If you’ve ever had a urinary tract infection (UTI), you know how uncomfortable it can be, with frequent trips to the bathroom, “having the intense urge to go and go now” — as Dr. Barbara Bawer, a family medicine physician at the Ohio State University Wexner Medical Center, puts it — and the burning sensation when you try to pee, along with lower abdominal pain.
UTIs, also known as cystitis, are a common problem. They account for nearly 25% of all infections, with up to 60% of women developing one within their lifetime. Women are particularly vulnerable to these infections. In fact, they get UTIs up to 30 times more often than men do.
Why is that the case? Here, experts break it down.
First, what causes UTIs?
UTIs are caused by bacteria, such as E. coli, in stool that enter the vaginal opening, move to the urethra, and then travel up the urethra and into the bladder, triggering an infection, Bawer tells Yahoo Life.
So how does bacteria actually get there? Several different ways, say experts. The most common cause is sexual activity, which can push bacteria close to the urethra. Dr. Rotimi Nettey, assistant professor of urology at Baylor College of Medicine, tells Yahoo Life that sex also causes microtraumas to the vaginal tissues and that makes women more vulnerable to an infection, same as “when you have a cut, you’re more susceptible to an infection.”
In older women, going through menopause is a factor. “The loss of estrogen reduces the population of good bacteria” — known as lactobacilli — “that defend the bladder from infection,” says Nettey. “The walls of the bladder and vagina also become thinner” — and therefore more vulnerable to infection — “because of the loss of estrogen.”
Other factors that increase the risk of UTIs include using spermicides, previous recurrent UTIs, having a catheter in place, structural abnormalities of the urethra or genital area either from birth or due to surgeries, diabetes, pregnancy and poor hygiene, such as not properly wiping front to back, according to Bawer. Though, as Nettey points out, even if you’re vigilant about preventing UTIs by peeing after sex to flush out bacteria, wiping front to back and washing the area, the bacteria is hard to beat. “No matter what you do, it never gets clean,” says Nettey — meaning the bacteria is never fully eliminated — “so it’s very easy for bacteria to translocate to the urethral area,” causing an infection.
Why are UTIs much more common in women than in men?
The reason why women get significantly more UTIs than men has a lot to do with anatomy. In women, “the urethra is located a shorter distance from the anus than in males and so bacteria can enter the urethra far easier,” explains Bawer. “The length of the urethra itself is also shorter in females than in males, which leads to more UTIs.”
As Nettey points out, the length of a woman’s urethra is 3 centimeters long, while a man’s is about 14 centimeters long, “so there’s a significant difference” and “bacteria has a shorter distance to traverse to enter the bladder” in women.
What happens if a UTI is left untreated?
In a nutshell, the infection can get worse. If a UTI is left untreated, “the bacteria can travel to the bladder via ureters and lead to a more severe infection called pyelonephritis,” explains Bawer. “Individuals typically develop fever, chills, severe fatigue, malaise, pain on the side of the abdomen and back.”
In even severer cases, says Bawer, the bacteria can enter your bloodstream and lead to sepsis, organ dysfunction, shock, kidney failure and, in rarer cases, death if all of these are untreated.
How are UTIs treated?
UTIs are commonly treated with antibiotics, but not just any antibiotic will do. Typically, when you see your health care provider for a UTI, they test your urine (urinalysis), but Nettey explains that the “real test is a urine culture,” where the sample is plated on a petri dish to see which type of bacteria is there and which antibiotic is best suited to treat it. “Unfortunately, it can take 48 hours, but it’s important to know what bacteria it is, especially if it’s a recurrent bacteria. Sometimes you get treated and it doesn’t help. You want the antibiotic to be tailored.”
Bawer agrees, saying, “Which one we choose depends on a few factors like severity of the infection, your specific allergies, resistance rates in the area you live to certain antibiotics.”
While finding the right antibiotic is key, Nettey adds that it’s also “important to finish the course” so bacteria won’t continue to multiply, which can cause the UTI to return.
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