A Painful Problem

WebMD Feature

Nov. 13, 2000 -- Even though it happened more than 10 years ago, Mary Sander still vividly remembers her first urinary tract infection (UTI), when an unimaginable pain wracked her abdomen. "The pain was so bad I thought I was going to die," says Sander, now a 32-year-old clothing designer in Reno, Nev. Medications soon brought comfort. But the agony -- more intense than childbirth, says the mother of four -- remains fresh in her mind.

For Sander, and an increasing number of women in the country, that first infection is just the beginning. Experts from the National Institute of Diabetes and Digestive and Kidney Diseases estimate that UTIs recur in about 20% of all sufferers. And the problem is widespread: Such infections affect 8 to 10 million Americans a year, mostly women, according to the American Foundation for Urological Diseases.

Since infections tend to recur, many women may need multiple rounds of antibiotics to treat them, says Frank Tally, MD, an infectious disease specialist in Boston. And when women take one antibiotic after another, they may be left with bacteria naturally resistant to all the drugs, he says. However, with the proper precautions, women can help prevent UTIs from occurring in the first place.

Bladder, Kidney, and Pain

What causes a UTI? Doctors point to the bacteria Escherichia coli (E. coli) or Staphylococcus saprophyticus (staph) as the usual suspects. They make their way into the urinary tract, typically through the narrow tube that directs urine out of the body (called the urethra), often encouraged by compressions that tend to occur during sexual intercourse.

The bacteria usually land in the bladder, causing cystitis, the most common type of UTI. This results in pain in and around the pelvis and lower back, as well as a burning sensation when urine -- which could be cloudy, bloody, or foul-smelling -- is passed. Sufferers also tend to have the urge to urinate frequently and usually get up more than once during the night to do so.

If the bacteria migrate higher in the body, from the bladder into the kidneys (through connecting tubes called ureters), women may develop a UTI called pyelonephritis. This causes pain in the middle of the back and often fever and chills.

Prevention Is Best

Antibiotics can only do so much to alleviate these symptoms, says Christiane Northrup, MD, a woman's health specialist in Maine. While the drugs may eliminate the bacteria causing the infection, they also can kill "helpful" vaginal bacteria. In turn, she says, you'll be less prepared (at least until the helpful bacteria repopulate after the drugs are stopped) to defend against future UTIs and yeast infections, and possibly suffer from diarrhea.

Once a UTI has cleared, preventing a subsequent one can avoid another round of antibiotics and the problems it may cause, says Sander. The National Kidney Foundation agrees. The organization recommends drinking at least eight 8-ounce glasses of water a day, which encourages you to visit the bathroom more often and gives your body additional opportunities to flush out any residual harmful bacteria.

Washing your genitals with soap and water every day (especially before and after sexual intercourse), taking a shower instead of a bath, wiping from front to back after bowel movements (to limit the introduction of intestinal bacteria), urinating after sexual intercourse, and urinating when you need to rather than holding it are also helpful in limiting unwanted bacterial migration up the urethra to the bladder.

Taking It Into the Kitchen

Supplement these precautions with a few home remedies. Many doctors recommend drinking unsweetened cranberry juice, which may prevent bacteria from adhering to the wall of your bladder, making them easier to flush.

Cranberry juice too sour for you? Try 1,000 to 2,000 mg of vitamin C every day. It has the same effect, Northrup says. It's a good reason to drink vitamin C-rich orange juice or other citrus juices instead of coffee, soda pop, or other beverages containing caffeine, which may irritate your bladder lining. Doctors also recommend avoiding alcohol and spicy foods for similar reasons.

These precautions may sound like a lot of work, but not for Sander, who has weaved UTI prevention into her lifestyle. After quelling two full-blown infections with antibiotics, she began to drink copious amounts of water and cranberry juice. She says she believes that her precautionary attitude has kept another infection -- with its excruciating pain -- at bay.

Dana Sullivan is a freelance writer in Reno, Nev.

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