Nothing clears your weekend plans faster than a UTI. In my 25 years of practice as an Ob/Gyn, I’ve treated thousands of them, from the mildest to the most severe. Though every case is different, my patients usually leave asking the same question: What can I do to never, ever experience this again?

While UTIs are typically easy to diagnose and treat, they are no cakewalk to experience. 50-60% of women will get one at some point in life, and a quarter of those women will face recurrent UTIs — defined as two recurrences within six months or three UTIs in one year.

Left untreated, UTIs can progress into more serious, systemic infections. Recognizing the signs your body is sending you is the key to a positive outcome, and practicing smart prevention can put a stop to stubborn, recurrent UTIs.

What exactly causes UTIs?

Sex is the top risk factor for UTIs, and the most widely known. All the movement, heat, and moisture give bacteria the perfect opportunity to travel up the urinary tract and multiply. If your immune system isn’t able to fight off the bacteria, you can end up with a UTI anywhere in your urinary tract — which includes the urethra, bladder, kidneys, and ureters. (Though most UTIs happen in the urethra and bladder.)

Why are people with vaginas more susceptible to UTIs than people with penises? The urethra in a vagina is much shorter than the urethra in a penis, and it’s located close to the rectum, where E. coli naturally live. During vaginal sex in particular, E. coli can easily travel the short distance into the urethra — it’s just a hop, skip, and a hump away.

However, pretty much any physical activity can cause a UTI, especially if it involves friction and moist heat or puts pressure on the bladder. That’s why so many people get UTIs after exercises like cycling, jogging, and swimming.

Aside from sex and exercise, many other factors can increase your risk:

1. Pregnancy - The constant pressure put on the bladder can cause inflammation and trigger a UTI.

2. Menopause - Estrogen helps keep bacteria in balance, and the hormone drops significantly during menopause.

3. Diabetes - Poor circulation, high blood glucose levels, and issues emptying the bladder can cause frequent UTIs in diabetics.

4. Use of a diaphragm, spermicides, or douches - They can all irritate the urethra and lead to infection.

5. Overuse of antibiotics - Antibiotics kill off the bad with the good and disrupt vaginal pH, leaving you more susceptible to opportunistic infections.

6. Anatomical problems - Structural abnormalities in the urinary tract can harbor bacteria and prevent urine from properly draining.

7. Genetic predisposition - Having female relatives that experience recurrent UTIs may increase your risk.

Common signs and symptoms

No matter the cause, when bacteria end up where they shouldn’t, the telltale symptoms of a UTI can appear within 24 hours. Here are the top signs to look out for: 

1. An urgency to pee, but only squeezing out a small amount

2. Pain in the lower belly

3. Red, pink or cloudy urine that has a foul odor

4. Pain in the lower back

5. Fever and chills

6. Nausea and vomiting

If you experience any of those last three symptoms, your UTI has probably developed into a kidney infection, and you need to see a doctor immediately for treatment.

The best UTI treatments

For uncomplicated UTIs (those without the more advanced symptoms) a 3-7 day course of antibiotics is the top treatment option. But if your UTI has progressed into the kidneys or ureters, it may require hospitalization and intravenous antibiotics to knock the infection.

People who experience recurrent UTIs will often be prescribed a low dose of antibiotics taken after sex. Though this approach is usually effective in the short-term, it can cause bigger problems down the road. As I touched on, frequent use of antibiotics can disrupt the body’s natural balance, creating the perfect environment for opportunistic infections. Plus, bacteria can adapt, leading to drug-resistant UTIs that are far more difficult to treat.

How to prevent UTIs in the first place

Though antibiotic treatment is usually necessary when you have an active infection, there are plenty of simple ways to reduce your risk.

1. Pee soon after sex to remove bacteria that may have found their way into your urethra and bladder. Also aim to pee every 2-3 hours or as soon as you feel the urge. Regularly emptying the bladder helps prevent the build-up of bacteria.

2. Stay hydrated. Drinking plenty of water will keep urine flowing and move bacteria out of your body quickly. The best rule of thumb: Divide your body weight in half and aim to drink that many ounces of water each day. For example, if you’re 140 pounds, you should shoot for 70 ounces daily.

3. Practice good hygiene. This goes without saying, but always wipe “front to back” to avoid carrying bacteria from the anus to the vaginal area. And make pre-sex cleaning a part of your routine – including washing hands and nails, sex toys, and anything else that will make contact with the genitals.

4. Avoid feminine products with fragrance or other irritants. Wear breathable, cotton underwear. And skip the douching! The vagina is self-cleansing and should only be washed with water and mild, gentle cleansers.

5. Avoid excessive saliva, spermicides, synthetic lubricants, diaphragms, vaginal sponges, and diva cups, which can all cause irritation.

6. Consider vaginal hormonal estrogen therapy if you are menopausal.

7. Consider cranberry, the long-standing incumbent in the UTI prevention world. The research and results around cranberry’s efficacy vary a lot. Still, many doctors recommend their patients give it a try. As long as you’re staying away from sugary cranberry juice, it probably can’t hurt.

8. Try Uqora. Their drink mix (Uqora Target) contains D-Mannose, Vitamin C, Vitamin B6, Magnesium, Calcium, and Potassium which together inhibit and flush UTI-causing bacteria out of the bladder. This is especially helpful after sex and other UTI triggers. Uqora’s daily capsule (Uqora Control) can also disrupt bacterial biofilm, which contributes to most recurrent UTIs.

UTIs may be painful, frustrating, and disruptive — but they don’t have to be a life sentence. My patients see the most success when they stay proactive. Practice prevention daily. Tune into your body’s signals. And don’t wait to seek help when something feels “off.” We’re our own greatest advocates, and listening closely to our bodies is the surest way to stay healthy and happy.

Dr. Sherry Ross is a board-certified Ob/Gyn and the author of She-ology: The Definitive Guide to Women's Intimate Health. Period. She’s been a fierce advocate for women’s health for over 25 years, with a mission to strengthen women’s connections to their intimate health and overall wellbeing. You can find her on Twitter, Instagram, and Facebook.

Posted: July 31, 2019