What are UTIs
Urinary Tract Infections – UTIs – are an uncomfortable or painful type of bacterial infection of the urinary system which most commonly affect women but can affect men too, and also children of either sex.
It can affect all parts of the body which create and expel urine including urethra, the bladder, the ureters (which carry urine from the kidneys to the bladder) and the kidneys.
Urethritis is an infection of the urethra (the tube which carries urine from the bladder and through which it is excreted)
The most common bacterial infection for women is Cystitis which is an infection in the bladder that has often moved up from the urethra. It affects about 50% of women at some point in their life.
N.B. Bacterial cystitis should not be confused with the condition called Interstitial Cystitis which is a chronic irritation of the bladder wall. Although it shoes some similar symptoms, it is different and not caused by bacterial infection and therefore not treatable with antibiotics. Interstitial cystitis may be a topic for a future post.
Pyelonephritis is an infection of the kidneys that is usually a result of an infection that has spread up the urinary tract, or from an obstruction in the tract which can cause urine to back flow into the ureters and kidneys.
Causes of Urinary Tract Infections
The main cause of UTIs is that bacteria (especially those which live in the large intestine and are excreted in faeces) find their way into the urethra and make their way towards the bladder. This can happen more easily with women which is why they get cystitis more often than men.
Bacteria can also enter the urethra during sexual intercourse
For gay men, bacteria can also enter the urethra during unprotected anal intercourse
Catheters are another possible entry point to the bladder
Conditions which make getting a UTI more likely include:
- Pregnancy
- Diabetes
- Postmenopause
- Some types of contraception, especially diaphragms with spermicidal agents
and conditions which block the passage of urine such as:
- Kidney stones
- An enlarged prostate gland
Additional Factors
Dehydration – drinking enough water (and not “holding it in” when you feel the need to go) can help flush the system and keep any bacteria from progressing up the urinary tract.
For women, it is thought that harsh soaps can upset the ph balance of the urinary tract and cause a UTI.
It is also possible that they can directly cause inflammation of the urethra, a condition called Dysuria, leading to symptoms similar to a UTI but not caused by bacterial infection.
Symptoms of UTIs
The typical symptoms of cystitis (UTI in the bladder) include:
- Feeling the need to pee more often
- Difficulty in passing urine or only being able to pass a small amount
- Pain or burning sensation when you pass water, or even afterwards
- Bad smelling urine
- Cloudy or pink urine
Symptoms of UTI in the kidneys include:
- Fever and chills
- Vomiting and nausea
- Back Pain one one or both sides between the waist and the rib cage
Urinary Tract Infections in Men
Women may contract UTIs more often than men partly because men’s longer urethra offers an extra level of protection but around 12% of men do get it, especially as they get older, and men’s physiology can make it more complicated.
A’ simple’ UTI will usually respond to antibiotics within 48 hours. Failure to respond to a single course of antibiotics could indicate a ‘complicated’ UTI. While women are more prone to simple UTIs, men are more likely to have complicated UTIs as they may require a longer course of antibiotics because the bacteria can linger in the prostate gland. In fact, some doctors regard UTIs in men as complicated by default.
For this reason, men who show symptoms of a UTI should consult their doctor as soon as possible, even if symptoms are relatively mild. It’s something which can be straightforward to treat early on but can quickly develop into something more uncomfortable, more difficult to treat and more dangerous, the longer it is left untreated.
Prevention of UTIs
There are a number of things you can do to help prevent getting a UTI. Chief amongst these is drinking enough water. Water passing through the system helps to flush out any bacteria present before they can take hold.
You should go to the loo when you feel the need and, when you do go, you should empty your bladder as completely as possible.
As with almost everything to do with your health, regular exercise, a healthy lifestyle will help keep up your immune system.
It should go without saying by now that you shouldn’t smoke.
A common belief is that drinking cranberry juice can help as it makes urine more acidic and contains a substance, proanthocyanidins (PACs), which is said to prevent bacteria sticking to the bladder walls.
