You notice in retrospect that you’ve been peeing more than usual. You tell yourself you’ve just been drinking more water lately. Then you notice a little twinge in your lower abdomen (what we call the supra-pubic region). You begin to suspect (okay, reluctantly admit) you are getting a urinary tract infection (UTI). (Note, this post is about UTIs in women.)

What to do? It depends a bit on your age, but everyone should drink lots of water, at least 20 oz. an hour. Recently the long-held belief that cranberry juice has a bacteriostatic effect and can nip a UTI in the bud has been disputed due to lack of scientific evidence. But it doesn’t do any harm so I do start drinking a cup of pure cranberry juice (not sweetened cocktail) an hour.

Women up to perimenopause (so teens to 40-ish) should see a health care provider if the symptoms persist more than a day, or worsen. The reason is that an annoying UTI can more easily turn into a serious kidney infection (pyelonephritis) if left untreated, and is especially common in younger women. Symptoms of pyelonephritis include lower back pain (bilateral or one-sided), pelvic pain, fever and chills. Any of these symptoms require prompt medical attention. It is very important that a urine sample is collected. Your provider will do a quick “dipstick” test that can indicate if you have an infection, and then, send your urine specimen out to the lab for a culture and sensitivities test. This second step is vital because UTIs can be caused by a variety of bacteria that require different antibiotics. (This is the reason I rarely will prescribe an antibiotic for a UTI over the phone. It’s is in the patient’s best interest to come in, if only to submit a urine sample.) Also if your infection is just getting started, the dipstick might be negative or inconclusive but the culture will usually demonstrate an infection if you have one.

Seeing a health care provider is important because the physical exam dictates the care. If I see a young women with all the symptoms of a UTI, including suprapubic tenderness, I will rule out pelvic inflammatory disease (PID) with a quick pelvic exam and send some tests out for STIs (sexually transmitted infections) like chlamydia and gonorrhea which can mimic the symptoms of a UTI. (I always do a pregnancy test too and a positive result will dictate further treatment.) I am going to treat her for a UTI, regardless of what the dipstick says. And if the pelvic exam is suspicious, I will treat for those STIs separately as well while we await lab results. It’s called treating empirically. If I suspect a possible kidney infection, I’ll use a certain type of antibiotic called a fluoroquinolone. If not, I’ll use a medication called nitrofurantoin because of the problem of bacterial resistance to some commonly-used drugs. If the culture and sensitivities test I ordered indicates a different antibiotic is needed, I will call the patient and change it. I always tell my patients to call if they are not much better in three days or if they feel worse, and to go to the ER if the symptoms of a kidney infection develop.

For women entering perimenopause, or if they are menopausal or post-menopausal, fluctuation in estrogen can make them more susceptible to cystitis which is inflammation of the bladder. Cystitis may or may not be caused by a bacterial infection. These women can try the water and cranberry juice for a few days as long as the symptoms don’t worsen and there is no fever or back pain involved. Ibuprofen also helps with the inflammation. It’s never a mistake however, to go to your health care provider at the first sign of a UTI at any age.

There are some things all women can do to prevent UTIs:

• Keep hydrated and don’t hold urine in when you feel the need to urinate. (‘Holding it’ for too long can definitely cause a UTI.)
• Wipe from front to back after a bowel movement
• Urinate ASAP before and after sexual intercourse.

Hope this helps the next time you have an “uh oh” moment.