Even before the first dash to the toilet, many women will feel
discomfort in their lower abdomen and know what's coming: painful,
stinging urination and the need to do so inconveniently often.
One in two women will experience a urinary tract infection (UTI) in their lifetime, and many will suffer from more than one.
UTIs are much more common in women than men, and this is partly due to anatomy. Women have a shorter urethra — the duct that carries urine out of the body — so it's easier for bacteria to reach the bladder.
So given their prevalence and persistence, how far have we come in understanding how UTIs work and how to treat them?
But one of the reasons UTIs are so common and acute is that bacteria that make their way into the urinary tract have the right tools to stay put inside bladder-lining cells, according to microbiologist Iain Duggin from University of Technology Sydney.
"Once they've taken over the bladder and used up all the resources of the cell, they can break open the cell and disperse themselves across the surface of the bladder and actually reinfect other bladder cells," he said.
"You see very rapid and acute symptoms in UTIs because this process is happening exponentially."
Dr Duggin said that hiding out in the bladder lining and lying dormant are key to E. coli's success in establishing a UTI.
The current standard treatment for UTIs is a short course of antibiotics, which can be followed by a longer, low-dose course if infection persists or keeps coming back.
"Even if you can get the antibiotics to the direct site of the infection, the bacteria might not be affected by them," he said.
The role of antibiotics is muddled further by the discovery of a diverse ecosystem of microorganisms in the female bladder.
"We're still at quite an early stage of understanding what will be a very complex ecological niche, no matter how those different microorganisms interact," Dr Duggin said.
"We would anticipate that everyone has a different bladder microbiome, and that could significantly influence their susceptibility to UTIs and potential treatments."
Port Macquarie GP obstetrician Judith Gardiner said that right now, it's hard to see a way around prescribing antibiotics for UTIs.
"Bacterial infections can go on to cause significant problems if they're not treated, which at this stage is still always with antibiotics," Dr Gardiner said.
"We steer away from broad-spectrum antibiotics because they are the ones that tend to cause the problems with resistance, and we start with narrow-spectrum antibiotics specific to the bacteria we know cause UTIs."
If it comes back positive, they'll send off a sample for analysis in a pathology lab to confirm the infection.
After studying and treating UTIs for 20 years, clinician and emeritus professor of medicine at University College London James Malone-Lee realised that standard dipstick tests for UTIs might yield "false information", and he suggested that UTI rates could be even higher than we think if current screening tests are missing infected people.
"You've got this crazy situation where you can go along to a doctor and have all the symptoms of urinary infection, and still be told 'no, you don't have a urine infection' because the test is negative," Professor Malone-Lee said.
Professor Malone-Lee thinks the best alternative to current diagnostic tests is to look at patients' urine under a microscope as soon as they have provided a urine sample — looking for cell changes that indicate infection.
However, there are training costs associated with using this technique in the doctor's office.
"We are starting to work with a robot that hopefully will do the cell counts successfully using image recognition," Professor Malone-Lee said.
Dr Gardiner said the initial tests are just for screening. If they produce a negative result but the patient has symptoms, doctors should still send a sample off to the lab in case the infection was higher up the urinary tract.
"The infection might be higher up in the kidneys because that doesn't show on a dipstick test," she said.
A recent study
investigated whether drinking more water can reduce recurrent urinary
tract infections in women — something that had been recommended but not
adequately studied.
University of Miami infectious diseases specialist Thomas Hooton told ABC RN's Health Report that hydration is effective against UTIs because it could prevent bacteria sticking to the bladder lining.
"What we'd like to see people do is put a little bit more emphasis on recommending to women that increased hydration reduces your risk," Dr Hooton said.
However, if bacteria already have a hold in the bladder, drinking lots of water won't treat the infection, said Dr Gardiner.
"It won't clear up more extensive infections," she said.
Another way to ease some of the discomfort caused by UTIs is to take an alkaliniser — often in the form of effervescent powder — to further reduce urine acidity.
"There are commercial products but it could be done just with sodium bi-carb that you might have at home," Dr Gardiner said.
"Anything that is going to change the pH of the urine to something less acidic might help clear the infection."
"Other promising research is in delivery methods of antibiotics," he said.
"But I'm sceptical about immune treatments because they tend to focus too much on the E. coli model of urine infection and that doesn't stack up when you've got hundreds of different bacteria in the bladder."
Many women drink cranberry juice or take a cranberry supplement when they have a UTI, but unfortunately the latest research found neither juice nor supplements were better than a placebo in treating UTIs.
How bacteria bind to sugars on the bladder wall could also be critical to treatment, Dr Duggin said.
"Those naturally occurring sugars are essential for the bacteria to be taken up, and essential for the infection to occur," he said.
"Some researchers are trying to develop sugars that resemble those on the bladder surface and use them as treatments to eradicate the bacteria from the body.
"The hope is that the bacteria are then able to be cleared out by the immune system."
One in two women will experience a urinary tract infection (UTI) in their lifetime, and many will suffer from more than one.
