PEE AS IN PAIN
Lower urinary tract infections are common among women, but so is urgency and frequency of urination
By Dr. Sheila R. Alcantara
WHEN NATURE CALLS, WE HAVE TO ANSWER. WHEN NATURE CALLS TOO FREQUENTLY, IT IS INCONVENIENT, BUT NOTHING TO BE ALARMED ABOUT. BUT WHEN PAIN ACCOMPANIES EACH ANSWER THERE MUST BE SOMETHING WRONG.
UROLOGIC SURGEON MARIE CARMELA LAPITAN SAYS THIS BURNING SENSATION AT THE TAIL END OF EACH URINATION IS THE REAL SIGNAL OF A LOWER URINARY TRACT INFECTION (UTI). "THE MOST PROMINENT [SYMPTOM] IN LOWER UTI IN FEMALES IS PAINFUL URINATION. THERE'S THIS DISTINCT PAIN TOWARDS THE END OF URINATION.
MASAKIT TALAGA SIYA, PARANG AYAW MO NANG UMIHI," SHE EXPLAINS.
Common though lower UTI is in females-about one in five women suffer from a UTI in her lifetime-it is not always a case of UTI if a woman complains of having to go use the ladies' room once too often.
"Actually, what they're just feeling is frequency, which is a totally whole new problem in itself," points out Lapitan.
However, this high incidence of lower UTI among women seems to have created a tendency among some physicians to overdiagnose, she reveals.
Lapitan relates that she had seen patients who were diagnosed with UTI-in particular, cystitis, which is commonly the case in women with lower UTI-but who actually did not have the disease but only one or two of its most prominent symptoms.
"Some patients, and unfortunately, some doctors, as long as the patient will complain of
madalas umihi-they label the patient as having UTI [already]," she laments.
Improper collection of the urine, from which a urinalysis would come up with a falsely high white blood count (WBC), is commonly responsible for a mistaken assessment of infection.
Patients are often unaware of the importance of collecting their urine midstream, and in clinics where they are examined, the medical staff might neglect informing them of this requirement. The results of the urinalysis would then be unreliable.
"For counts less 10/high power field, when culture of the urine is done, that is, seeing if bacteria will grow in the urine, it will often be negative," she clarifies. The presence of an abnormally high count of epithelial cells in the urine signal that the urine was not properly collected, but this is often disregarded or overlooked, she notes.
Thus to be really sure it is UTI, doing a urine culture is the gold standard, Lapitan says.
A colony count of >105/ml of the pathogenic culprits in the urine would confirm the proliferation of either Escherichia coli-which is responsible for about 90 percent of first-time cases of lower UTI-or Staphylococcus saprophyticus, which is the infecting organism in about five to 15 percent of cases.
However, doing a urine culture could be expensive and impractical. "You don't get the results right away; you get the results one week later," Lapitan admits. So if a woman does have an infection, before you get the urine culture results, it might either be too late to catch the disease early or the infection was already treated with antibiotics, she explains.
A clinical eye is really what's needed, she points out. Besides taking into account the classical symptoms of UTIs, the patient needs to be worked up. If the woman complains of recurring symptoms, she could have something structurally wrong with her urinary system already, or stones might be blocking the bladder outlet.
The most telling symptom for UTI, Lapitan stresses, is pain. It would make her suspect UTI more than if there were only frequency and urgency. And which might prevent overdiagnosis.
A very serious problem, she points out. This is because giving antibiotics when inappropriate could also tilt the balance of microorganism flora in one's vagina. So if the woman did not have UTI before, she would now be at risk for it.
Social Climbers
E. coli and S. saprophyticus are normally present in the colon and the genital areas, but because of their proximity to the vagina, sometimes find their way inside the urinary tract and remain there because of poor toilet habits.
Lapitan explains that women who habitually delay going to the bathroom seem more predisposed to lower UTI. It has to do with the length of time bacteria-if bacteria did manage to reach the urinary system-could multiply in the bladder, a hospitable environment for them.
According to Lapitan: "Once you feel that your bladder is full, you must find a way to expel that urine within a reasonable length of time and not delay it for a long time."
This advice though does not imply urinating even when the bladder is not full.
