Bladder Bother: Debunking common misconceptions about UTIs

Urinary tract infections can make some people, particularly women, feel needlessly ashamed. “For years, women were told that UTIs were related to their cleanliness, but they’re not,” says Dr Barbara W. Trautner, physician at Houston’s Michael E. DeBakey VA Medical Center and professor of medicine at Baylor College of Medicine. 

It is true that women get UTIs up to 30 times more often than men, but it’s a matter of anatomy, not hygiene. For anyone, a UTI develops when bacteria in the bladder—usually introduced via the urethra—cause inflammation or other symptoms somewhere along the urinary tract. Since the urethra in women is shorter than it is in men, the bacteria have less distance to travel to reach the bladder. As well, in women’s bodies, the urethra opening is closer to the anus, where E. coli—a common cause of UTIs—reside. Other factors make certain women more prone to the condition: sexual activity, pregnancy and birth control with spermicides, for example.

Another misconception about UTIs is that they cause delirium in seniors. Trautner says the evidence around that isn’t conclusive. A fever related to a UTI could be a contributing factor causing confusion, but it’s more likely to be a symptom of an underlying brain disease, taking multiple medications, malnutrition, untreated pain or organ failure. Muddling matters, Trautner adds, is the fact that bacteria are often present in the urine of older adults without causing harm—a condition known as asymptomatic bacteriuria, which normally requires no treatment.

UTIs do become more common with age, however. In women, oestrogen levels drop after menopause and the vagina loses protective bacteria that keep harmful bacteria out. In men, the prostate begins to enlarge after age 50, trapping urine in the bladder. Also, all older adults are more likely to acquire risk factors such as kidney stones, catheter use or a suppressed immune system from diseases like diabetes.

Determining whether you have a UTI depends on where the infection is located. In the lower parts of the urinary tract, like the bladder, symptoms are related to peeing: an urgent need to go, burning while urinating, blood in the urine or pain in the pelvic region. An infection that affects the kidneys is known as an upper urinary tract infection, and the symptoms are more vague, consisting of back and flank pain, high fever, vomiting, nausea or chills.

Antibiotics are the recommended treatment for UTIs, but there’s a high risk of recurrence, especially among women. In fact, approximately one in four women will have a second UTI within six months. If an infection recurs, it’s not the patient’s fault, says Dr Larissa Grigoryan, an assistant professor of family and community medicine at Baylor. “In some cases, it’s due to increasing antibiotic resistance,” she says, explaining that physicians will then prescribe another course of that antibiotic or try a different one.

It’s long been believed that cranberry juice can prevent or cure UTIs. While some research shows that an active ingredient in cranberry juice can prevent bacteria from sticking to the bladder wall, larger studies have not confirmed a benefit. Even though cranberry juice is not a fix, it’s not harmful. In fact, drinking plenty of non-alcoholic fluids is a good prevention strategy.

Along those lines, in a 2018 study in JAMA, women who increased their regular intake of fluids by 1.5 litres each day were less likely to get a UTI. So, to keep these infections at bay, the best prevention strategy is simple: drink water and empty your bladder often.