UTI stands for urinary tract infection. This could be a urethral, bladder, or kidney infection.
UTI causes in females are the same as in men, but ladies are 30 times more likely to develop a UTI. 1
This is purely down to our anatomy. Let me explain.
The most common bacteria to cause a UTI is E. coli.
This is a bug that occurs naturally in your bowel as a commensal. Commensals are bacteria and organisms living together harmoniously in a healthy environment. Most E. coli do not cause infection in your gut. When you have a bowel movement, E. coli move with the stool out of your gut and onto the skin.
Now for the anatomy lesson. I refer you to the picture below.
The urethra is the pipe that leads from the bladder to the external body surface immediately above the vagina.
The female urinary and gut openings are very close together.
This makes it easy for E. coli on the skin to enter the urethra, and because it is so short in ladies, the bacteria can get into the bladder much easier.
This is why women have a higher baseline UTI risk than men. One in three women have had their first UTI by age 24. 1
I know what you are thinking, “Does this mean I’m not cleaning the area adequately after passing a stool?”
No, there will always be some E. Coli on the skin. As you will learn later, washing excessively can be a risk factor for UTIs.
Why is it important to know what increases the risk of UTI?
Taking antibiotics recurrently is a problem. Uropathogenic E. coli (UPEC) is becoming drug-resistant. 2
If you identify a preventable cause, antibiotics might be avoided.
UTI causes in females
1. Sex
Young sexually active women are most affected by UTIs.1
Many of you are too young to remember the term ‘honeymoon cystitis.’ Years ago, when sex before marriage was frowned upon, a bride was guaranteed a UTI on her honeymoon.
Why was this the case? It is all down to anatomy and the mechanics of sex.
You’ve already learned about E. coli in the area close to the urethra. Women are already at an increased baseline risk for UTI.
The friction and thrusting during intercourse push the E. coli into the urethra and increase the risk exponentially.
You can avoid this by emptying your bladder immediately after intercourse. It is a passion killer but will save you from discomfort and antibiotics.
2. Wiping from the back to the front
Our parents teach most of us this from a young age. However, some have missed this lesson.
Always wipe front to back to avoid contaminating the urethra with E. Coli.
3. Tight clothing
This is contentious; some urologists do not believe this causes UTIs. I beg to differ. I saw this as a cause of recurrent UTIs in my general practice. Many ladies said goodbye to their fitting jeans and UTIs at the same time.
Tight pants rub and chafe the vaginal area. This friction can push E. coli into the urethra.
4. Altered vaginal flora
These are similar to the causes of vaginal thrush.
The urethra is between the labia above the vaginal opening.
Anything that kills the normal vaginal bacterial flora upsets the commensal balance. Commensals are bacteria and organisms living together harmoniously in a healthy environment. Fewer healthy bacteria means less competition for non-commensals. This allows E. Coli to overgrow, increasing the likelihood of UTI.
Soap
Soap kills bacteria. It, therefore, changes the vaginal flora balance. It also can irritate the urethra.
“Avoid using any soap in the vaginal area at all if you are prone to UTIs. Only rinse with water between and around the vulva.”
Ladies often wash more with soaps when they hear E. Coli causes UTI. This is the worst possible thing to do. Overwashing aggravates the situation.
Specially formulated gynecological products can even cause problems.
A change of toiletries
Some lucky individuals do not have a problem with their usual soap. The problem comes in when they change their shower gels or soaps. This is common when people travel as they use hotel toiletries.
If you develop a UTI for the first time, ask yourself the question, “Did I change any toiletries recently?”
Hygiene wipes
It is the same concept but in convenient packaging. Hygiene wipes are usually bactericidal and upset the flora.
Bathing
Shower, don’t bathe.
Even if you are not washing your privates with soap in a bath, you are still sitting in soapy water.
Bubble bath
A long soak in a bubble bath might help you forget the day’s problems while causing a new one.
Soaps and fragrances in bubble baths upset the vaginal balance and cause urethral irritation.
Spa baths and chlorine pools
Swimming pools and spa baths contain chemicals to keep them clean and bacteria-free. They might also upset the vaginal flora balance.
Avoid spa baths and rather seek out saltwater pools if you are prone to recurrent UTIs.
