Urinary tract infections

A recent article in The New York Times covered many of the basics about urinary tract infections (UTIs, aka bacterial cystitis). Here’s a summary:

• Over half of us women will get a UTI at some point in our lives. Fourteen percent of men will get UTIs. (Their number is smaller because of their longer urethras, which makes it more difficult for bacteria to reach the urinary tract.)

•  UTIs are mostly caused by E. coli bacteria, which live in the gut and sometimes hang out in the area between the anus and vulva (or scrotum).  How and in what circumstances the bacteria migrate into the urethra and urinary tract is “not 100 percent worked out” (an understatement).

•  A UTI can occur anywhere along the urinary tract (urethra, bladder, kidneys and, in men, the prostate). Symptoms vary, but common ones include burning and the constant sensation of needing to pee.

•  Whether or not sexual practices cause UTIs is debatable. Studies have not been conclusive. Hygiene practices—wiping front to back, avoiding tightfitting underwear, how well you bathe, etc.—are “not rooted in scientific evidence.”

•  Antibiotics are not always needed: “Young, healthy patients find that the body can eventually flush out bacteria on its own.” (See comments below about this one.)

•  Cranberry products—juice, tablets, or capsules—reduce the risk for women with recurrent infections. For older women with decreasing levels of hormones, vaginal estrogen can prevent infections.

Over 700 people—many of whom were physicians—wrote comments in response to the article. Here are some worth noting:

Important:

• Antibiotics: One physician wrote, “Delaying treatment of urinary infection can cause serious damage before it can be stopped. Before the introduction of antibiotics one of the most common causes of death among women was ‘Brights disease’—kidney failure from recurrent and chronic UTIs.” Other physicians made similar comments. For example, “A UTI affecting the kidney (pyelonephritis) can lead to sepsis…it’s very, very common!” A lay person added, “My mother developed a UTI in her assisted living facility which became sepsis and she died from it.”

• Delirium in the elderly:  Many people, including physicians, made comments such as, “UTIs in elderly patients are likely to be manifest as confusion or delirium, increased lethargy, blunted fever response, new-onset incontinence, changes in personality, and anorexia.” These symptoms go away after the infection has cleared up.

Worth considering: Many commenters swore by a product called D-Mannose powder to prevent infections. There’s some truth to this. The powder is a type of sugar that might stop bacteria from latching on to cells in the urinary tract.

Sex: Lots of people mentioned sex as a culprit, for example: “I had UTIs constantly, until I divorced and came out as a lesbian.” “A friend’s recurrent UTIs cleared up after her husband became too ill to have intercourse.”

Interesting symptom: Three people mentioned that, when urinating, they experience tingling in their hands, and/or pain and discomfort in their hands and arms.

Eyebrow-raising:  Many commenters contributed their remedies for UTIs, including boric acid suppositories, a gallon of water every 24 hours, 100% cotton underwear, oil of oregano, forgoing toilet paper, avoiding consumption of chicken, and, my favorite, washing “down there” with tequila spritzer.

As for myself, I had a UTI once in my 20s, and have had a couple more recently. Even though I resist taking antibiotics, the minute I felt the symptoms I grabbed the first antibiotic I saw in the medicine chest, which happened to be my husband’s amoxicillin. I took it for two days and the symptoms went away. (I also saw a doctor and got a different antibiotic for future infections.)  As a preventive measure, I use a vaginal estrogen cream once a week. So far, so good.

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