Real talk: three years ago I started getting urinary tract infections (UTIs) with period-like regularity. Every month, almost to the day, I’d wake up to an unrelenting urge to pee and that telltale burning pain. Antibiotics would clear things up quickly, then one day I got stuck: I went to the doctor, but the test for UTI came back clear. I was sent away with no meds and little sympathy. Meanwhile, the infections kept coming, morphing in frequency and intensity. In the last 12 months I’ve only had two full blown infections, but they both went straight to my kidneys, causing severe pain and fever.
My story might sound unlucky, but it’s actually pretty common. While most UTIs are sent packing with a short course of antibiotics, research has found that initial treatment fails for 25-35 per cent of patients. And when the meds fail, many report falling into a pattern of recurring infections coupled with debilitating pain. The kicker? Tests don’t always show an infection, leaving doctors and patients stuck.
Here, everything you need to know about urinary tract infections.
What are UTIs?
Put simply, a UTI is an infection, usually bacterial, in some part of the urinary system. Your urinary system includes your kidneys, ureters, bladder, and urethra.
There are many different types of bacteria that can cause an infection in your urinary system, but the most common is e. Coli, a germ found in your poop and raw meat, according to the Mayo Clinic.
Normally your lady parts run a tight ship and your labia and urethral sphincter keep bad stuff out, says Sherry Ross, M.D., ob-gyn, women’s health expert, and author of She-ology: The Definitive Guide To Women’s Intimate Health. But occasionally, bacteria makes it in, and once inside you, it will multiply, usually in your bladder, causing the symptoms of the infection.
How common are they?
Accord to analysis by national consortium, OUTBREAK, UTIs are one of the world’s most common infections will cost Australia more than $1 billion a year within the next decade. They’re also becoming more persistent and harder to treat, resulting in more people being admitted to hospital where they require longer stays and more costly medicines.
“Drug-resistant infections are a global health threat but this is the first time we’ve been able to connect the overuse and misuse of antibiotics to the health and economic impact of a single disease,” Assoc Prof. Morgan said.
“UTIs affect 1 in 2 Australian women and 1 in 20 men in their life-time, currently resulting in more than 2.5-million GP appointments, 100,000 emergency department visits and 75,000 hospital stays each year.
“We found that UTIs already cost Australia’s health system $909 million per year, not including indirect costs such as lost productivity. If we do nothing to stop the rise of antibiotic-resistance, that figure could easily hit $1.6 billion by 2030.
“Those figures are very conservative and don’t take into account the increasing numbers of people with UTIs, so realistically it could cost much, much more than that.”
Chronic UTI Australia | chronicutiaustralia.com.au
UTI symptoms
1. Your pee smells: Urine that smells like ammonia—a pungent chemical commonly used in kitty litter and window cleaners—is one of the first really noticeable signs of a urinary tract infection, says ob-gyn Sherry Ross, MD, women’s health expert and author of She-ology: The Definitive Guide To Women’s Intimate Health. Stinky pee can be a side effect of many things, ranging from medical issues—like other types of infections—to silly things, like eating certain foods, so one of the main determinants in terms of *what* type of infection you’re dealing with is discharge, says ob-gyn “Dr. Lady Doctor,” Kelly Culwell, MD. “Yeast infections, bacterial vaginosis, or sexually transmitted infections (STI) will have vaginal discharge as one of the symptoms, which doesn’t happen with UTIs,” she notes.
2. Your pee is discoloured: Discoloured, cloudy urine often accompanies the strong smell of a UTI, Ross says. Normal pee should look clear or light yellow, similar to lemonade. Pee that looks pink or brown might mean there’s bacteria or even a little blood mixed in with your urine. After all, many infections in your urinary tract can cause irritation and bleeding.
3. You need to pee constantly, but not much is coming out: Feeling like you have to pee all the time, even right after using the bathroom, is a telltale sign of a urinary tract infection, Ross says. It isn’t that you really have to pee every 10 minutes, but rather that you feel the urge to pee constantly. Why? When you have a UTI, bacteria irritate the urethra and bladder.
4. Or you can’t stop the pee from coming: On the other hand, another symptom of UTIs can be incontinence.
5. Your pee burns: It may even feel like your urethra is spasming or cramping. Again, this has to do with the bacteria irritating and inflaming your urethra.
UTI treatment
The best way to diagnose and treat a UTI is by going to your GP and collecting a urine sample. That way the GP can send it to the lab for culture. Once diagnosed, your doctor will most likely prescribe you with a course of antibiotics.
