Why many women are suffering from UTIs

Recent studies carried out in Uganda indicate that there is an upsurge in the number of women suffering from Urinary Tract Infections (UTIs).

The studies show that UTIs account for majority hospital visits among women aged 18 years and above. 

One such research is a 2019 study on the prevalence of bacterial UTIs and associated factors among patients attending hospitals in Bushenyi district, Uganda. The cross-section study was based on 267 urine samples from women. 86 of these (32.2%) were found to be with UTIs.

The study also found that the infections are commonest among all adult females but specifically, the most at-risk group are those with underlying health issues.

Early this year, the Minister of state for gender and culture, Peace Mutuuzo revealed that there was a rapid increase in the number of women and girls being diagnosed with UTIs in the country.

"A study recently conducted at Mulago (national referral hospital) found the prevalence to be 72.5% in those tested. The problem is largely prevalent in urban areas due to poor hygiene levels at public lavatories while the risk is even higher for Persons with Disabilities owing to design inefficiencies," she said.

UTIs are infections, caused either by bacteria, fungi or viruses, which affect any part of the urinary tract. The urinary tract system is made up of the kidney, bladder, ureters or the urethra. 

According to Dr Susan Kizaala, a gynecologist at Mulago hospital said UTIs are very common in women with an incidence of one in every two women and the lifetime risk of about 50%.

This means that every woman has a 50% chance of getting a UTI, with or without any complications. She explained that this is so because a woman's urethra is very short, about 4cm² from the bladder. Therefore, it is easy to pick up infections.

Kizaala said the highest risk is among pregnant women, post-menopausal women, those that are immunocompromised and those with obesity, masses in the pelvis and kidney damage.

For the obese, she said, the excessive fat shortens the urethra, while during pregnancy the uterus compromises on the capacity of the bladder, making the person urinate frequently than usual.

However, Dr Robert Busingye of Busingye Medical Centre noted that some people seem to be more prone to UTIs than others because of their nature and how efficiently their bladder empty's correctly.

"When there is residual urine in the bladder, the person is likely to get UTI," he noted. 

He also stated that the differences in the local defence systems in the urinary bladder makes some people more prone to infections than others.

Busingye also notes that whereas UTIs are different from vaginal tract infections, many people and including some medics, mix them up. 

"It's very important from the outset to differentiate the urinary tract infection from the vaginal or genital tract infection because a lot of times the two are mixed up both in the laypersons' mind and medical mind," he said.

He said that vaginal infections present with a vaginal discharge with a foul smell, vaginal itching and vaginal pain after sex. These include infections such as candida, bacteria vaginosis, gonorrhoea, chlamydia, trichomoniasis and viral vaginities

"Just because these two systems are near each other and sometimes could be affected at the same time doesn't mean they are the same. Sometimes, however, a vaginal infection can go higher to the fallopian tubes and make Pelvic Inflammatory Disease (PID) which is mainly in the uterus and fallopian tubes, but it's not UTI," he noted.

Risk factors for UTIs

According to medics, some of the factors that put a person at risk of contracting a UTI include sexual intercourse. Kizaala explained that seminal fluids have some bacteria that when it comes in contact with the urinary tract system, it turns abnormal and can cause an infection.

Busingye said that after sexual intercourse there tends to be a minor inflammation around the bladder and people prone to UTIs can develop them immediately after the sex.

Personal hygiene is another predisposing factor. Kizaala noted that most times people use baths and basins to bathe and wash their genitals. However, in the process, they tend to recycle the bacteria since the water from the genitals drops back into the basin or bath.

Urinary catheters also increase one's risk of getting a UTI. A urinary catheter is a hollow, partially flexible tube that collects urine from the bladder and leads to a drainage bag. Kizaala said the equipment tends to act as a trap for bacteria from outside to the bladder.

According to Mayoclinic.org a recent urinary tract surgery or urinary tract exam that involves medical instruments can increase one's risk of contracting the disease.

It also notes that the short female urethra shortens the distance that a bacterium has to travel to reach the bladder, making it easy for one to contract the disease. 

Other predisposing factors include menopause, bladder stones that lead to a blockage, vaginal douching, holding urine for long, lubricated condoms, prolonged use of antibiotics and use of some contraceptive measures such as spermicides and diaphragms.

Signs and Symptoms

The early signs and symptoms of UTIs, according to medics include urinary frequency whereby a person urinates more frequently than usual. However, this can also be a symptom of diabetes or late pregnancy.

Busingye noted that one develops a strong persistent urge to urinate and feels pain on passing urine especially towards the end of urination.

He said if the UTI is on the upper part of the urinary tract system, there may be fever or general feeling of sickness.

Kizaala said the colour of urine tends to change to deeper yellow than normal and most times it forms and smells. In severe instances, she said, during urination, one may pass blood at the beginning and end of the process.

She noted that since the infection causes irritation of the bladder, it may lead to lower abdominal pain which radiates to the back.

"It's a progressive disease.  If you don't treat it, you get irritation of the bladder, blood in urine, lower abdominal pain and incomplete emptying. If you still don't treat it, it goes to the ureters causing constant back pain, you get fevers and if it gets to the kidneys, the pain is excruciating and can lead to kidney failure," she said.

Common UTIs among women include urethritis which affects the urethra, cystitis which affects the bladder and is caused by the E-coli bacteria, and acute pyelonephritis which affects the Kidneys.

Complication

Doctors say when the disease is not treated in time, and it works its way to the kidneys, it becomes acute and can even lead to death.

"The upper urinary tract UTI is the worst. Pyelonephritis is the worst and has many complications," noted Busingye.

 He said in the non-pregnant women it can lead to frequent recurrent kidney infections, which ultimately may cause permanent kidney damage which can potentially lead to kidney failure.

"It can spread to the bloodstream and cause a blood-borne infection (Septicemia). In pregnancy whereas lower UTIs are unlikely to cause any harm, the upper UTI can cause complications such as abortions, low birth weight or premature labour," he said.

The Mayo Clinic says if a UTI is not promptly and properly treated, it can lead to sepsis, a potentially life-threatening complication of an infection, especially if the infection works its way up one's urinary tract to the kidneys.

Diagnosis and treatment

Busingye said diagnosis for a UTI is a midstream urine analysis. This involves collecting midstream urine (urine collected after the first one drops have passed) sample and submit it for lab tests. 

However, he said the most conclusive test is the culture and sensitivity, which test takes between two to three days before the results can be got. The test identifies the bacteria and what medicine would work best for the infection.

"The 30min type of examination it could be suggestive especially when they see many white blood cells but the real confirm is the culture and sensitivity but very few people undergo it," he stated.

Prevention

Kizaala advised women to drink a lot of water daily to flush out the bacteria through urination. She said people should drink water at a rate of 60mls for a kilogram body weight.

She advised against douching and using perfumed products in the genital areas, use of basins and bath tabs for washing the genitalia, and use of sanitary cups and tampons.

She said women should empty their bladder before and immediately after sexual intercourse.

Busingye urged women to desist from holding urine for long but to always empty their bladder whenever they get the urge to urinate.