What Causes UTI: Essential Information

Older woman on laptop

Urinary tract infections (UTIs) are among the most common bacterial infections. These bladder infections primarily occur when bacteria enter the urinary system, leading to discomfort, pain, and, in severe cases, complications like kidney infection. Understanding what causes a urinary tract infection (UTI) is helpful for effective UTI prevention and treatment. In this article, we look at the factors contributing to UTIs, ranging from common triggers to underlying health conditions. 

Common UTI Causes

Bacterial infections stand as the leading cause of UTIs. Among the bacteria responsible, Escherichia coli (E. coli) reigns supreme, accounting for approximately 80% of UTI cases. These bacteria typically inhabit the gastrointestinal tract but can migrate to the urinary tract, especially in women, due to the proximity of the urethra to the anus.

Apart from E. coli, other bacteria such as Klebsiella, Enterococcus, and Proteus species can also trigger UTIs, albeit less frequently. The introduction of these bacteria into the urinary system often occurs through improper wiping techniques after using the toilet or during sexual activity. 

Furthermore, factors like urinary catheterisation, which creates a direct pathway for bacteria to enter the bladder, increase the risk of bacterial growth and developing urinary tract infections. Understanding these common bacterial causes is key to adopting preventive measures to reduce the risk of UTIs.

Risk Factors for UTI

While bacterial infections are the primary cause of UTIs, several risk factors can increase susceptibility to these uncomfortable and sometimes recurrent UTI infections.

Gender

Women are more prone to UTIs than men, due to their shorter urethras, which allow easier access for bacteria to travel into the bladder. Hormonal changes during pregnancy and menopause can further elevate the risk for women. Learn more about men and UTIs.

Age

UTIs are more prevalent in older adults, particularly those over the age of 65, due to factors such as weakened immune function and age-related changes in the urinary tract.

Urinary Tract Abnormalities

Structural abnormalities in the urinary tract, such as kidney stones or an enlarged prostate gland in men, can obstruct urine flow and promote bacterial growth, increasing the risk of UTIs.

Urinary Catheterisation

Using a urinary catheter when hospitalised, provides a direct pathway for bacteria to enter the bladder, significantly increasing the risk of bladder infection.

Immune System Deficiencies

Individuals with weakened immune systems, whether due to conditions like HIV/AIDS, diabetes, or immunosuppressive medications, are more susceptible to UTIs as their bodies may struggle to fight off bacteria effectively.

Sexual Activity

Engaging in sexual activity, particularly for women, can introduce bacteria into the urinary tract, increasing the likelihood of UTIs. Certain sexual behaviours, such as using spermicide-coated condoms or having multiple sexual partners, can further increase this risk.

Poor Hygiene Practices

Inadequate personal hygiene, such as improper wiping techniques after using the toilet or infrequent changing of sanitary products, can facilitate the spread of bacteria from the anus to the urinary tract, leading to UTIs.

Diverse women

UTI and Poor Hygiene

Maintaining proper hygiene practices is paramount in preventing UTIs, as poor hygiene can significantly increase the risk of bacterial contamination in the urinary tract.

Improper Wiping Technique

Inadequate wiping technique after using the toilet, particularly in women, can lead to the transfer of bacteria from the anal region to the urethra, increasing the likelihood of UTIs. It is essential to wipe from front to back to prevent the spread of bacteria.

Infrequent Changing of Sanitary Products

Prolonged use of sanitary pads or tampons can create a moist environment conducive to bacterial growth, increasing the risk of UTIs. Regularly changing sanitary products is key to maintaining cleanliness and preventing bacterial colonisation.

Personal Hygiene Habits

Neglecting personal hygiene, such as infrequent bathing or wearing soiled underwear, can promote bacterial growth in the genital area, potentially leading to UTIs. Maintaining a regular hygiene routine, including daily bathing and wearing clean underwear, is essential for urinary tract health.

UTI and Sexual Activity

Sexual activity, particularly in women, has been identified as a significant risk factor for UTIs. The proximity of the urethra to the anus and the friction involved during sexual intercourse can facilitate the transfer of bacteria from the perineal area to the urinary tract, increasing the likelihood of infection.

Introduction of Bacteria

Sexual intercourse can introduce bacteria, such as Escherichia coli (E. coli), into the urethra and, subsequently, the bladder, leading to UTIs. Bacteria from the genital region or the rectum can be transferred to the urinary tract during sexual activity, especially if proper hygiene practices are not followed.