She clarifies: "I would rather say [that] women who go to the toilet at the right time and voids at the normal frequency are less prone to UTI than those who delay going to the toilet for an abnormally long time."
She explains that delaying urination beyond the normal interval and frequency is really one of the risk factors for lower UTI, particularly cystitis.
The bladder is the most frequently hit, when it comes to lower UTIs in women-in 70 to 80 percent of them with this disorder,
she says. The main reason is the shorter urethra of women. "The length of the urethra itself is protective," she notes, which also explains why lower UTIs are more common among women. In men, any microorganism that bodes infection if unchecked would have to ascend a longer urethra.
Other organisms also cause UTI, such as Chlamydia trachomatis and Mycoplasma hominis, which are sexually transmitted. In the urinary tract, they tend to be limited in the urethra and the reproductive system.
Vulnerabilities
Some women seem more predisposed to UTIs. Despite practicing proper hygiene and toilet habits, they still seem unable to shake off bouts of infection.
"Once you've had one episode, there's a high likelihood you'll have another one compared with somebody who has never had one," Lapitan comments.
Some women therefore engage in a frustrating battle against recurring infections. They scrupulously wash with feminine wash with the appropriate pH balance, since soaps could strip the vagina of its natural protection.
As Lapitan explains it: "The acidity of the vagina is, in a way, protective, because the normal environment of the vagina allows only certain organisms, bacteria to grow-and those certain organisms do not cause UTI normally."
These predisposed women also make sure to drink plenty of fluids every day to make them urinate more often, which helps treat their UTI because bacteria are flushed out as well. "The best preventive measure for UTI and one of the foundations of treatment is really to drink lots of water," Lapitan confirms.
However, these measures seem to no avail against another distressing episode of having to always rush to the ladies' room and experiencing pain with each urination.
Of course, there are several susceptibility factors for UTI, and cystitis could even suggest other abnormal conditions in the urinary tract.
Lapitan says a suppressed immune system could make a woman more vulnerable-when normally harmless microorganisms suddenly turn opportunists. Diabetes and the use of some contraceptive methods like a diaphragm and spermicidal could affect the normal vaginal bacterial flora-again increasing the risk for bladder infection. Then if one has had UTI before, a pregnant woman is at increased risk for it, reveals Lapitan.
And contrary to what some women believe, she asserts, lower UTIs do not lower their chances of conceiving a child. "It's maintaining your pregnancy that becomes the problem-if you have infection during pregnancy. But if you've never had infection during the pregnancy, then your chances of completing the pregnancy is the same as those of any other normal person."
And in case the woman develops lower UTI during pregnancy, the baby should not be in danger specifically from it. "Not unless the mother goes into sepsis, wherein the infection goes into the blood and circulates throughout the body. Until this occurs, lower UTI among women affects the baby only through the mother's response to the infection," she explains.
Missing Safeguards
She says that menopause is also a predisposing factor. In postmenopausal women and in some premenopausal ones, certain chemicals secreted by the mucosa in the urinary tract are depleted. Since these chemicals somehow mask the sites where pathogens could adhere to, they act as a defense against UTIs.
But in some women who have proper secretion of these chemicals UTI still somehow develops, Lapitan points out. She explains that even the presence of pathogenic bacteria in the urine or inside the urinary tract is not actually the definition of an infection. Infection is when your body reacts adversely to this presence.
In some women, the protective mechanism that makes other women resistant against UTIs is lacking. "So how the bacteria affect your body is how you become prone to UTI. If you have something that will fight the bacteria or the effects of the bacteria in your tissue, then you don't develop infection," she explains.
What exactly protects them, she says, is not definitely known yet.
3 or 7
The question in the antibiotic treatment of women with UTIs is, how long should the patient take antibiotics?
"Studies have shown that a three-day antibiotic course can be as good as a seven-day course," Lapitan relates. She says that whether three days or seven days, the patient would be infection-free. "The difference is, your risk of a recurrence of the infection is higher if you only completed three days."
What treatment course to take would then be balanced by the cost of the medication and what is appropriate for the individual's specific needs-as some patients do have a tendency to forget to take their antibiotic after the third day, says Lapitan.
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