UTIs: The Unspoken Struggle for Women

Hey, it’s Aunt Julie, reporting for duty to normalise the conversation on women's health. I recently heard some statistics that caused me great concern as a woman, and it has led me to discuss urinary tract infections (UTI) this month. 

What Is a Urinary Tract Infection (UTI)?

If you don’t already know what a UTI is, then I count you lucky! Urinary tract infections are very common, with 50% of women experiencing acute symptoms in their lifetime according to NICE, while statistics vary but often land below the 15% range for men. A UTI occurs when bacteria enter and multiply in the urinary tract. E. coli, a type of bacteria commonly found in the bowel, is responsible for many UTIs. Factors such as sexual activity, wiping from back to front, pregnancy, menopause and difficulty fully emptying the bladder can increase the risk.

What Are the Symptoms of a UTI?

• Painful urination 

• Needing to urinate more often, which can be painful or sudden

• Blood in your urine 

• Thick or cloudy urine

• Feeling the need to urinate urgently

• Lower abdominal pain

When Can a UTI Become More Serious?

A healthcare provider will be able to assess your symptoms and advise whether antibiotics or other treatment are appropriate. However, if a UTI spreads beyond the bladder, it can affect the kidneys and, in some cases, lead to sepsis.

Symptoms that may suggest the infection has become more serious include:

• Nausea or vomiting

• Fever or chills

• Pain in your back or side, particularly below the ribs

• Feeling unusually weak or unwell

• If your symptoms worsen quickly or you develop these symptoms, it is important to seek medical advice promptly.

• What Is Urosepsis and How Is It Linked to UTIs?

Urosepsis refers to sepsis caused by an infection originating in the urinary tract. A UTI can spread to the kidneys and, in some cases, lead to sepsis, which can be life-threatening. If your immune system is already compromised or you have weak kidneys, the risk factor increases. 

Sepsis itself is not an infection; it is the body's response to an infection, and it can not be transmitted. The diagnosis of sepsis is based on symptoms, not bacteria. Urosepsis is a medical emergency because sepsis can cause organs to stop working properly. This is why recognising worsening urinary symptoms and seeking medical help when necessary is so important.

Signs of Sepsis Can Include:

• confusion or difficulty speaking

• difficulty breathing or very fast breathing

• feeling extremely unwell

• very high or low temperature

• severe shivering

• very little or no urine

You can see the full list of symptoms on the NHS website so you know what to keep an eye out for. 

One study found that urinary sources accounted for around 32% of sepsis cases in the subjects it examined. While this figure may vary between studies and populations, it highlights why urinary infections should not always be dismissed as harmless. In some circumstances, a urinary infection can develop into a serious, life-threatening illness. 

What Is a Recurrent UTI?

Recurrent UTI is generally defined as two UTIs within six months or three within 12 months.

If you're experiencing UTIs this frequently, it's worth speaking to your GP rather than simply treating each infection as an isolated event. Recurrent UTIs can have different underlying causes, and your healthcare professional can help identify possible triggers and discuss ways to reduce your risk.

Recurrent UTIs After Menopause

As menopause shares its continuous joy with us (not), unsurprisingly it can also play a role in recurrent UTIs. As oestrogen levels decline, changes to the vaginal and urinary tissues can make it easier for bacteria to establish an infection. For women experiencing recurrent UTIs during or after menopause, a healthcare professional may discuss options such as vaginal oestrogen, which can help reduce the risk of future infections in some women.

In one study by The University of Pittsburgh, researchers found that over the age of 65, women are at a 1-2% risk of an uncomplicated UTI turning into urosepsis. There are a few reasons behind this: 

• Post-menopausal changes: Lower oestrogen levels can cause changes to the vaginal and urinary tissues, which may increase susceptibility to UTIs.

• Difficulty emptying the bladder: Some conditions affecting mobility, cognition or bladder function can make it harder to empty the bladder completely, potentially allowing bacteria to multiply.

• Urinary incontinence: Leakage and changes around the urinary tract can sometimes be associated with an increased risk of UTIs.

• A weakened immune system: Some health conditions and medications can make it harder for the body to fight infections.

• Catheters and hospitalisation: Urinary catheters can introduce bacteria into the urinary tract, and the risk can increase the longer a catheter remains in place.

For women who experience sensitive skin or irritation around the intimate area, comfortable, breathable underwear can also make everyday life more comfortable. While underwear cannot prevent a UTI, choosing soft, breathable fabrics and avoiding unnecessary irritation can be helpful when you're already experiencing discomfort. This is particularly relevant when you're already dealing with the burning, tenderness, or general discomfort that can accompany a UTI.

The Stigma Around Urinary Tract Infections 

As is the running theme of my blogs, I’m discussing the stigma that surrounds UTIs. Perhaps because it can affect both males and females, it is a little less taboo than some of the other subjects I have mentioned. However, I do feel that there is still a certain level of ‘That’s just not something we talk about.’ 

When considering the realities of having an occasional, or Goddess forbid, recurrent UTI, we learn that there is a delicate dance we must walk. It can be a painful, uncomfortable and irksome experience. Pair that with a planned date we have been looking forward to or a 10-mile weekend bike ride,  we don’t very well want to cancel our plans. 

So, often enough as women, we are likely to push on through without saying a word about it. And why? Because the idea that there is anything remotely out of kilter with us ‘down there’ is mortifying. Unfortunately, ignoring symptoms or delaying treatment can sometimes allow an infection to become more serious, which is why knowing when to ask for help matters.

How Can You Help Prevent UTIs?

If you experience recurrent UTIs, some simple habits may help reduce your risk.  Consider trying some of the below: 

• Vaginal oestrogen: For some women during or after menopause, vaginal oestrogen may help reduce the risk of recurrent UTIs by improving the health of the vaginal and urinary tissues. Speak to your GP or another healthcare professional to find out whether this is appropriate for you.

• Avoid cleansers. Vaginas are naturally self-cleaning and should not be interrupted by harsh washes and perfumes.

• Stay well hydrated: Drinking enough fluid throughout the day can help you urinate regularly. Try not to regularly hold your urine for long periods and take the time to empty your bladder fully.

• Always wipe from front to back.

UTIs are common and usually treatable, but that doesn't mean they should be ignored. As we age and experience changes such as childbirth, menopause, surgery, urinary incontinence or catheter use, it's important to understand our individual risk factors and recognise when symptoms may point to a bigger problem.

Awareness about symptoms and better understanding our bodies is the first step to a better healthcare system. If we can advocate for ourselves and educate ourselves about our bodies, perhaps we can recognise problems earlier, seek help sooner, and reduce the risk of serious complications.

With bountiful boldness, Aunt Julie x