Spermicides and Contraceptives

Certain birth control methods, such as spermicide-coated condoms or diaphragms, can alter the vaginal pH and increase the risk of bacterial overgrowth, predisposing individuals to urinary infection. Additionally, the friction associated with the use of these contraceptives during intercourse can cause irritation and inflammation of the urinary tract, further contributing to UTI risk. Exploring alternative contraceptive methods or using lubricants without spermicides may reduce the UTI risk associated with sexual activity.

Frequency of Sexual Activity

Frequent sexual activity, especially with multiple partners, is associated with an increased risk of UTIs. This heightened risk may be attributed to the recurrent introduction of bacteria into the urinary tract.

Postcoital Voiding

Urinating shortly after sexual intercourse can help flush out any bacteria that may have entered the urinary tract during intercourse, reducing the risk of UTIs. Encouraging postcoital voiding is a simple yet effective preventive measure for individuals prone to recurrent UTIs.

Postcoital voiding

UTI and Urinary Tract Abnormalities

Structural abnormalities within the urinary tract can predispose some people to UTIs by creating conditions conducive to bacterial colonisation and proliferation. These abnormalities may interfere with normal urinary flow, impair voiding mechanisms, or create pockets where bacteria can thrive, increasing the risk of infection.

Kidney Stones

Kidney stones can obstruct urinary flow, leading to urine stasis and creating an environment favourable for bacterial growth. Bacteria may adhere to the surface of kidney stones, forming biofilms that protect them from the body’s natural defence mechanisms and antibiotics, thereby increasing the risk of UTIs.

Urinary Tract Obstructions

Any obstruction along the urinary tract, such as strictures, tumours, or anatomical abnormalities, can impede urine flow and promote bacterial retention. Stagnant urine provides an ideal breeding ground for bacteria, increasing the likelihood of UTIs.

Vesicoureteral Reflux (VUR)

Vesicoureteral reflux is when urine flows backward from the bladder into the ureters, potentially reaching the kidneys. This reflux of urine can introduce bacteria from the bladder into the upper urinary tract, increasing the risk of kidney infections (pyelonephritis) and recurrent UTIs.

Neurogenic Bladder

Neurological conditions that affect bladder function, such as spinal cord injury or multiple sclerosis, can disrupt the normal coordination between bladder muscles and nerves, leading to incomplete emptying of the bladder. Urine retention in a neurogenic bladder creates an environment conducive to bacterial growth and increases the risk of UTIs.

Enlarged Prostate

In men, an enlarged prostate gland can obstruct the urethra, impairing urinary flow and predisposing to urinary retention. Stagnant urine in the bladder provides an opportunity for bacterial colonisation, increasing the susceptibility to UTIs.

UTI pain - woman with weakened immune system

UTI and Weakened Immune System

The immune system plays a vital role in defending the body against bacterial infections, including UTIs. When the immune system is compromised or weakened due to underlying medical conditions or certain medications, the body’s ability to combat bacterial invaders is reduced, increasing the susceptibility to UTIs.

Immunodeficiency Disorders

People with primary immunodeficiency disorders, such as common variable immunodeficiency (CVID) or severe combined immunodeficiency (SCID), have impaired immune responses, leaving them more vulnerable to infections, including UTIs.

HIV/AIDS

Human immunodeficiency virus (HIV) infection, particularly when it progresses to acquired immunodeficiency syndrome (AIDS), weakens the immune system, compromising the body’s ability to fight off infections. HIV/AIDS patients are at an increased risk of developing recurrent and severe UTIs, which may require prompt and aggressive treatment.

Diabetes Mellitus

Uncontrolled diabetes mellitus can impair immune function and increase the risk of UTIs. Elevated blood sugar levels create a favourable environment for bacterial growth in the urinary tract, while diabetic neuropathy may interfere with bladder emptying, promoting urine retention and bacterial growth.

Immunomodulatory Medications

Certain medications used to manage autoimmune disorders, organ transplantation, or cancer (e.g., corticosteroids, chemotherapy agents) can suppress immune function, predisposing some people to infections, including UTIs. These medications may weaken the body’s ability to mount an effective immune response against bacterial pathogens.

Chronic Illnesses

Chronic illnesses such as chronic kidney disease, liver cirrhosis, or chronic obstructive pulmonary disease (COPD) can compromise immune function, increasing susceptibility to infections like UTIs. Patients with these conditions may require close monitoring and proactive management to prevent UTIs and complications.

