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As I was gathering information for the early July article on urinary incontinence and overactive bladder (see the Top 15 Qs & As About Urinary Incontinence and Overactive Bladder in Women), it became evident that my next focus for this month should be on urinary tract infections, with a particular emphasis on UTIs in women during perimenopause, menopause, and post-menopause. Regardless of our backgrounds, as women, we share common health concerns that encourage meaningful conversation. I am excited to introduce this topic to close out the month of July, but an entrée toward future discussions.
Facts about UTIs and Signs, Symptoms, and Risk Factors
First, here are some important basics for women of all ages. Urinary Tract Infections (UTIs):
The second most common type of infection in the U.S.
UTIs lead to over 8 million medical visits annually
Women get UTIs up to 30 times more often than men do. Also, as many as 4 in 10 women who get a UTI will get at least one more within six months.
After menopause, a decline in circulating estrogen causes changes in the urinary tract, which can increase the risk of UTIs.
The Office of Women’s Health explains that women get UTIs more often than men because our urethra (the tube from the bladder to where the urine comes out of the body) is shorter than a man's. This makes it easier for bacteria to get into the bladder. A woman's urethral opening is also closer to both the vagina and the anus, the main source of germs such as Escherichia coli (E. coli) that cause UTIs.
The National Institutes of Health describes a UTI as a condition where bacteria invade and grow in the urinary tract (the kidneys, ureters, bladder, and urethra). Most urinary tract infections occur in the bladder or urethra. Signs and symptoms may include:
pain or burning during urination,
cloudy or bad-smelling urine, blood in the urine,
feeling a need to urinate often or right away,
pain in the back or lower abdomen,
fever, chills, and fatigue.
Certain conditions, such as diabetes, hormone changes, kidney stones, an enlarged prostate, or a spinal cord injury, may increase the risk of a urinary tract infection. If nausea and vomiting are present, these symptoms may indicate that the infection has reached your kidneys.
Other risk factors include radiation therapy or surgery to the pelvis, taking certain types of medicines (such as anticancer drugs), or using a catheter to empty the bladder.
Prevention of UTIs
To prevent UTIs, you can take the following steps:
Stay hydrated: Drinking plenty of water and other liquids may help. Some women have found cranberry juice to be helpful, but the evidence is inconsistent on its effectiveness. The video below featuring Dr. Jennifer Ashton will speak to some evidence to prove this practice helpful. At the same time, Penn Medicine’s Dr. Pamela J. Levin, Assistant Professor of Clinical Obstetrics and Gynecology, in this article states, “Though studies have demonstrated potential ability to decrease symptomatic UTIs, there isn't sufficient data to determine the duration of therapy or the dose of cranberry necessary to achieve effect.” Of course, your clinician will best guide you about treatment.
Empty your bladder when you urinate and go when your body is prompting you versus holding it.
Urinate immediately after sexual intercourse to prevent UTIs from sex. Avoid using condoms coated with spermicide or a diaphragm for birth control. If you get UTIs often, ask your doctor about taking antibiotics right after sexual intercourse to prevent recurrent UTIs.
Wipe from front to back after using the toilet to avoid spreading bacteria from your anus to your urinary tract.
VIDEO - Dr. Jennifer Ashton, ABC News Chief Medical Correspondent, succinctly wraps up the “FYI on UTIs: All you need to know to treat and prevent urinary tract infections” in the easy-to-follow video below. Her tips, recommendations around the test you may need, and questions to ask about the type of treatment (not all antibiotics are equal) is time well spent. Click the image or link to view the video. Also, the full article is available on the Good Morning America website.
UTIs As We Age
Urinary tract infections are found in girls and women, and in our later years, UTIs show up a bit differently in older adults, which we’ll discuss.
The Urology Care Foundation says that women may notice more bladder infections after sexual activity. "For patients who experience this issue, taking a low dose antibiotic around the time of sexual activity can be very useful in lowering the overall rate of infection," says Dr. Tomas Griebling, professor of urinary system problems at the University of Kansas School of Medicine. However, you must be willing to have transparent discussions with your primary care or OB/GYN clinicians so that they can help direct you to the right preventive approach that works best for you. In some cases, recurrent UTIs may be adequately managed by general practitioners, family physicians or general OB/GYNs. However, when things get complicated or treatments are unsuccessful, referral to a subspecialist called a urogynecologist may be warranted.
