Prevention of Urinary Tract Infection (UTI) in Women: General ...

General Guidelines and Suggestions
There are a number of general guidelines and suggestions that will help women avoid urinary tract infections (UTIs) in most instances. These may be conveniently divided into the categories of hygiene, clothing, diet, activities, and medications. Most UTIs are ascending infections of bacteria that colonize the vaginal wall and eventually the urethra. From the urethra, the bacteria can travel upwards and infect the bladder (lower tract infection) or continue from the bladder up the ureters and infect the kidneys themselves (upper tract infection). The effective preventive measures are able to block this bacterial migration.
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Hygiene
Wipe front to back. Always wipe from the front to the back after using the bathroom. Do not try to reach from behind because germs from the rectum can be transferred to the hand and tissue. After bowel movements, clean the area around the anus gently, wiping from front to back. Never wipe twice with the same tissue. Any wiping motion that starts nearer to the rectum and then approaches the bladder-opening area moves potentially pathogenic bacteria closer to the bladder.
Take showers and avoid prolonged baths. Bath water may fairly quickly become contaminated by the bather's own skin florae. Sitting in a tub allows bacteria to reach the bladder opening area.
Wash properly, front to back, in the shower or bath. Rinse well and remember to wipe correctly from front to back. Douches have no proven benefit in preventing bladder infections.
Use tampons for periods. Tampons are advised during the menstrual period rather than sanitary napkins or pads because they keep the bladder opening area drier than a sanitary pad, thereby limiting bacterial overgrowth.
Extremely effective is avoiding long intervals between urinating. Try to empty the bladder at least every 4 hours during the day while awake, even if the need or urge to void is absent. When feeling the need to empty the bladder, do not try to “hold it” until a more convenient time or place.
Clothing
Do not wear tight-fitting undergarments made of nonbreathing materials. With such fabrics, accumulating moisture builds up .This leads to maceration of the skin and bacterial over growth adjacent to the opening of the bladder Cotton underwear for general use is suggested.
Diet
Drink more water. Start with 1 extra glass with each meal. If the urine appears any darker than a very pale yellow, this means not enough liquid is being ingested; increase the fluid intake.
A study of 140 women with recurrent UTIs showed that increased fluid intake reduces the risk of repeat infections. The study participants were otherwise healthy premenopausal women who had experienced three or more UTIs in the preceding year and who self-reported low fluid intake (< 1.5 liters/day). The intervention group was instructed to increase their water intake by an additional 1.5 liters per day, whereas the control group was instructed to continue with their usual intake. At 1 year, the intervention group had experienced 48% fewer UTIs than the control group. The only fluid involved in the study was water, although other fluids would probably provide similar results, and the benefits would probably also apply to postmenopausal women. In addition, the intervention group used 47% fewer courses of antibiotics than the control group (1.8 vs 3.5; P < 0.0001).
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Cranberry juice and cranberry pills may have benefit in reducing urinary infections.{ref 3} They appear to be most effective in younger women.
Activities
When engaging in physical activity and exercise, make sure to empty the bladder frequently and drink plenty of water and other fluids.
Take special precautions after sexual activity; such activity may also increase risk because it can introduce bacteria into the bladder area. The bladder should be emptied after intercourse; drink 2 extra glasses of water. Some patients are advised by their physician to take a urinary antiseptic or antibiotic after sexual activity. Make sure to take the medication according to the physician’s recommendation.
Avoid the use of spermicidal jelly. This kills sperm as well as normal vaginal florae, which are extremely important in suppressing colonization with pathogenic bacteria.
Medications
An estrogen vaginal cream may help increase resistance to bladder infections. An estrogen cream for the vagina may be suggested for women after menopause even if an oral estrogen supplement or patch has already been prescribed. The cream helps keep the tissues around the bladder healthy and more resistant to infection.
Take antibiotics only as prescribed by a doctor. If a medication has been prescribed as preventive therapy, follow the physician’s instructions carefully. Be aware that medications may be necessary for up to a year or more depending on the nature and severity of the urinary infection problem.
For some patients, a small amount of urinary antibiotic or antiseptic taken daily prevents most urinary infections and allows the bladder to heal and restore its natural resistance. Other patients may be told to take an antibiotic only when they think they are getting an infection. Take any prescribed medication exactly according to the physician’s advice. Contact the physician or pharmacist if no clear instructions are on the bottle of medicine.
Further steps
The guidelines and suggestions listed above help most women avoid bladder infections most of the time. If an infection develops in spite of these precautions, promptly seek medical help. A urine specimen for examination should be provided. Seek prompt attention for excessive vaginal discharge or other signs of vaginal inflammation and infection. If an antibiotic has been prescribed for this purpose, begin taking it. In some cases, the physician may request additional tests (eg, kidney radiographs or examination of the bladder).
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Sterilizing Washcloths for Home Use
Sterilizing washcloths for washing and personal hygiene to help prevent recurrent UTIs may be recommended. This extra step is probably unnecessary for most patients with recurrent infections, but for the more resistant or severe cases, it may be very helpful. Home sterilization of washcloths is only one part of an ongoing program to help prevent these infections. Use only those washcloths purchased for this purpose and remember to wipe correctly, front to back.
Wash the washcloths with hot water and soap in a clothes washer. If a clothes washer is unavailable, use soap and hot water in the sink.
Boil the washcloths in water for at least 20 minutes (optional).
Take the washcloths out of the water and allow to dry or use a clothes dryer.
When dry, place each washcloth in a separate sealable plastic bag, such as a zip-lock bag. Leave the bags open; do not seal them yet.
Place the bags containing washcloths in a microwave oven. Put a large glass of cold water in the center of the microwave oven. Do not place the bags with the washcloths in the water.
Put the microwave oven on high power, set the timer for 5 minutes, and turn it on. Replace the glass (which is very hot) with a new glass of cold water, and run the microwave oven on high power for an additional 5 minutes.
Let the bags cool, then close the bags. The sterile washcloth is now inside a sterile bag.
This technique kills the germs and bacteria by using microwave radiation to sterilize the washcloths. Without the glass of cold water to absorb the heat, the bags would melt and the washcloths would burn.
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Summary of Tips
Tips for UTI prevention may be summarized as follows:
Wipe in the correct direction, from front to back, after using the bathroom
Clean the bladder area first when washing to prevent contamination with bacteria from other parts of you the body.
Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London