means a  descent of the pelvic organs due of weakness of the pelvic floor layers. The vaginal wall bulges out of perineum as a result of increased pressure exerted by the pelvic organs. Genital prolapse can be due to descent of either the urethra & urinary bladder / the vagina/ the rectum & anus or a combination of any of these organs.UTIs are significantly caused due to cystocele ( prolapse of urethra/urinary bladder) which causes an increased pressure on the urethra affecting voiding which increases the risk of UTI. To a certain extent, the prolapse can be prevented or managed by doing Kegel’s pelvic floor exercises and avoiding conditions which increase the pressure on abdominal muscles. In severe cases, surgical interventions are required to treat genital prolapse. 
• Catheterization: Catheters are used in women who can’t pee on their own , eg those who are hospitalised or are very sick, especially those suffering from neurologic conditions like paralysis. In such women ,there is incomplete emptying of the bladder, reflux of urine back into the bladder and ureters, bladder dysfunction which increase the risk of UTI. These catheters become a source of entry of bacteria into the urinary tract. 
• Poor hand hygiene, inappropriately placed catheter, not following aseptic techniques are additional risk factors that predispose to UTI. Hence it is important to maintain strict hygiene for women who are having indwelling catheter in their urinary tract. 
• Abnormalities in the urinary tract and obstruction: Abnormalities in the urinary tract or presence of kidney /ureteric/bladder stones  will disrupt the normal passage of urine out of the body and also damage the lining of the urinary tract. This can increase the risk of recurrent infections in the urinary tract. Physical abnormalities in the urinary tract can cause reflux of urine back into the ureters. This can further cause UTI.It is important to seek medical help urgently in cases where there is a sharp, shooting pain on either side of lower back/flanks or while urination or if there is any fever.
• Immunosuppression: When the body’s defence mechanism is affected, the body becomes vulnerable to infections. In conditions like diabetes, HIV, Viral infections, cancer, use of cytotoxic medications etc the immune system is affected and the risk of infection increases.

Understanding the risk factors is essential to prevent recurrent UTI. Recurrent UTI has the potential to cause chronic kidney damage. Preventing UTI is essential even during pregnancy to prevent pre term labour and use of antibiotics that can be harmful to the fetus. 

Visit your doctor when the symptoms of UTI persist and remember to always complete the course of antibiotics given.

For more information on Menstrual Health & Hygiene, please check our other videos.