Ladies, do you know that women are 30 times more likely to get Cystitis or a UTI than men? I know it sounds unfair, but it’s true. And in this article, we will figure out the reason why. Before we get into the nuts and bolts of it, let’s take a look at the following statistics to understand the prevalence of urinary tract infections.
- Research from 2019 now states that 50-60% of women will have at least one bout of Cystitis or a UTI in her lifetime
- In women, sexual activity is a primary risk factor for UTIs, and sex often triggers a recurrence within six months.
- While 50-60% of women will get a UTI in their lifetime, only about 12% of men will get the same condition.
- If you’ve already had one, your risk for having another one increases significantly.
- 27% of women who are prone to this condition have more than two UTIs every year.
- UTIs are the second-largest single group of healthcare-associated infections in the UK, accounting for 19.7% of all hospital acquired infections.
- In 2013/14 the NHS spent £434 million on treating unplanned admissions associated with a UTI
When you look at it like this you can see these numbers are of epidemic proportions. The reality is these numbers are likely understated as they only indicate cases where women have been to their doctor or needed hospital treatment.
But What Is UTI?
Clinically speaking, in women, cystitis is the most common type of urine infection.
Cystitis is the medical term for inflammation of the bladder. Most of the time, the inflammation is caused by an overgrowth of e-coli bacteria.
The usual symptoms are pain or a burning sensation when you pee. An urge to pee a lot more often, some women will feel the need to go every 15 minutes or so even if only a tiny bit of pee comes out. Urine often takes on a strong, unpleasant odor. It can look darker than usual and cloudy. Sometimes there will be blood or mucus in your pee too.
When left untreated, or treatment is incomplete, Cystitis may progress to a Urinary Tract Infection (UTIs). UTIs often affect your bladder (cystitis), urethra (urethritis) or kidneys.
So that’s the bland, matter of fact medical outline taken care of.
The reality for women who get recurrent infections or inflammation flare ups is rather more dramatic than that. Cystitis and UTIs are horribly painful, disruptive and exhausting. Although Doctors will diagnose a “Simple or Uncomplicated” Infection there is nothing simple about the suffering and disruption they cause to everyday life.
How does A UTI Happen?
In simple language, when faecal bacteria enters into the tube through which urine is excreted from the bladder (the urethra) and the bacteria proliferates causing symptoms, it is classed as a urinary tract infection.
There are three types of UTI, and they are as follows:
- The first one is Urethritis, which is an infection located at the urethra. The most common UTI symptoms are burn during urination and discharge.
- Cystitis: When the infection spreads from the urethra to the bladder, then it is called Cystitis. The common symptoms are pelvic pressure, lower abdomen discomfort, frequent, painful urination, and blood in the urine.
- If the infection has reached the bladder, there is a possibility that it can spread to the kidneys as well, which is the third and last type of UTI. The common symptoms of kidney infection are upper back and side (flank) pain, high fever, shaking, chills, nausea, and vomiting.
1 and 2 are the most common urological infections that women face. A kidney infection is more rare and has more serious health implications.
It used to be that “simple lower urinary tract infections” were easy to treat with antibiotics. However, as between 25-35% of prescribed antibiotic treatments are now failing, and as antibiotic resistance in patients increases, it is worrying that this is no longer the case.
What Causes UTIs?
Technically, the urinary system is designed to ward off any microscopic invaders, but sometimes, these defences fail. In the absence of our body’s own safeguards kicking in, bacteria can multiply unchecked. The result is what we know as a full-blown infection in the urinary tract.
Escherichia coli (E. coli) is the most common cause of this type of UTI. E.coli bacteria are generally found in the gastrointestinal (GI) tract. However, other bacteria may also be responsible for Cystitis. A urine culture may be able to distinguish which bacteria is causing the problem however, these days up to 50% of tests show inaccurate results and therefore in our opinion should not be relied on for a complete diagnosis.
Let’s get back to the question as to why women are more at risk than men?
The quick answer that most Google searches will bring you is that your anatomy is the culprit. Women have a shorter urethra than men. Although this is an anatomical fact, the general narrative around these questions is quite outdated and old fashioned. We’d like to give you a broader perspective and bring you up to date with modern understanding of the increasing UTI epidemic.