UTIs are much more common in women than men, and this is partly due to anatomy. Women have a shorter urethra — the duct that carries urine out of the body — so it's easier for bacteria to reach the bladder.
So given their prevalence and persistence, how far have we come in understanding how UTIs work and how to treat them?
'Bacterial know-how'
Our urinary tract is not a particularly desirable environment to live in, especially compared to the gastrointestinal tract where E. coli bacteria are typically found.But one of the reasons UTIs are so common and acute is that bacteria that make their way into the urinary tract have the right tools to stay put inside bladder-lining cells, according to microbiologist Iain Duggin from University of Technology Sydney.
"Once they've taken over the bladder and used up all the resources of the cell, they can break open the cell and disperse themselves across the surface of the bladder and actually reinfect other bladder cells," he said.
"You see very rapid and acute symptoms in UTIs because this process is happening exponentially."
Dr Duggin said that hiding out in the bladder lining and lying dormant are key to E. coli's success in establishing a UTI.
The current standard treatment for UTIs is a short course of antibiotics, which can be followed by a longer, low-dose course if infection persists or keeps coming back.
Threat of resistance
Dr Duggin is concerned about the antibiotic resistance that UTIs are developing."Even if you can get the antibiotics to the direct site of the infection, the bacteria might not be affected by them," he said.
"We're still at quite an early stage of understanding what will be a very complex ecological niche, no matter how those different microorganisms interact," Dr Duggin said.
"We would anticipate that everyone has a different bladder microbiome, and that could significantly influence their susceptibility to UTIs and potential treatments."
Port Macquarie GP obstetrician Judith Gardiner said that right now, it's hard to see a way around prescribing antibiotics for UTIs.
"Bacterial infections can go on to cause significant problems if they're not treated, which at this stage is still always with antibiotics," Dr Gardiner said.
"We steer away from broad-spectrum antibiotics because they are the ones that tend to cause the problems with resistance, and we start with narrow-spectrum antibiotics specific to the bacteria we know cause UTIs."
Stumbling at the first test
When you present to your GP with the symptoms of a UTI, your doctor might do a "dipstick test", which checks the pH of a urine sample.If it comes back positive, they'll send off a sample for analysis in a pathology lab to confirm the infection.
After studying and treating UTIs for 20 years, clinician and emeritus professor of medicine at University College London James Malone-Lee realised that standard dipstick tests for UTIs might yield "false information", and he suggested that UTI rates could be even higher than we think if current screening tests are missing infected people.
"You've got this crazy situation where you can go along to a doctor and have all the symptoms of urinary infection, and still be told 'no, you don't have a urine infection' because the test is negative," Professor Malone-Lee said.
Professor Malone-Lee thinks the best alternative to current diagnostic tests is to look at patients' urine under a microscope as soon as they have provided a urine sample — looking for cell changes that indicate infection.
However, there are training costs associated with using this technique in the doctor's office.
"We are starting to work with a robot that hopefully will do the cell counts successfully using image recognition," Professor Malone-Lee said.
Dr Gardiner said the initial tests are just for screening. If they produce a negative result but the patient has symptoms, doctors should still send a sample off to the lab in case the infection was higher up the urinary tract.
"The infection might be higher up in the kidneys because that doesn't show on a dipstick test," she said.
Can you flush out the bacteria?
Because the E. coli bacteria need to glue themselves to the bladder wall, if you can wash them out before they have latched on, could that prevent the infection from progressing?
University of Miami infectious diseases specialist Thomas Hooton told ABC RN's Health Report that hydration is effective against UTIs because it could prevent bacteria sticking to the bladder lining.
"What we'd like to see people do is put a little bit more emphasis on recommending to women that increased hydration reduces your risk," Dr Hooton said.
However, if bacteria already have a hold in the bladder, drinking lots of water won't treat the infection, said Dr Gardiner.
"It won't clear up more extensive infections," she said.
Another way to ease some of the discomfort caused by UTIs is to take an alkaliniser — often in the form of effervescent powder — to further reduce urine acidity.
"There are commercial products but it could be done just with sodium bi-carb that you might have at home," Dr Gardiner said.
"Anything that is going to change the pH of the urine to something less acidic might help clear the infection."
Sugars the target for new treatments
Professor Malone-Lee thinks manipulating the chemistry of the urine — similar to the way alkalinsers do — could be useful for future treatment options."Other promising research is in delivery methods of antibiotics," he said.
"But I'm sceptical about immune treatments because they tend to focus too much on the E. coli model of urine infection and that doesn't stack up when you've got hundreds of different bacteria in the bladder."
Many women drink cranberry juice or take a cranberry supplement when they have a UTI, but unfortunately the latest research found neither juice nor supplements were better than a placebo in treating UTIs.
How bacteria bind to sugars on the bladder wall could also be critical to treatment, Dr Duggin said.
"Those naturally occurring sugars are essential for the bacteria to be taken up, and essential for the infection to occur," he said.
"Some researchers are trying to develop sugars that resemble those on the bladder surface and use them as treatments to eradicate the bacteria from the body.
"The hope is that the bacteria are then able to be cleared out by the immune system."
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