Infections of the urinary system are the common to women. In fact, the risk of urinary tract infections (UTI) is twice as high in women compared to men. A number of anatomical and physiological peculiarities in women are responsible for this. The first peculiarity is the length of the female urethra (the tube which transports urine from the bladder where it is normally stored, to the outside). Women have a much shorter urethra compared to men. The second is the closeness of the anus to the female urethra. This means that the germs which cause infections of the urinary tract can easily enter through the urethra opening lying just a few centimeters in front of the anus, and move up to infect any of the organs making up the urinary system.
To get a better understanding of the process, a brief description of the urinary system is in order.
The urinary system is made up of the following parts: The urethra, as described above; Bladder – storage reservoir for urine; Ureters – tubes which conveys urine from the kidneys to the bladder; and Kidneys –the paired organ in which urine is produced as a liquid waste product of metabolism. See image 1 below.
Causes of urinary tract infections in women
Most UTI are caused by bacteria coming from the gastro-intestinal tract (the digestive system). This is the reason why young girls are taught early to clean the pelvic area from the front to the back. Doing the opposite actively conveys UTI causing bacteria from the back to the front where the urinary system opening lies. But poor pelvic hygiene is not the only cause of UTI in women. Other causes include:
1. Sex. During sex, the germs causing UTI may be pushed towards and sometimes into the urethra opening.
2. Waiting too long before passing urine can cause bacteria in the bladder to multiply, and give rise to UTI.
3. Stones in any part of the urinary system can cause urine stasis, and ultimately a UTI. In fact, anything that causes urine stasis will cause germs to multiply, and lead to a UTI.
4. Post menopause, older women are also more disposed to having UTI. This is due to the drastic drop in circulating levels of estrogen (the major female reproductive hormone). This causes a loss of some immune protection as the bacteria balance in the female reproductive system change.
5. The use of diaphragms for birth control can also cause the translocation of bacteria towards the urethra, and lead to a UTI.
6. Any disease that causes a drop in resistance to infections e.g. HIV, cancers, diabetes, or misuse of steroids (bleaching creams etc).
Signs and Symptoms of a Urinary Tract Infection
Infections of the urinary tract are usually characterized by varying symptoms which include : urgency – UTI causes an almost irresistible urge to urinate at short intervals; frequency – frequent passing of urine; dysuria or discomfort- pain on passing urine. Dysuria often comes as a burning sensation as the urine is being passed out. Other associated symptoms may include urinary pelvic pressure, urine discoloration- milky, red, dirty brown etc – often with an associated foul odour, hematuria – the passing of blood in urine, fever, vomiting and flank pains. Complicated or untreated infections of the lower urinary tract (urethra and bladder) can cause worse infections such as uretritis or pylonephritis – infection of the ureters and kidneys. Ultimately, this may lead even to failure of the kidneys. It is therefore very important to get treated early.
Management of UTI
A sound diagnosis of the causative organism of a UTI will start with a thorough history of presenting complaints. The doctor will usually ask about the timing of the symptoms and the presence or absence of the symptoms listed above. This is then followed up by a few tests, often including an analysis of the urine sample to ascertain the exact germ causing the infection, and the type of drug which this organism responds to. Sometimes, the doctor might need to do an ultrasound of the bladder, or any other imaging test to visualize the urinary system. Very often, a course of antibiotics will suffice in eliminating the infection and restoring the woman back to perfect health.
Image courtesy of the National Institute of Diabetes and Digestive and Kidney Diseases Image Library. NIDDK, National Institutes of Health. United States.