Another peak time for bladder infections in women is after we stop having periods because the lower estrogen levels make it easier for bacteria to grow. As estrogen production falls in menopausal women, UTIs can occur more frequently because as we age, our vaginal tissue thins, making it more prone to infection – it changes our vaginal environment. Our vagina normally has ‘good bacteria' that kill off other types of bacteria that can cause bladder infections. Good bacteria can only grow in slightly acidic vaginal environments, which need some estrogen.
Note: The stages of menopause are provided below, with related information in the “Resources” section on UTIs and menopause.
Estrogen replacement options like pills and skin patches do not help with this problem, but vaginal estrogen therapy can be helpful for certain individuals. Talk to your doctor to see if this is a choice for you. Estrogen replacement options like pills and skin patches do not help with this problem, but vaginal estrogen therapy can be helpful for certain individuals. Please talk to your doctor to see if this is a choice for you or a loved one. See “Resources” below for more information on this topic.
Ensuring an adequate water intake is crucial for preventing UTIs, particularly as we get older and undergo regular health check-ups. However, if managing incontinence makes it challenging to drink enough water, it's important to address this with your doctor and explore alternative options or treatment plans. Additionally, maintaining cleanliness and changing adult briefs frequently are essential
steps to minimize the growth and spread of bacteria, especially for those who wear them.
Other Groups at High-Risk for Bladder Infections
According to the National Institutes of Health, people with high blood sugar and vesicoureteral reflux (more common among infants and young children) are at higher risk of getting a bladder infection. Vesicoureteral reflux is when urine goes backward from the
bladder toward the kidney. Over time, this reflux of infected urine may raise a person's risk for kidney damage. Some patients with kidney stones and indwelling catheters may also be at higher risk of getting a bladder infection. An indwelling catheter is a hollow tube placed into the bladder and left inside your body. The catheter drains urine from your bladder into a bag outside of your body. A catheter-associated bladder infection happens when bacteria enter the urinary tract through the catheter and cause an infection.
How Bladder Infections are Diagnosed
In most cases, if you have bladder infection symptoms (“UTI”), you should visit a doctor and will likely be asked to provide a urine sample for testing. The test examines white blood cells, red blood cells, bacteria, and other chemicals in your urine. A proper urine test can pinpoint an infection, and a urine culture can help your doctor choose the best antibiotic for treatment. Getting a urine test and culture is important to ensure you have an infection and receive the right treatment. Note: The Good Morning America video and article linked above explain the difference between the urine test and culture.
Urinary Tract Infections in postmenopausal women Symptoms of UTIs in postmenopausal women are often different, and it’s generally believed that this is due to the blood vessels that supply the brain being weaker in seniors. This leads to a unique range of signs, such as restlessness, hallucination, social withdrawal, confusion, and agitation, in addition to the other symptoms discussed earlier.
According to the National Libraries of Medicines article, “Urinary Tract Infection in Older Adults,” several risk factors associated with UTI in post-menopausal women have been identified, many of which are similar to younger sexually active women. In one study, postmenopausal women with a prior UTI were over four times more likely to develop a subsequent infection compared with women without a previous diagnosis. In women with over six lifetime UTIs, the risk of developing a subsequent UTI is over seven times higher than in women without a prior history of UTI. Diagnosis of UTI, specifically before the age of 15 years, has also been shown to increase the risk in postmenopausal women, suggesting that genetic factors may predispose certain women to recurrent infections.
Here are points to review and share:
Urinary tract infections (UTIs) are common and can lead to severe problems such as kidney infections.
Most UTIs are treated with antibiotics.
UTIs are more common in girls under 5 years (see Resources section for more information on UTIs in children).
Girls can lower their risk of UTIs by staying hydrated and following good toileting habits.
Women are advised to wipe from ‘front to back’ and consider discussing low-dose antibiotics with their clinician if they frequently experience UTIs after sexual activity.
Older adults can lower their risk of UTIs by staying hydrated, using the bathroom regularly, and getting routine health exams.
People with high blood sugar, vesicoureteral reflux, kidney stones, and indwelling catheters are also at a higher risk for UTIs.
UTIs are diagnosed through a urinalysis and a urine culture to identify the infection and determine the best antibiotic for treatment.
