Worldwide, 150 million people are affected by UTIs each year, and about 10.5 million of those individuals are in the United States. (2) Women get urinary tract infections up to 30 times more often than men do, with up to 60 percent of women getting a UTI at least once in their lives. (1,4)
The Different Parts of the Urinary Tract, and Those More Prone to Infection
The urinary system is well designed and can often keep E. coli and other types of microscopic invaders at bay. For instance, urinating usually does an excellent job of flushing out lingering bacteria from the urethra before it causes any issues. (2) But when this defense fails, bacteria such as E. coli enters the urinary tract (which is made up of the kidneys, ureters, bladder, and urethra), multiplies, and then a urinary tract infection can develop. (5) While any part of the urinary tract can be impacted, most E. coli–caused UTIs occur in the lower urinary tract, which includes the bladder (where urine is stored) and the urethra (the tube urine passes through to leave the body). A UTI that resides in the bladder is called cystitis; one that resides in the urethra is called urethritis. (5) One of the reasons that women are more prone to urinary tract infections is that they have very short urethras. The E. coli bacteria from the rectum does not have a long distance to travel to reach the urethra and then bladder to cause an infection. (5) Some common ways in which this migration or infection can happen include:
Sexual Contact A woman’s urethra is located next to the vagina and anus. This design makes it very easy for bacteria to move into the urinary tract during sexual intercourse and sexual contact.Improper Wiping For women, wiping from back to front after a bowel movement can drag E. coli directly into the urethra. Because of this, it’s always recommended to wipe from front to back.Holding Urine Frequent bathroom use allows the body to continue to flush bacteria such as E. coli from the system. This is especially important before and after intercourse. To encourage frequent urination, drink plenty of water throughout the day. (5)
In addition, there are other factors that elevate your risk of developing a UTI. These include:
Menopause It’s thought the hormone estrogen helps to protect against urinary tract infections. During menopause, estrogen is low, making menopausal women more susceptible to UTIs. (5)Birth Control For women, the use of diaphragms as well as condoms with spermicidal foam is associated with a greater risk of getting a UTI. The former pushes on the urethra, making it harder to completely empty the bladder of bacteria, while the latter can kill good bacteria that protect from UTIs. (7,8)Diabetes Those with high blood sugar are not able to fight off germs and bacteria as well as others, making them more prone to UTIs. (9)Pregnancy From week 6 through week 24 of pregnancy, hormonal changes make it easier for bacteria such as E. coli to travel into the urinary tract. In addition, a growing uterus puts pressure on the bladder, making it more difficult to completely empty. (10)Potty Training While UTIs in children peak in infancy (often due to anatomic abnormality), they peak again between ages 2 and 4, coinciding with potty training. In this scenario, withholding urine and poor wiping likely contribute to UTIs. (11)Enlarged Prostate Gland This puts extra pressure on the bladder, which prevents it from emptying properly and flushing the system of E. coli. (5)Spinal Cord Injury This type of nerve damage prevents an individual’s ability to completely empty their bladder, thereby allowing the E. coli bacteria to multiply. (5)Kidney Stones Having kidney stones or a condition that blocks the urinary tract can trap urine in the bladder and contribute to UTI infection. (5)
Strong, persistent urge to urinatePainful and burning urinationPassing only minimal amounts of urineStrong-smelling, cloudy urineRed or pink-tinged urine, which indicates blood is presentPain in the upper back and sidesFever and chillsNauseaPelvic pressure (5)
UTIs From Antibiotic-Resistant E. Coli
Antibiotics are the first-line treatment for UTIs, but some strains of E. coli, including extended-spectrum beta-lactamase (ESBL) E. coli, have become more resistant to many of these drugs. In fact, resistant strains of E. coli appear to be causing more UTIs now than ever before. In one study from 2021, researchers tracked more than 1.5 million UTI cases from 2011 to 2019 and found that E. coli resistance ranged from 3.8 percent (with nitrofurantoin) to more than 25 percent (trimethoprim-sulfamethoxazole), depending on the antibiotic. Individuals most at risk for resistant E. coli UTIs include those with urinary catheters, anyone with a history of recurrent UTIs, and people who recently had a course of antibiotics. Not only are resistant infections harder to treat, people who get these infections are also at an increased risk for a potentially life-threatening infection complication called sepsis. (13) While ESBLs can break down many antibiotics, making them ineffective, it cannot do the same with a specific class of antibiotics called carbapenems. These are considered the gold standard treatment for serious and invasive ESBL infections. (14) Different forms of this medication include:
imipenem (Primaxin IV)meropenem (Merrem)ertapenem (Invanz) (14)