A woman’s urethra is much closer to their anus. It is shorter in length than men’s and more narrow. This may make it easier for infection causing bacteria to grow and reach the bladder faster.
Women’s hormonal fluctuations in the second half of their cycle (after ovulation) are known to suppress the immune system (as during pregnancy) and thereby increase their sensitivity to infection.
Progesterone based contraception keeps womens bodies in the same hormonal state as during the second half or their cycle. Thereby reducing the body’s ability to identify and fight off bacterial infections.
Spermicides found in most condoms and gels contain the ingredient Nonoxynol-9. This is known to irritate sensitive genital tissues, especially if you use it several times a week. That irritation increases the risk for urological infection and sexually transmitted diseases because it gives bacteria and other pathogens an easy pathway into the body.
Menopause and Aging
Women who have gone through menopause are at greater risk for urinary tract inflammation and infection, even if they have never had one in earlier life. This is because low levels of estrogen in postmenopausal women enables more bacteria to grow.
Estrogen encourages production of natural antimicrobial substances in the bladder and also makes it harder for bacteria to penetrate the deeper layers of the bladder wall by closing gaps between cells lining the bladder. Without these beneficial effects postmenopausal women are more likely to experience UTIs. Luckily the latest research suggests that Vaginal estrogen treatment (creams) may help prevent UTIs for this group.
Weakening muscles around the bladder are also a problem. As urinary system muscles weaken with age, they become less able to force urine out, causing pooling in the bladder, which increases the chance of infection. Pelvic Yoga exercises may help reverse this decline in urinary muscle strength.
Work and Career
Did you know that women in certain careers have a higher incidence of recurrent Cystitis and UTIs? It’s not often thought about as an infection trigger but it’s a fact that when urine is held in the bladder for long periods of time, the pooling of urine allows more bacteria to grow.
Anyone who works long shifts where they’re not necessarily near a bathroom or easily able to get away from the task at hand has a higher risk of getting a urinary infection.
Nurses, teachers, delivery and bus drivers, surgeons, assembly line workers and many other professions are all on the list as they tend not to have a lot of opportunities to use the bathroom in the course of a day.
Chronic health conditions
There are quite a number of conditions that can increase a person’s risk for developing a UTI. Diabetes is one that is becoming common. Women with diabetes tend to have more frequent and more severe UTIs, and the infections can be more difficult to treat than in others. Diabetes can also cause sensory and neurological issues that make it harder for the bladder to drain and harder for the patient to realize their bladder is full. Both issues can result in pooling of urine, which, as mentioned above, can lead to increased bacteria growth and infection.
Antibiotics and Antibiotic Resistance
The medically prescribed treatment for Cystitis and urinary tract infections has not changed in the past 50 years. Doctors are reliant on single and combination prescriptions and over that time have handed out antibiotics like candy. This approach, and lack of researched alternatives, has caused a rapid increase in antibiotic resistance. Nowadays between 25-35% of urological related E-coli infections do not respond to single dose antibiotics.
It is becoming evident that antibiotics themselves are driving stronger and stronger strains of resistant bacteria. Further, the more antibiotics (of different types) a patient is prescribed, the more likely it is that the bacteria in their bladder will become resistant to antibiotics.
What’s more, in chronic infections, described as getting 2 or more flare ups in 12 months, it is common for biofilms to be present in the patient’s urological system and bladder lining. Biofilms development is driven by antibiotic use. Biofilms are becoming recognised as a major contributor to chronic and recurrent infections and Interstitial cystitis (IC), often called painful bladder syndrome.
It’s a catch 22 with womens’ health stuck in the middle.
I hope now you have some idea about why women are more prone to UTIs (urinary tract infections) than men.
Although a mild, or even recurrent infection is not life-threatening it does cause most sufferers extreme pain and discomfort. It also diminishes every aspect of a woman’s quality of life. In more extreme cases, as in many chronic and painful conditions, it is not an exaggeration to say that many women confess that they feel “trapped in a cycle of misery and pain” that “sucks the joy out of living”.
We would advise that if you are experiencing any of the symptoms we have listed above, that you visit a doctor for urinary tract tests and treatment as soon as possible.
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