Everything You Need to Know About UTIs

If you’ve ever had a urinary tract infection, you know exactly how uncomfortable, unpleasant and painful it can be. If you’ve had recurrent or persistent urinary tract infections (UTI) symptoms with no identifiable infection, you know that it can be frustrating, discouraging, and downright unbearable. If any of this resonates with you, you’re not alone. UTIs are very common in the U.S. In fact, UTIs are the second most common type of infection in the body and are the reason for more than 8 million visits to the doctor each year. About 10 in 25 women and 3 in 25 men will have symptoms of a UTI during their lifetime.  Despite its prevalence, this condition is extremely misunderstood and commonly misdiagnosed. So, we’re going to take a deep dive into UTIs, starting with the basics.  

What is a UTI?  

A UTI is an infection in any part of the urinary system, the kidneys, bladder, or urethra. Urinary tract infections are more common in women. They usually occur in the bladder or urethra, but more serious infections involve the kidney.    Bladder pain can also often be a sign of a lesser-known urological condition known as interstitial cystitis or bladder pain syndrome. This is a chronic bladder health issue characterized by pain and/or pressure in the bladder, as well as urinary tract symptoms that last longer than six weeks without an infection present. Due to the discomfort and pain in the bladder that this condition causes, interstitial cystitis is often known as bladder pain syndrome or painful bladder syndrome. An estimated 4 to 12 million Americans suffer from bladder pain syndrome.  

What differentiates a UTI from chronic UTIs? 

The difference is that a chronic UTI is a UTI that, despite antibiotics, persists. The way to really diagnose that is with a urine culture. Doctors will treat the infection with antibiotics and then test again once the antibiotics are finished, and if the patient is still symptomatic and still showing that bacteria, then it is chronic. The term chronic UTI can also mean recurrent UTIs, which is defined by ADA guidelines as 3 or more UTIs in a year. A general UTI is something that most of the population will get at some point in their life, but if it persists despite antibiotics or continues to recur, that is a chronic UTI. 

What causes a UTI?  

The most common cause is a bacteria known as E. coli. It’s important to remember that bacteria live in our body all the time, but when there is an overgrowth of bacteria inside of the urinary tract and the person is experiencing symptoms, then it is called a UTI.   Anatomical abnormalities, such as a posterior urethra valve for example, make people more likely to get UTIs. Another example is in post-menopausal women who are experiencing a decrease in hormones, so it alters the pH of the vagina making them more likely to get recurrent infections. It also should be noted that any UTI in a penis owner is considered a complicated UTI because their urethras are longer, which makes it harder for them to get a UTI. 

What are the symptoms?  

Symptoms and severity vary from person to person, but most people with urinary tract infections can also experience some combination of the following symptoms: 

• Pressure in the abdomen/bladder 
• Pain in the abdomen/bladder 
• Blood in the urine 
• Pain during urination (burning/stinging) 
• Pain during sex 
• Frequency and urgency of urination 
• Difficulty starting/completing a stream 
• Pushing or straining to start stream 
• Pain with bladder filling 

The American Urological Association defines recurrent urinary tract infections as two infections in a three-month period (must be culture-proven, i.e., show up as bacteria in a urine culture) or over three infections in a 12-month period. It only takes 48-72 hours for untreated UTIs to turn into kidney infections, depending on the person and how often they empty their bladder. Having too much bacteria close to the kidney can potentially damage the kidneys. UTIs can also be symptomatic of a larger health concern when they are recurrent. There are many other things it could be, such as a kidney stone that’s harboring infection or an alteration in the pH (for people with vaginas), all of which can be treated in other ways. But what if you feel like you have a urinary tract infection, but antibiotics stop working, and cultures start coming back negative, but symptoms don’t abate? Well, the most important thing to know about bladder pain syndrome is that even though they share many of the same symptoms (bladder pain accompanied by frequent, urgent, and painful urination), a urinary tract infection and bladder pain syndrome are not the same condition. Their causes are completely different, as are the methods to treat them. To further complicate things when it comes to the causes and symptoms of a UTI, patients with confirmed recurrent UTIs are also at a higher risk of developing IC/BPS. 

What causes Interstitial Cystitis? 

All too often, interstitial cystitis is misdiagnosed as a UTI and subsequently treated using antibiotics. But unlike a UTI, bladder pain syndrome is not caused by a bacterial infection. At best, antibiotics will not make any difference in relieving symptoms. At worst, they’ll create a dangerous antibiotic resistance. Unfortunately, the exact cause of bladder pain syndrome is unclear. Experts believe it to be the result of a number of different factors.  Here are some of the theories about potential causes of interstitial cystitis: 

• A defect in the lining of the bladder (the G-A-G layer) that allows substances to penetrate or irritate the bladder 
• Neurogenic upregulation 
• Inflammatory issues 
• Auto-immune causes where the body’s immune system attacks its own tissues, in this case the bladder 

Even though we don’t fully understand the exact cause of bladder pain syndrome, it has been associated with several risk factors, including: 

• Other chronic pain syndromes: If you have a condition such as fibromyalgia, irritable bowel syndrome, rheumatoid arthritis, endometriosis or pelvic floor dysfunction, you may exhibit symptoms of interstitial cystitis. 
• Gender: Bladder pain syndrome is significantly more common in women than in men, although men can still have the condition and may often be under-diagnosed. 
• Skin and hair color: People with fair skin and red hair are more likely to have interstitial cystitis. (In my opinion, this simply indicates there can be a genetic predisposition which can be unmasked by other environmental and lifestyle issues.) 
• Age: Most cases of interstitial cystitis are diagnosed in the patient’s 30s but are seen in patients as young as 12 and in patients over the age of 65. 

How do you prevent and treat UTIs and Interstitial Cystitis? 

While there’s no surefire method to prevent urinary tract infections, there are several things' people can do that may help prevent UTIs. I’ll start by saying the cranberry juice myth is nothing but a myth and is not an effective way to prevent UTIs. The myth started because cranberries do contain a bioflavonoid that prevents adherence of bacteria to the urinary tract, but there is not enough in cranberries to actually prevent UTIs. A few common things that people can do instead are:

• Staying hydrated because it helps to clear the urinary tract 
• Peeing after sex to get rid of extra bacteria that may be there 
• Certain probiotics such as lactobacillus which is a “good” bacteria 

In terms of treating interstitial cystitis, it is often misdiagnosed or occurs in conjunction with other pelvic pain syndromes, so appropriate diagnosis and treatment can take time. In many cases, you may need to try a number of treatments to find the one that works best to alleviate your symptoms.  Treatment for bladder pain syndrome may include any (or a combination of) the following: 

• Anti-inflammatory medications 
• Tricyclic antidepressants 
• Bladder installations 
• Nerve stimulation to block pain and relax your bladder 
• Surgery 
• Lifestyle changes, including diet, exercise, and dietary supplements
• Alternative medicine, such as acupuncture 
• Pelvic floor physical therapy 

Experiencing UTIs and living with bladder pain syndrome can be extremely stressful, both physically and emotionally. Relief doesn’t happen overnight, but working with a trusted specialist will help to put you on the road to recovery. It is important to understand the nuances of the urinary tract and how it varies. After all, the most important step in any health journey is the first one. It’s time to start feeling better, one day at a time.