While using natural, homeopathic, or over-the-counter treatments can help alleviate the symptoms or possibly help prevent a recurrence, they won’t kill the bacteria causing it. Because it’s a bacterial infection, antibiotics are the only way to cure a UTI.
There are definitely, however, some ways to prevent UTIs – which you can check out here.
Are some people more prone to UTIs?
The number-one risk factor for getting a UTI? Being a woman. Why? Because a woman’s urethra is shorter than a man’s, and [because of] it’s location, we are more likely to get infections,.
But while some women only get them once in a blue moon, other unlucky individuals seem to have a constant stockpile of cranberry juice on-hand to deal with more frequent infections. If you’re getting more than three infections a year, that’s out of the ordinary (read below: chronic UTIs).
Sex may be to blame—at least in part, (the thrusting, bacteria that starts in the rectal area can easily get relocated and colonise near the urethra), but there are a bunch of other possibilities including the use of spermicide for birth control, menopause, having untreated STDs, having diabetes, being pregnant, and having kidney stones, according to the National Kidney Foundation.
What are chronic UTIs?
This messed-up situation has a name: chronic UTI. You’re probably familiar with the acute version – half of all women will experience at least one in their lifetime. But for those struggling with chronic UTI, the symptoms never fully go away, even after treatment. And even though you have all the signs of an infection, the tests may not agree.
That’s the cruel twist: for decades, researchers have been flagging that the standard tests for UTI are unreliable or – as London-based urologist and leading chronic UTI researcher Professor James Malone-Lee puts it – “grossly incompetent”. In 2018, a study by the University College London, co-authored by Malone-Lee, found that the gold-standard UTI test, the midstream urine culture, missed a significant proportion of bacteria and was unable to discriminate between patients and control subjects. Urinary dipstick analysis, used in clinics to diagnose UTI, have been shown to miss more than 50 per cent of infections. “The patient is then denied treatment,” says Malone-Lee. “That infection gets more established and it becomes more of a problem to remove.”
What causes recurrent UTIs?
The reason UTIs hang around, says Malone-Lee, is that the bacteria avoid attack from the immune system and antibiotics by burrowing into the bladder wall, or clinging to it in a sticky substance called biofilm. Once embedded, they go quiet. “They’re a bit like a weed seed out in the garden, just waiting for a suitable day to open up,” he explains. “From time to time they wake up, divide and break out of the cells, causing an acute flare.” Malone-Lee’s solution is simple: he uses microscopy of a urine sample to confirm infection, with high-dose, narrow-spectrum antibiotics to destroy embedded bacteria – a process that takes, on average, a year.
While he has published studies to validate his approach and is working towards a randomised control trial, it’s not a treatment likely to be recommended by a GP. “It’s not widely accepted practice, and we obviously haven’t applied it to the Australian setting,” explains Dr Lin Li Ow from the Urogynaecological Society of Australasia. “If every GP were to start patients on high-dose antibiotics you’d see a lot of resistance building up.” She adds that it’s important to consult a specialist when symptoms recur and tests are negative. “We would recommend seeing a urologist or a urogynaecologist … to exclude any pathology in the bladder like a stone or cancer or growth that can cause this urine urgency that could be mimicking a UTI.”
What is the treatment for chronic UTIs?
Limited awareness of chronic UTI in the general medical community means many are left in painful limbo. “It pervades every aspect of your life,” says Imelda Wilde, a spokesperson for patient advocacy group Chronic UTI Australia. “You spend so much [time] going to doctors and specialists. You miss out on things with your family and friends. You get tired because your body is constantly fighting off infection. And the emotional stuff as well. Just not being believed … there’s a lot of frustration involved.” It’s why some people, such as communications manager Lauren Syzlarski, 36, have taken the drastic step of travelling across the globe for treatment. Lauren was living in Scotland when she got a UTI that didn’t fully clear after six weeks of medication. Refused a further dose, “I went from mild symptoms in October to fairly severe pain most days by November,” she recalls. “I wasn’t sleeping, I wasn’t eating … I was going back to the GP almost weekly in tears.” She ended up quitting her job and moving home to Melbourne, but returned to the UK six months later for an appointment at Malone-Lee’s clinic.
It took 22 months, but Lauren is now off medication and, so far, symptom-free. The good news for those who can’t afford a trip to London? Change is coming, albeit slowly. Wilde says Chronic UTI Australia is working with the Royal Australian College of General Practitioners to share the latest research, and scientists are developing new treatments, from probiotics to nano capsules that deliver antibiotics directly into the bladder. For anyone grappling with this recurring nightmare, it’s a glimmer of hope – we might not know when the next flare is coming, but at least we’re not riding this roller-coaster alone.
