Picture this: You’re bursting to use the toilets, but the nearest public toilets are so dirty, you can’t bear the thought of sitting on one to pee. If you’re an Indian woman, chances are you’ve faced just such a situation at least once in the recent past.
In such circumstances there are few good choices available. Some women may compromise by wiping down the toilet seat with paper before use. Some others prefer to hover in a semi-squat without actually touching the toilet, or even carry and use urination devices that let them stand and pee. Most women often make the other common-sense choice of holding in their pee till they get home.
While this last option might seem like an uncomfortable but reasonable tradeoff, experts warn that the reverse may actually be true. Dr Vijayashree Saravanan, consultant urogynaecologist at Apollo Hospital, Chennai, warns that holding in urine over long periods of time significantly increases the risk of developing urinary tract infections (UTIs).
“Unclean toilets can cause an infection, but the solution is not to holding in. Holding it in could often be more of a cause of urinary infections,” she cautions, explaining that holding in urine is one of the main actions that allow bacteria to grow in the bladder and cause an infection.
A common but ignored problem
As a urogynaecologist, Dr Vijayashree says that the most common complaints she deals with are of UTIs. Studies have found that one in every two women is likely to experience at least one such infection in her lifetime, and over a third of those affected experience recurrent infections. The problem is particularly acute for women because they have shorter urethras than men, and because their urethras are positioned closer to the anus. Yet, a lack of awareness about urinary tract infections means that most women don’t take the simple, everyday precautions that could help them stay one step ahead of these infections.
UTIs occur when a person’s urethra, bladder or, in rare cases, kidney become infected due to foreign bacteria from the vagina or the colon. Depending on where the infection occurs, symptoms can range from a burning sensation while urinating to blood in the urine, frequent burning urine, and pelvic discomfort to fever, nausea, chills and shaking, vomiting and back or flank pain.
‘Stasis’ and UTIs
When it comes to reducing the risk of UTIs, says Dr Vijayashree Saravanan, the key word to remember is “stasis”. “Basically, UTIs are more common where there is stasis. Stasis also contributes to kidney or bladder stones,” she says. The most common form of stasis with regard to UTIs is the presence of urine in the bladder for an extended period of time, she explains. Such stasis allows infection-causing organisms to thrive in the bladder, leading to UTIs.
Aside from holding in urine, says Dr Vijayashree, not drinking enough fluids is another important contributor to UTIs. “Where there is no free flow of fluid in a person’s urinary tract, that causes UTIs. During the summer, people get dehydrated because they do not match the increased water requirement,” she says.
“When I ask patients, they say they drink whenever they are thirsty. But that's not enough for our weather. We need to drink three litres of water per day,” explains the doctor, adding that this water consumption should be spread out through the day to ensure regular toilet breaks.
Another key point ignored, particularly by a lot of teenagers, is the importance of menstrual hygiene. Ideally, sanitary pads should be changed every four hours, or at most, every six hours, explains Dr Vijayashree. If not, the sanitary pads can become like a culture medium on which organisms can grow. “But often, particularly school-going girls use a pad in the morning and leave it till evening. Especially, if the flow is less, they assume that they can leave it for longer. But even a pad with a small amount of blood, if left too long, can cause infection which can be taken up by the bladder,” says the doctor.
Dr Vijayashree Saravanan, consultant urogynaecologist, Apollo Hospitals, Chennai
Sex and UTIs
While UTIs cannot be sexually transmitted, sex is a major contributor to developing infections, because it can allow the transfer of bacteria from the vaginal region to the urethra. What this means is that women should focus on general pelvic hygiene and the prevention of any infections in the vaginal region, as these could, in turn, contribute to bladder infections.
When it comes to sex, the doctor explains, it’s important to follow some simple measures immediately afterward. “We do say that women should wash themselves carefully after intercourse. Women should also pass urine because it prevents bacteria from going up the urethra, it flushes them off as much as possible,” she says.
UTIs post menopause
The problem of UTIs is particularly acute for post-menopausal women, as a combination of hormonal and other changes increase the risk of infection. “Around the time of menopause, women undergo hormonal changes. And in a lot of women, a few years after menopause, there is a lot of dryness in the vaginal and urinary tract areas. So, that reduces the local immunity, the local barriers that prevent infection,” explains Dr Vijayashree. To counter this problem, doctors often prescribe topical estrogen creams or hormonal creams to reduce dryness and improve pelvic health.
As women get older, she adds, they also lose some of the sensation in their nerves, which prevents them urinating regularly and contributes to infections. “With some women, with age or due to medical problems, their nerves are not so sensitive, and their bladder sensation is not great. So, we tell them to look at the clock and follow what is called timed voiding, which is to void their bladders every three-four hours even though they really don't get that urge to pass urine.”
When UTIs become recurrent
While most women are fortunate to only experience an occasional UTI infection, a significant proportion become susceptible to frequent infections. According to studies, at least a quarter of women affected by a UTI will experience a second infection within six months.
“We haven’t narrowed down the exact cause for this. But it is believed that for some women, their local immunity (in the pelvic region) is not well-developed, and this makes them more prone to recurrent infections,” explains Dr Vijayashree.
For doctors, one of the main precautions to take in such cases, is to more assiduously check urine cultures for infections before and after treatment, she says. This is because recurrent infections can often actually be improperly or incompletely treated infections that flare up periodically. “We make sure that we treat the infection completely, and then take a repeat urine culture test to ensure that the infection has gone,” says the doctor.
Another useful measure doctors rely on in such cases is to prescribe prophylactic antibiotics for women, especially in cases where episodes of sex lead to infections. “This gives their pelvic regions time to heal, which is not possible if infections keep coming back. Sometimes, we prescribe just one dose of antibiotics to be taken after each episode of intercourse. And they do respond well to that single dose,” explains Dr Vijayashree.
This article has been produced by TNM Brand Studio in association with Apollo Hospitals and not by TNM Editorial.