Elderly Population

Aging is often accompanied by immune system changes, referred to as immunosenescence, which can impair immune responses and increase susceptibility to infections. Older adults are more prone to UTIs due to age-related changes in the urinary tract, comorbidities, and weakened immune function.

UTI and Menopause

Menopause, a natural transition marking the end of menstruation and reproductive capability in women, brings about hormonal changes that can influence the urinary tract and increase the risk of UTIs.

Oestrogen Deficiency

During menopause, the ovaries produce less oestrogen, leading to vaginal dryness and thinning of the vaginal walls (vaginal atrophy). This reduction in oestrogen levels can disrupt the natural balance of bacteria in the vagina and urethra, making women more susceptible to UTIs. Oestrogen deficiency also weakens the urethral sphincter muscles, compromising their ability to prevent bacterial entry into the bladder effectively.

Changes in Vaginal pH

Oestrogen plays a lead role in maintaining the acidic pH of the vagina, which helps inhibit the growth of harmful bacteria. With declining oestrogen levels in menopause, the vaginal pH may become less acidic, creating an environment conducive to bacterial overgrowth and increasing the risk of UTIs.

Genitourinary Syndrome of Menopause (GSM)

GSM encompasses various urogenital symptoms experienced by menopausal women due to oestrogen deficiency, including vaginal dryness, itching, burning, and dyspareunia (painful intercourse). These symptoms can disrupt the vaginal epithelial barrier and increase susceptibility to UTIs by facilitating bacterial growth.

Bladder Changes

Menopause-related hormonal changes can affect bladder function, leading to urinary symptoms such as increased urinary frequency, urgency, and nocturia. Changes in bladder elasticity and capacity may result in incomplete bladder emptying, promoting bacterial growth and UTI development.

Hormone Replacement Therapy (HRT)

Hormone replacement therapy, which involves supplementing oestrogen and sometimes progestin to alleviate menopausal symptoms, may influence UTI risk. While oestrogen therapy can help restore vaginal health and reduce UTI risk in some women, the use of systemic oestrogen alone or in combination with progestin may have variable effects on UTI susceptibility. It should be carefully considered based on individual risk factors.

Woman practising good hygiene with fresh cotton underwear

Prevention Tips for UTI

Preventing UTIs means taking proactive measures to reduce the risk of bacterial growth in the urinary tract, such as looking into foods to avoid with a UTI. Incorporating the following prevention tips into daily routines can help maintain urinary tract health and prevent urinary tract infections.

Stay Hydrated

Drinking adequate water helps flush bacteria out of the urinary tract by increasing urine production and promoting frequent urination. Aim to drink at least eight glasses of water daily if engaging in vigorous physical activity or hot weather.

Practise Good Hygiene

Maintain proper hygiene practices, including wiping from front to back after using the toilet to prevent the spread of bacteria from the anal region to the urethra. Additionally, ensure regular bathing and changing of underwear to minimise bacterial colonisation in the genital area.

Urinate Frequently

Avoid holding urine for prolonged periods, as this can promote bacterial growth in the bladder. Urinate when you feel the urge to do so, and try to empty your bladder completely each time.

Urinate After Sexual Activity

Voiding shortly after sexual intercourse can help flush out any bacteria that may have been introduced into the urinary tract during sex, reducing the risk of UTIs. Encourage postcoital voiding as part of your routine.

Wear Breathable Underwear

Opt for cotton underwear and loose-fitting clothing to promote air circulation in the genital area and reduce moisture, creating an environment conducive to bacterial growth.

Avoid Irritants

Certain products, such as spermicide-coated condoms, feminine hygiene sprays, and douches, can disrupt the natural balance of bacteria in the vagina and increase the risk of UTIs. Avoid using these irritants, and opt for gentle, unscented products for genital hygiene.

Cranberry Products

Drinking cranberry juice or taking cranberry supplements may help prevent UTIs by preventing bacteria from adhering to the urinary tract lining. However, evidence supporting the efficacy of cranberry products in UTI prevention is mixed, and their use should be discussed with a healthcare provider.

Consider Probiotics

Probiotics containing Lactobacillus species may help maintain the balance of healthy bacteria in the urinary and genital tracts, reducing the risk of UTIs. Discuss the use of probiotics with your healthcare provider to determine if they may be beneficial for you.

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