Lubrication
This could be lubes used during sexual intercourse or lubricants on condoms.
Buy reputable condom brands like Durex. Avoid anything fancy with flavors, scents, or promises of tingling and warmth. Avoid Massage and Play combinations gels.
Go back to basics with good old-fashioned plain KY-Jelly.
5. Hormone changes
Menopause
It is well-documented that menopause predisposes women to UTIs. The low estrogen levels affect the surface cells of the urogenital tract and microbiome. 3
Combined oral contraceptives (COC)
COC hormones change the vaginal environment. There is controversy about whether this predisposes women to UTIs. Some studies conclude no link.
“I believe that they are related. In my clinical practice, a few patients with recurrent UTIs were cured after stopping COC.”
COCs cause lower estrogen levels than in a normal menstrual cycle, like in menopause. 4 A study also supports this theory; recurrent UTI sufferers on COC, when treated with vaginal estrogen suppositories, showed improvement. 4
6. Delayed bladder emptying
It is essential to empty your bladder on demand. As mentioned, small numbers of E. Coli are in the female urethra most of the time.
Because the urethra is so short in ladies, the bacteria travels into the bladder quickly. Every time you empty your bladder during the day, this E. coli is washed out and cannot cause infection.
Now imagine a stagnant pool of water and all the gunk that grows in it.
E. coli overgrows in the inactive bladder.
7. Dehydration
Drink lots of fluids and flush your bladder.
When dehydrated, your body produces less urine, and the urge to empty is infrequent. This means that there are stagnant low urine volumes that promote bacterial infection.
8. Diarrhea
Increased loose stools lead to easier E. coli contamination of the urethra. Also, patients with gastroenteritis are prone to dehydration, which further increases the risk.
9. Urinary tract abnormalities
Lindsay E. Nicolle says that genitourinary abnormalities promote infection through obstruction of urine flow and persistence of organisms in protected environments within the genitourinary tract. 5
Usually, patients with recurrent or complicated UTIs are referred to a urologist who will then exclude anatomical abnormalities.
10. Hereditary
I include this for completeness. Recurrent female UTIs can run in families. Unfortunately, there is not much you can do about genetics. 6
11. Antibiotic-resistant E. coli and UTIs in vegetarians vs meat eaters
I will leave you with this interesting video about how your diet might contribute to complicated UTIs.
Studies in the USA have shown that chicken is contaminated with E. coli ST131. Dr Greger explains that over the past twenty years, E. coli ST131 has become the most important multidrug-resistant uropathogen.
References
- Tan, C. W., & Chlebicki, M. P. (2016). Urinary tract infections in adults. Singapore medical journal, 57(9), 485–490. https://doi.org/10.11622/smedj.2016153
- Zhou, Y., Zhou, Z., Zheng, L., Gong, Z., Li, Y., Jin, Y., Huang, Y., & Chi, M. (2023). Urinary Tract Infections Caused by Uropathogenic Escherichia coli: Mechanisms of Infection and Treatment Options. International journal of molecular sciences, 24(13), 10537. https://doi.org/10.3390/ijms241310537
- Jung, C., & Brubaker, L. (2019). The etiology and management of recurrent urinary tract infections in postmenopausal women. Climacteric : the journal of the International Menopause Society, 22(3), 242–249. https://doi.org/10.1080/13697137.2018.1551871
- Pinggera, G., Feuchtner, G., Frauscher, F., Rehder, P., Strasser, H., Bartsch, G., & Herwig, R. (2005). Effects of Local Estrogen Therapy on Recurrent Urinary Tract Infections in Young Females under Oral Contraceptives. European Urology, 47(2), 243-249. https://doi.org/10.1016/j.eururo.2004.09.008
- Nicolle, L. E. (2016). Complicated Urinary Infection, Including Postsurgical and Catheter-Related Infections. Infectious Diseases (Fourth Edition), 539-546.e1. https://doi.org/10.1016/B978-0-7020-6285-8.00059-9
- Zaffanello, M., Malerba, G., Cataldi, L., Antoniazzi, F., Franchini, M., Monti, E., & Fanos, V. (2010). Genetic risk for recurrent urinary tract infections in humans: a systematic review. Journal of biomedicine & biotechnology, 2010, 321082. https://doi.org/10.1155/2010/321082
