Urinary Tract Infection (UTI)

A urinary tract infection (UTI) is an infection in any part of your urinary system - your kidneys, ureters, bladder and uretha. Women are at greater risk of developing a UTI than are men. ​About five percent of women aged 15 to 65 years old have significant amount of bacteria (>105) in their urine. About 25% of women experience at least one proven recurrence of UTI within six months of the first attack.

A recurrent or repeated UTI is when you have more than three episodes of UTI in a year but it must be confirmed by urine tests showing:

• more than 105 organisms (bacteria or germs) per ml of a single organism.
• with more than 10 white blood (pus) cells per ml.

• Not drinking enough fluids
• Dehydration from activities such as sports, being outdoors in hot weather or even food poisoning (vomiting and diarrhoea)
• Passing urine infrequently (for example, your job does not allow you to visit the toilet frequently, your fear of dirty toilets, long distance travel with infrequent toilet breaks)
• After painful sex in younger women, for example, after just beginning sexual intercourse or too frequent coitus ("honeymoon cystitis")
• After painful sex in more matured women, from infrequent coitus or too frequent sex over a short period of time, for example, when the husband comes home from working abroad
• Menopause
• Unhygienic toileting habits, e.g. wiping or cleaning from back to front
• Difficulty in passing urine, e.g. after vaginal delivery, pelvic organ prolapse, after prolapse and or incontinence surgery
• Kidney and/or bladder stone, tumour or foreign body in bladder

Typical symptoms of UTI include painful urination, feeling urgent but passing small amounts of urine frequently and a sensation of incomplete bladder emptying. Your urine may appear cloudy and even bloody.

• Drink adequately (at least 1.5 - 2.5 litres of fluids per day, 7 - 8 glasses of water)
• Avoid dehydration
• Pass urine regularly (every 2 - 3 hours)
• Pass urine before and after sex and to drink more in the next 1 - 2 days after sex
• Use lubrication if necessary, practise foreplay to reduce vaginal dryness and painful sex
• Experiment by trial and error to find out which sexual positions suit you and your partner best, causing the least discomfort and pain during sex
• Wipe or clean from front to back after opening your bowels

• Urine tests to check for UTI
• Bladder scan to check the amount of urine still left inside the bladder after you have voided - to exclude a high residual urine which is common in voiding difficulty
• Kidney and bladder scan to check for stones, tumours, foreign body, fro example, tapes or meshes
• Cystoscopy where a medical telescope is inserted to inspect inside your bladder and urine pipe

When your doctor examines you, he/she may find:

• High and/or tight, painful and tender (pain on examination) posterior fourchette (the entrance of the lower part of the vagina), especially on parting the vagina.
• Pain and/or tenderness of the bladder (lower part of the tummy and/or top of the vagina).
• Pelvic organ prolapse, especially of the bladder (cystocoele) and/or uterus (womb).
• Menopausal changes: narrowing, dryness, thinning and paler colouration of the inside of the vulva and vagina.

Initially, UTI will be treated with a broad spectrum antibiotics which may need to be changed to the appropriate antibiotic after the return of the urine culture and sensitivity result.

To prevent UTI from occurring, it is important for the causes to be treated. Post-menopausal changes may be treated with local Premarin (oestrogen) cream and vaginal Vagifem (oestradiol) tablets to prevent vaginal dryness, painful sex and recurrent UTI.

If the cause of UTI is due to pelvic organ prolapse, it can be treated with pessary or surgery to prevent the occurence of UTI.

Patients with kidney and/or bladder stones, tumours and foreign bodies will usually be referred to urologists to treat their condition in order to prevent conditions such as UTI.

Treat a high and/or tight, painful and tender lower part of the entrance of the vagina with surgery by a minor procedure called Fenton perineoplasty.