July 16, 2018

The Hong Kong Guide to Urinary Tract Infections in Women

Urinary tract infections (UTIs) are incredibly common in women, with some sources estimating one in every two women will experience a UTI over their lifetime. A UTI is an infection that occurs anywhere along the urinary tract, made up of the urethra, bladder, ureters and kidneys (in ascending order). Cystitis (bacterial infection of the bladder) is the most common presentation. While UTIs do occur in men, they’re more common in women because female urethra (the tube leading externally from the bladder) is shorter, allowing bacteria to enter the bladder more easily.

There are only two female urologists in private practice in Hong Kong and we spoke to one of them, Doctor Vera Chung 鍾楊醫生, about the symptoms and best treatments for urinary tract infections.

Causes of urinary tract infections

A UTI occurs when bacteria (and less commonly, a virus or fungus) enters the urinary tract. E. coli accounts for around 80% of community-acquired UTI.

Common risk factors for urinary tract infection include:

being female
increasing age
diabetes mellitus
a previous history of UTIs
indwelling catheters
stone disease
genitourinary tract anomalies
voiding dysfunction

Contrary to popular belief, there is no evidence to show that humid weather increases the risk of urinary tract infection.

Symptoms of urinary tract infections

The symptoms of a lower tract UTI (cystitis) in the urethra or bladder:

A frequent or intense urge to urinate with little urine when you do
A burning sensation during urination
Bloody, cloudy, odd smelling, or strangely colored urine
Pelvic pain

If your lower tract UTI goes unchecked (they can move very quickly so this can occur easily), it may migrate upwards towards your kidneys. An upper tract UTI is very serious and can be potentially life-threatening if bacteria from your kidneys enter the bloodstream. In addition to the above, symptoms your UTI may have progressed to the kidneys or higher are as follows:

Pain or pressure in your lower back or abdomen
Chills
Nausea and/or vomiting
Fever

Natural home remedies and prevention for UTIs

If you suspect a UTI, it’s important to see a doctor promptly for antibiotics to prevent it from spreading to your kidneys or blood. There are a few things you can do to make yourself more comfortable and prevent the infection from worsening:

Drink plenty of fluids and urinate frequently to flush out the infected area as much as possible.
After using the toilet, ensure to always wipe from front to back.
Try to urinate after having sex to flush any bacteria from your urethra.
Cranberry extract and D-mannose do not treat UTIs, but they do help prevent them in women who come down with UTIs regularly.

Contrary to popular belief, oral probiotics do not prevent UTIs. Vaginal estrogen and probiotics help to restore vaginal pH-levels and lactobacilli, preventing infection from bowel bacteria

Medication for a UTI

As mentioned above, you are likely to need antibiotics for your UTI. If you suspect a UTI, your doctor will usually give you appropriate antibiotics and may or may not test your urine to confirm the infection and determine the bacterial strain and drug sensitivity (or less commonly, virus or fungus). With proper use of antibiotics, your infection should clear up in a few days. If not, let your doctor know.

In the private sector in Hong Kong, you can see a GP, gynecologist obstetrician or a urologist for urine testing and prescribed medication. For recurrent UTIs, you may want to see a urologist.

In the public sector in Hong Kong, you can book an appointment at your Cluster’s General Outpatient Clinic but the waiting time will likely be much longer than private sector.

Recurrent UTIs

If you are getting a lot of UTIs, it’s important to talk to your doctor about ways to prevent them. At home, you can practice the healthy prevention methods listed above. To figure out why you’re getting recurrent UTIs, your doctor will talk to you about your lifestyle habits and possibly use a number of diagnostic tools (ultrasound, CT scan or a cystoscopy) to get down to the bottom of your chronic infections.

New research on recurrent UTIs

Recently, there have been other non-antibiotic treatments developed to prevent recurrent UTIs.

1 – Vaccine

OM-89 is an oral preparation of 18 different serotypes of heat-killed uropathogens. In a systematic review and meta-analysis of four trials that together included 891 participants, OM-89 decreased the relative risk of UTI recurrence by 39%.

2 – Glycosaminoglycan layer replacement therapy

The glycosaminoglycan (GAG) layer forms a mucous barrier over the superficial facet cells of the bladder urothelium. It has been proposed that a deficiency of this layer predisposes people to more UTIs. Injection of GAG into the bladder is currently being investigated as a potential treatment for recurrent UTIs.