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Women And Her Bladder Infections


The commonest causative agent is Escherichia Coli. It must be remembered that even though urine contains so called waste products of the body, it does not contain bacteria. However if bacteria enters the urinary system and multiplies, it can reach a critical concentration to cause a urinary infection which in selected situations can cause sepsis and even death.

There are two kinds of urinary infections, upper tract or kidney infection and lower tract or bladder infection. Lower tracts infection are more common and occur >95% of all UTI and the women present with pain passing urine (dysuria), urinary urgency and frequency and sometimes blood in the urine with fever. Upper tract infection are less common but potentially more serious. Patients can complain of flank pain and high fever and may even have a drop in blood pressure if sepsis occurs. Elderly patients with lower immunity status example in diabetics or those with retention of urine are at higher risk to be overwhelmed with infection.

In general, women are more susceptible to UTI when compared to men due to their anatomy of a short urethra which places the entrance of the bladder much close to the external environment. It does not help that the neighbor (vaginal cavity) is a potential reservoir for bacterial multiplication. In general, a sexually active woman is expected to have a couple of bladder infections a year and she only needs more investigations if UTI becomes more frequent and/or persistent in nature or if any upper tract infections occur.

Men on the other hand need a full investigation if he ever has a single episode of urinary tract infection be it lower or upper tract infection. In fact, we only expect men to have a UTI when he is older than 50 years and his prostate is enlarged and causing obstruction.

Most cystitis in women are simple in nature and they response to a course of appropriate antibiotic within a week after starting medications.

When woman has recurrent and/or persistent UTI, the attending doctor needs to order investigations to identify any precipitating factors.

This includes urinary stones disease, associated vaginal infections example fungal or sexually transmitted infections like chlamydia, congenital abnormalities in the urinary systems especially if the women are below 25 and not sexually active. These precipitating factors need to be treated/corrected to minimise UTI and prevent damage and scarring of the kidneys.

On occasion, a women presents with symptoms similar to a typical cystitis but are not suffering from cystitis. It is especially important to remember this fact when one’s symptoms are not resolved despite a negative urine culture after an adequate course of antibiotics. Some conditions which mimic cystitis include interstitial cystitis, carcinoma-in-situ, overactive bladder and post-menopausal cystitis. This needs a totally different approach to resolve the bladder symptoms.

Special UTI situations in women would include:

A new sexual partner

Women can suffer from what was previously called “honeymoon cystitis” where recurrent cystitis can occur up to 18 months as the vaginal mucosa gets use to a new flora from a new partner. Voiding after every sexual event and long term low dose antibiotic may help in selected cases.


Bladder infection in pregnancy may cause various issues like uterine irritation and reflux leading to increase chances of upper tract infection. Antibiotics are carefully chosen so as not to affect the fetus. Your obstetrician can advice you on this.

Post-menopausal women

Older women especially after more than 10 years post menopause may have an increase chance of bladder infection due to decrease immunity associated with thinning of the bladder and vaginal mucosa and decrease vascularity. There may also be associated bladder prolapsed causing incomplete emptying of urine which also potentially cause recurrent UTI.

A consultation with a urologist with interest in female urology or uro-gynaecologist would be useful in women with complicated UTI.

Dr Michael Wong

Medical Director & Senior Consultant Urologist
FAMS (Urology), FICS (USA), FRCS (Edinburgh),
M Med (Surgery), MBBS (S’pore)

Dr Michael Wong is a Senior Consultant Urologist who is internationally recognized for his surgical expertise and academic contribution to the field of Urology, in particular the subspecialized field of minimally invasive Endourology.

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