In truth, while the evidence has been positive in studies for some groups, it does not seem to help all sufferers and there is little guidance as to what the dosage should be.
It may be that cranberry supplements, which typically have a higher dosage, may help more.
That however is for prevention of recurrence – Cranberry juice does not appear to help if you already have a UTI and probably should not be taken as the acidity may irritate the bladder.
Some sufferers of cystitis also swear by the supplement D-Mannose, present in cranberries and which, again, seems to work by preventing the bacteria from sticking to the bladder wall and therefore is more easily flushed out of the system by drinking water.
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Acidity & pH levels
This can seem somewhat confusing but is important to how the urinary system works.
The general consensus has been that normal acidity (lower pH) of the urine helps prevent the growth of bacteria.1
This is partly backed up by a study showed that patients with a recurring UTI were more likely to have had a higher pH (alkaline) urine.2
However, according to another study, a urine pH closer to neutral was more beneficial to helping a naturally occurring antimicrobial protein called SCN in inhibiting bacterial growth.3
The urine pH of non-vegetarians tends to be acidic while a diet of vegetables, legumes and citrus fruits raises the pH; i.e. makes it more alkaline.
(If you’re surprised that naturally acidic citrus fruits make your urine more alkaline, it’s because citrus fruits are metabolised as alkaline in the body. I warned you it was confusing!)
If slightly acidic, or neutral pH urine is preferable, this would appear to make vegetarians more vulnerable to UTIs. However, a study on women found that there was actually a lower risk for vegetarians. This is probably that, in spite of pH issues, it may be explained by less e coli (the main bacterial culprit) in a vegetarian diet than in some meat products.4, 5
Bacteria causing a urinary tract infection or bacterial contamination will produce alkaline urine.6
Another study found that urine alkalinization with sodium bicarbonate orally had a positive effect on lower urinary tract symptoms in female patients.7
Food and drinks to consume or avoid
To Avoid:
Alcohol
Excess sugar. Molasses
Caffeine should be avoided.
Citrus fruits – The acidity of citrus fruits can inflame the bladder while also lowering the pH of urine.
Spicy foods
Artificial sweeteners
Don’t overdo milk products
Very sweet fruits e.g. raisins, dates dried fruits (prunes are ok)
To Consume:
Meat, poultry, Fish, Eggs.
Most fresh vegetables are ok.
Most non-sugary carbohydrates
Bread, preferably whole-grain
Some milk and a small amount of cream or cheese is ok.
Cranberries, plums, prunes, others not on the Avoid list.
Treatment of Urinary Tract Infections
Although mild symptoms can go away on their own, they can also get worse and become very uncomfortable. Once the infection has taken hold only an antibiotic can really deal with it so it is always advisable to seek medical help if you feel the symptoms of a UTI and the sooner the better.
You may be asked to give a urine sample and, if a bacterial infection such as cystitis is suspected, you are likely to be prescribed an antibiotic such as Nitrofurantoin or Trimethoprim.
Depending on the particular drug and the severity of the condition, you may be given a short, 3-day, course or a 7-day course. You should finish the course completely even if you feel fully better only half way through.
Men with a complicated UTI may require a longer, or additional course(s) of antibiotics.
You may be advised that paracetamol is ok to take if it helps ease any discomfort or fever, but always consult your doctor about any drugs, painkillers or supplements you might think of taking.
But, even if urinating is unpleasant, make sure you keep drinking enough water. Many have found that another cranberry-based product can help reduce the burning sensation, which may be a blessing while waiting for the antibiotics to work.
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References
- https://www.womenshealthspecialists.org/health-information/bladder-infections/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6809364/
- https://www.urologytimes.com/view/diet-urine-ph-may-affect-urinary-tract-bacterial-growth
- https://www.everydayhealth.com/urinary-tract-infection/vegetarian-diet-linked-to-reduced-risk-for-urinary-tract-infection/
- https://www.nature.com/articles/s41598-020-58006-6
- https://www.rnceus.com/ua/uaph.html
- https://pubmed.ncbi.nlm.nih.gov/28975365/
