There are hardly words to explain the searing pain that can come with a urinary tract infection: “It made me want to curl up in a ball and die,” says a 36-year-old Washington woman. The woman, who did not want to be identified for privacy reasons, has suffered through three urinary tract infections.
Symptoms of a UTI — the condition is called cystitis when the bladder is infected — may include burning, pressure, pain over the bladder area, nausea, blood in the urine and a persistent, wildly urgent need to urinate. Typically confirmed by a quick urine test or through a urine culture, they account for more than 8 million health-care visits in this country each year, according to the American Urological Association, with women four times as likely to be as affected as men. Half of all women will have one at some point.
Women often get what’s quaintly referred to as “honeymoon cystitis” — an infection that follows sexual activity. Although the urinary tract has mechanisms to prevent infection — valves keep urine from flowing toward the kidneys, and microbes are flushed out in urination — intercourse is an ideal opportunity for bacteria from the bowel to migrate around and up the urethra to the bladder.
The good news: Most women find relief from the fiery pain quite quickly after taking antibiotics. (If the pain persists, medical attention is needed to rule out kidney infection and other causes.) And many will go to great lengths to prevent it from happening again.
The age-old prevention method for UTIs has been cranberry juice, but with concerns about sugar consumption these days, some people have turned to cranberry pills.
An older premise was that the fruit helps fight bacteria by changing the acidity of the urinary tract; more recently, some scientists have pointed to proanthocyanidins, compounds in the berry that can prevent bacteria from binding to the bladder wall. A popular brand, AZO Cranberry, offers caplets containing concentrated cranberry powder that help “flush” the urinary tract “to maintain urinary tract cleanliness.”
Many trials have cast doubt on cranberries’ preventive powers. In a widely discussed study published in JAMA in November, researchers found that nursing home residents who ingested cranberry capsules were no less likely to develop infections than those given a placebo.
The American Urological Association dismissed cranberry’s usefulness rather firmly after the JAMA study’s release. Urologist Kathleen Kobashi, speaking for the association, said via email, “Given the lack of any evidence supporting the utility of cranberry supplements for UTI prevention considering their cost and the sugar content in juice, there does not seem to be any point in continuing them.”
But the study’s lead author, Manisha Juthani-Mehta, an infectious-disease specialist at the Yale School of Medicine, noted that there’s no obvious downside to ingesting a moderate amount of cranberry: “If you like cranberry juice or other cranberry products,” she says, “by all means, continue to eat or drink whatever you enjoy or think works for you.”
Unfortunately, there are not a lot of proven ways to prevent UTIs, but there are a few things that may work:
● Drinking lots of water. “Drinking a few liters of water per day can truly help” frequent UTI sufferers, says Juthani-Mehta. The AUA lists “reduced urine flow” as a risk factor for UTIs.
● Urinating after sex. The idea is to wash out the bacteria before they can get to work. “There’s no research that has shown that this helps,” notes Andrew Sokol, a uro-gynecologist at MedStar Washington Hospital Center in the District, “but the risk is so low, it’s a reasonable thing to suggest.”
● Taking low-dose antibiotics after sex. Some women who have recurrent infections (generally more than three a year) with no apparent underlying health issue are prescribed a low-dose antibiotic to take prophylactically after sexual activity. If recurrent UTIs are not correlated with sex, Sokol says, prophylaxis can be given with a daily dose for three to six months.
● Keeping the area around your urethra clean. Don’t wear thong underwear, for instance, because those garments “allow bacteria to travel easier to the urethra,” Berkeley explains. “It’s just something to think about.” Wipe from front to back. Many women also wash with soap and water immediately after sex. Sokol calls it “a common-sense thing.”
The Washington woman, who hasn’t had a UTI in more than five years, says she does most of the above, including drinking a full glass of water and urinating before and after sex and showering after sex.
She says she sticks to the routine “without fail”: “The thought of getting another one is just too much.”