Our urinary tract consists of the upper urinary tract (kidneys, ureter) and the lower urinary tract (bladder, urethra, and in males, the prostate).
Urinary tract infections (UTIs) refer to infections within the urinary tract. UTIs can affect areas such as the kidney, bladder (cystitis), and urethra (urethritis), and they can be treated with antibiotics, although antibiotics are not always indicated.
Overall, UTIs occur quite commonly in the general population and are a frequent complaint seen by doctors in both primary care clinics as well as urology clinics. In Singapore, around 40% of women develop a UTI at one point in their life. Other susceptible populations include the elderly and patients who require urethral catheterisation.
Myth #1: UTIs only happen to women
While adult women are 30 times more likely to develop a UTI, UTIs can occur in men too. However, the incidence is much lower because of the anatomy of the male genitourinary tract — with the males having a longer urethra than females. Thus, there is a lower likelihood of bacteria in the area causing a UTI. Furthermore, fluid from the prostate also prevents bacteria from growing as it has antibacterial properties.
However, this is not to say that UTIs do not occur in men at all. UTIs in men are associated with sexually transmitted diseases such as chlamydia and gonorrhoea, benign prostatic hyperplasia (BPH), prostate inflammation, as well as diabetes. As such, men are still at risk of getting UTIs.
Clinical symptoms faced by both men and women with a UTI are similar, and this includes painful urination, increased urgency to pass urine and more frequent urination. When UTIs happen in males, they are usually complicated and tend to warrant a course of antibiotic treatments.
Myth #2: UTIs are not a big deal and go away on their own
Even though UTIs are commonly seen in medical practice, this does not mean that they are not a big deal. In young, fit adults, UTIs may resolve on their own. However, if UTIs are recurrent, or if they are left untreated for prolonged periods of time without any resolution, patients may be at risk of the infection spreading upwards along the genitourinary tract, and a UTI that was initially confined to the urethra may end up spreading to the bladder and kidneys. This can cause irreversible damage and scarring, and affect kidney function.
It is therefore better to start finding UTI treatment if you suspect that something isn’t right.
Myth #3: Hygiene habits and tight clothes contribute to UTIs
There are many risk factors which increase the risk of getting a UTI. This includes medical conditions such as:
- being immunocompromised and having a weak immune system (due to medical conditions such as diabetes)
- having a medical condition that makes it difficult to pass urine (e.g. BPH, recent surgery, having an anatomical defect in the genitourinary tract)
- having to use a urinary catheter regularly.
Lifestyle factors that increase the risk of UTI include:
- not drinking enough water
- passing urine infrequently – this causes bacteria to build up in the urethra and not get expelled in the urine
- poor hygiene in the genital area (e.g. wiping from back to front after defecation)
- Overwashing of introitus
While hygiene habits and tight clothes may be risk factors for UTIs, they do not contribute to UTIs per se, as UTIs develop due to bacteria entering the urinary tract. To reduce the risk of such a possibility, it is good to ensure the area is clean and to wear loose cotton undergarments to improve air circulation so that bacteria cannot thrive in a warm, moist environment. Most importantly, hydrate!
Myth #4: A long course of antibiotics for UTIs is more effective
Antibiotics are one of the main treatment methods for UTIs. Uncomplicated UTIs usually require a dose of antibiotics of about 3 days. Contrary to popular belief, a long course of antibiotics for UTIs may not always be more effective.
For one, having too long a dose of antibiotics can be detrimental as this increases the risk of bacteria becoming resistant to the antibiotics, rendering its use ineffective in the infection. This phenomenon is known as antimicrobial resistance (AMR), and it often results from prolonged antibiotic use as the bacteria adapt to resist the antibiotics.
Furthermore, taking antibiotics you don’t need and for too long can often lead to other side effects such as potential allergic reactions, diarrhoea, abdominal cramps, vomiting, genital itching and discharge.
Long-term antibiotic use is only indicated in patients with complicated UTIs, and this is very rare and the dosage is often prescribed only after a thorough discussion and investigation by the urologist.
Myth #5: If my UTI returns, it’s because my antibiotics didn’t work
There are many reasons why a UTI may return as antibiotics are usually effective in helping to clear the initial infection. As long as there is a risk factor that predisposes a patient to getting a UTI, an infection may occur again as bacteria is always building up in the urinary tract. As such, when a UTI returns it is important to examine your risk factors and to have a discussion with your doctor as to why the infection has returned. Many a time, it can be due to factors such as not drinking enough water and urinating infrequently.
Myth #6: A UTI is an STD
UTIs are not a sexually transmitted disease (STD). However, UTIs can occur as a result of sexual intercourse as bacteria can build up in the area quickly. This is especially so in women.
In men, STDs such as chlamydia and gonorrhoea can lead to a UTI occurring if the bacteria infects the urethra. This can lead to painful urination and pus in the urine. Treatment with antibiotics is prudent in such cases.
Summary
UTIs are common in the general population and are often seen by many doctors. Thankfully, it is also a very treatable condition. Do make sure to see a doctor if you suspect yourself to have a UTI, as early treatment is key in helping to ensure the best outcomes! Dr Fiona Wu will work with you in creating a treatment plan that best suits your lifestyle habits and needs.
