Why UTIs are becoming harder to treat in women

Very few women in their lifetime will be lucky enough to not have a urinary tract infection (UTI).  That’s because UTIs are so common in women that one of every two women will experience this bacterial condition.  At one time, women who developed these painful and inconvenient infections were able to fight them back successfully once treated with a course of antibiotics. This is not necessarily the case anymore. Since the early 2000s, there is a growing number of UTIs that are no longer responding to treatment with common antibiotics.

The increasing resistance to antibiotics from bacteria causing UTIs is concerning. Annually in the U.S., UTIs are the reason for more than 8 million office visits and one million emergency department visits.

Why women get more UTIs than men

To understand why women are more prone than men for developing UTIs, it helps to understand the urinary tract system. The kidneys make urine which helps eliminate toxins and excess water from the blood. Once urine is made, it will travel down a small tube called a ureter that connects the kidneys to the bladder. The bladder is a temporary holding pouch collecting urine round the clock. Once the bladder is filled with urine, the sensation to urinate will be felt. When we expel urine from the bladder, it travels urine through a tube called the urethra which carries the urine out of the body.

There are several reasons why women are at a greater risk for developing a UTI than men. One is the fact bacteria have an easier time reaching the bladder in women than in men since the urethra in women is shorter than in men. Another factor is the location of the urethra in women – it is near the rectum.  Again, bacteria can easily travel from the rectum up the urethra causing an infection. Sex is another possible cause of UTIs in women since bacteria can be pushed into the urethra during sex. Women who use a diaphragm are at a higher risk for UTIs as diaphragms push against the urethra making it more difficult to completely empty the bladder. Urine that is not eliminated frequently from the bladder is more likely to grow bacteria leading to a UTI. Women, who use antibacterial vaginal douches, spermicides, and certain oral antibiotics, may have a change in their vaginal bacteria, increasing risk of UTIs also. Lastly, postmenopausal women are at an especially high risk for UTIs, primarily due to physiologic and hormonal changes after menopause. These changes include thinning of vaginal tissue, trouble completely emptying the bladder, and lower levels of the hormone estrogen, which may promote the growth of good bacteria helping keep infectious bacteria in check.

Why are UTIs becoming more drug-resistant?

There is various reason why UTIs have become more drug-resistant. The most common reason is the overuse and abuse of prescription antibiotics.  Generally, UTIs can be easily treated with a short course of a common antibiotic such as Bactrim, Macrobid, or Cipro. But bacteria that have become drug-resistant are more difficult to treat since the usual antibiotics are no longer effective. For women having to deal with the unpleasant symptoms of frequent, painful urination, cloudy urine, and sometimes even fever, abdominal pain or bloody urine, this can be excruciating waiting for a drug to work. This can delay proper and appropriate antibiotic treatment which can lead to possible complications such as kidney and bloodstream infections. These more serious infections may require intravenous antibiotics to treat the infection.

How to prevent and treat UTIs

Prevention is always key, but when it comes to UTIs, not all are preventable. All of us have bacteria that live in our bodies.  The trick is to stay on top of preventing these bacteria to invade the urinary system. 

One first step in prevention is to stay well-hydrated.  Drink at least 8 cups of water daily to help flush bacteria from the urinary tract by causing frequent urination. When using the bathroom, always wipe from the front of your body to the back. This prevents transfer of bacteria from the rectum to invade the vaginal tissue. Do not scrub, douche or use harsh cleansing chemicals in the vaginal region. While it may not be proven, it also doesn’t hurt for women to urinate after sex to reduce UTI incidence.

Any woman, who suspects she has a UTI, should see her primary care physician. To get a definitive answer, a urine test will need to be done and women should also ask to have a culture done to determine what type of bacteria caused the infection. To culture the urine involves growing a sample of the urine’s bacteria in a lab and test to see what antibiotic will clear it up. For women who have recurrent UTIs, especially if drug-resistant, they may need to see a specialist to help them manage and ideally prevent their infections.

David B. Samadi, MD, Urologic Oncology Expert and Robotic Surgeon located at 485 Madison Avenue on the 21st floor, New York, NY – 212-365-5000.  Follow Dr. Samadi at www.samadimd.com,  www.prostatecancer911.com, and www.roboticoncology.com