UTI and Menopause Related Resources
UTIs in Women of All Ages
Urinary Tract Infection, a Comprehensive Factsheet, Office of Women’s Health
Urinary Tract Infection in Adults, National Institute of Diabetes and Digestive and Kidney Diseases
Urinary Tract Infection FAQ, American College of Obstetricians and Gynecologists
IAWH note to readers: We encourage you to read this fact sheet, which also contains specific information about UTIs in pregnancy, recurring UTIs, and their ease of use:
Update in Female Hormonal Therapy: What the Urologist Should Know, National Institutes of Health, National Library of Medicine
IAWH note to readers: Although the article listed above is directed toward "urologists," its research is helpful to anyone with a heightened interest in female hormonal therapy, especially regarding chronic UTIs.
Vaginal Estrogen Eases Recurrent Urinary Tract Infection in Hypoestrogenic Women (Renal and Urology News)
IAWH note to readers: Hypoestrogenism, or estrogen deficiency, refers to a lower-than-normal level of estrogen. It is an umbrella term used to describe estrogen deficiency in various conditions:
Vaginal Estrogen Therapy Is Associated with Increased Lactobacillus in the Urine of Postmenopausal Women with Overactive Bladder Symptoms
IAWH note to readers: According to HealthMatters.io, Lactobacillus is important for gastrointestinal function, as it is involved in vitamin synthesis, natural antibiotic production, immune defense, digestion, detoxification of pro-carcinogens, and a host of other activities. Ideally, levels of Lactobacillus should be 2+ or greater.
Multidisciplinary Overview of Vaginal Atrophy and Associated Genitourinary Symptoms in Postmenopausal Women, National Library of Medicine
Low Estrogen (a helpful overview), Cleveland Clinic
Myths and Facts About Male UTIs, Urology Center of Florida
Urinary Tract Infection Basics, Centers for Disease Control and Prevention
UTIs After Menopause: Why They’re Common and What to Do About Them, American College of Obstetricians and Gynecologists (ACOG), is written with understanding, is comprehensive and detailed, and does not use a lot of jargon.
What is Menopause, National Institute on Aging
More Videos:
UTIs
Video - Urinary tract infection with Dr. Suzette Sutherland, a board-certified physician and UW Medicine's director of Female Urology and a University of Washington Associate Professor of Urology, shares common urinary tract infection symptoms and treatment options:
Video - How to Prevent UTI | Dr Anjali Kumar | Maitri, Maitriwoman.com
IAWH note to readers: Like IAWH, Maitri is a digital space where [they] discuss anything and everything about women's health. Maitri’s video on UTI is no exception. It shares health and well-being tips on UTI and symptoms and treatments.
Menopause
IAWH Videos - Select videos on menopause (with Dr. Arianna Sholes Douglas) from the IAWH library:
IAWH: Symptoms of perimenopause with Dr. Arianna Sholes Douglas
Perimenopause & Thyroids and Adrenals with Dr. Arianna Sholes Douglas
Menopause: Food inflammation and the gut with Dr. Arianna Sholes Douglas
Perimenopause is diagnosed by symptoms by Dr. Arianna Sholes Douglas (and advises seeking a nurse practitioner or M.D.)
Sex, Hormones, and Getting Relief through Supplements with Dr. Arianna Sholes Douglas
Video - Menopause Talk: Menopause Stories from Black Women and the Doctors Who Listen to Them
Video - Doctor Exposes How the Medical System is Failing Women! (They Don’t Want You to Know This!) Lewis Howe hosts Dr. Mary Claire Haver, board certified
OB/GYN.
Video - Breaking Down Common Menopause Myths with Oprah, Drew Barrymore, Maria Shriver, and others.
UTIs in Children
Prevention of Urinary Tract Infection in Children, Nationwide Children’s Hospital
IAWH note to readers: With so many of our subscribers either raising a family, serving as auntie-mothers, and grandmothers to our young, we felt it important to include this resource from the Nationwide Children’s Hospital (NCH), which also serves as an excellent source for other information about caring for the child in your life.
IAWH note to readers: Though developed for clinicians, the video is one of the best we reviewed and provides general and detailed information that IAWH feels will be helpful for anyone concerned about a child who demonstrates symptoms of UTIs. In this video, you will learn more about urinary tract infections, how to recognize its risk factors, and how you can expect clinicians to diagnose and care for affected children.
Janine E. Payne, MPH
Co-Director
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