Constant confusion around UTIs

(Science time)

More than half of women in the United States will contract a urinary tract infection during their lifetime. (As opposed to about fourteen percent of men.) “While these infections are common, they are almost always fraught with frustration and stigmatization,” says Kalpana Gupta, a professor at Boston University’s Chobanan and Avedisyan School of Medicine, which conducts research on patients with urinary tract infections (UTIs). . These patients “feel some personal responsibility,” he says. “Like they’re doing something wrong.”

In most cases, UTIs (known as bacterial cystitis) don’t really have much correlation with any personal behavior, he says. The main reason that UTIs are more common in women is that their urethra is shorter than in men, which makes it easier for bacteria to enter the urinary tract; Gupta noted that in men, UTIs are almost always part of a larger health problem.

The vast majority of UTIs are caused by E. coli, a bacterium that lives in the intestines and is sometimes found in the perineum. “We haven’t figured out 100 percent” how and under what circumstances bacteria migrate into the urethra and infect the urinary tract, the researcher said.

“Many of the misconceptions about UTIs come from the fact that very little high-quality research is being done on the subject,” said Ja-Hong Kim, a urologist at the UCLA Department of Health. These are some of the most frequently asked questions by patients.

Is UTI possible without burning sensation?

Maybe. Kim explained that a UTI can be anywhere in the entire urinary tract, including the urethra, bladder, kidneys and, in men, the prostate. For a problem to be considered a UTI, the patient must have certain symptoms and a confirmed presence of bacteria in the urine.

Many of the most well-known symptoms, such as burning sensations and needing to constantly go to the toilet, “are known from studies of young college-age adult women who would otherwise be healthy,” Gupta said. But in fact, the symptoms can be different.

He explained that in older people, UTIs can be accompanied by fever or a feeling of fullness. Some patients experience lower back pain, indicating that a UTI may be in the kidneys, making it a more serious case that can lead to sepsis and kidney damage, although these outcomes are “very, very rare,” he said. Kim.

Is it because I had sex?

Not necessary. Women are almost always encouraged to urinate before and after intercourse to get rid of any bacteria, but the practice is not supported by any evidence, said Benjamin Bricker, director of urogynecology at NYU Langone Medical Center. “I don’t have any research that says that urination before or after intercourse reduces the risk of infection,” he said.

However, oddly enough, it might work for some women, she added.

The most common hypothesis about the link between sex and UTIs, Gupta says, is that during penetrative sex, bacteria from the skin of the perineum enters the urethra, which can lead to a UTI. Another is that some products, such as spermicides, alter the vaginal microbiota and can create an environment in which bacteria multiply and migrate into the urethra. But some women never develop a UTI with increased sexual activity, even if they don’t urinate either before or after.

Is this a hygiene issue?

Doctors often tell women that hygiene — such as cleaning from front to back, not wearing a wet bathing suit for long periods of time, and avoiding tight underwear — can reduce the risk of developing IVA. The rationale for this is that front-to-back cleaning reduces the chance that bacteria from faeces will enter the urethra and that wet bathing suits or tight underwear will irritate the vaginal area.

Gupta mentioned that these methods are not harmful, but they are also not based on scientific evidence, adding that such advice in the context of UTIs can end up making women obsessed with cleaning.

“The bottom line is that the risk of contracting a UTI is not related to how well we swim,” or the bathing suit, or the choice of clothing, he said.

Are antibiotics my only option?

Not always. “Imagine that you scratched yourself on a tree while walking and the scratch turned a little red. Because your body can fight these bacteria, you don’t need to take antibiotics,” Brooker said. “UTIs are caused by bacteria like any other,” and many healthy young patients find that the body is eventually able to clear the bacteria on its own. While antibiotics are part of the routine protocol, it’s worth doing a culture first, which takes some time to determine the best treatment, he explained.

In mild cases, being well hydrated can help the body clear the infection, according to Brooker. There are some over-the-counter pain relievers like Tylenol, ibuprofen, and azo that can help relieve discomfort while your body is doing its job.

Some research published in April suggested that there may be some truth to the long-standing idea that blueberries can prevent UTIs. In a meta-analysis of 50 randomized controlled trials, cranberry products—juice, tablets, or capsules—reduced the risk of re-infection in women with recurrent infections, children with UTIs, and people susceptible to them, but not in other groups such as older men or pregnant women. women.

In menopausal women, a decrease in hormone levels can change the vaginal environment and increase the risk of developing a UTI. In this scenario, vaginal estrogens could be a “great way” to prevent infections, Brooker said.

More than half of women in the United States will contract a urinary tract infection during their lifetime. (Michelle Mildenberg/New York Times)