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The Dose Transcript for March 29, 2023

Host: Dr. Brian Goldman

STORIES FROM THIS EPISODE

BRIAN GOLDMAN: Hi, I'm Dr. Brian Goldman. Welcome to The Dose. There are a lot of myths out there about urinary tract infections or UTIs, as we call them. We want to debunk some of those myths and expand your knowledge. So this week we're asking what should I know about UTIs? Hi, Peter. Welcome back to The Dose.

PETER LIN: Thanks very much, Brian.

BRIAN GOLDMAN: So how often do you see patients for UTIs?

PETER LIN: It's very often. And this is the one where they will bug me. In other words, they will call my office pretty much every every minute of the day until they get an appointment. And it's because it's very debilitating for our patients and they really can't get on with their life when they have a urinary tract infection.

BRIAN GOLDMAN: Right. You're the right person to to have this conversation with. But before we begin, can you give us a. Hi, my name is. Tell us what you do and where you do it. Just ad lib.

PETER LIN: Sure. So I'm Peter Lin. I'm a family doctor in Toronto.

BRIAN GOLDMAN: Here we go. For those of us who aren't in the know, aren't medical providers, how and why do urinary tract infections happen?

PETER LIN: Yeah. So basically urinary tract infection, it's an infection. A bacteria usually is coming into the system. And the most common way to come in is up through the system. So up through the urethra, which is the pee hole that we all know about. And then it goes into the bladder. And once the bacteria sets up shop in there, it's just like an infection in your throat. So then everything gets swollen and then you get irritated and you'll have some irritative symptoms. And then there's also the infection that can go up even further. And if it goes up further, then it could reach your kidneys as well. And so therefore, we sort of separate. Upper tract infection, which is infections of your kidney. Now, that's very serious. There's lots of fever and lots of back pain involved in that, whereas the lower tract infections is what we're talking about, the bladder and the urethra, the tubing. And so that's the irritative symptoms that people might have where they go to the bathroom very often is burning when they pee. So the lower urinary tract infection is usually the more common urinary tract infection that we're talking about.

BRIAN GOLDMAN: Will get into kidney infections or upper urinary tract infections a little bit later on. But let's stick with the lower urinary tract infections. And I'd like you to explain to listeners why women are more prone to getting UTIs than men.

PETER LIN: Well, it's just basically structure. So that little urethra tube that connects the bladder to the outside world, is very short in women. So think of your bladder in a short tube about an inch long, and then basically you're now out into the real world. So therefore, bacteria really don't have to go very far to get up into that tube and into the bladder area. Whereas with men the tubing is very long and so therefore it goes all the way down the penis. And so for a bacteria to go all the way back into the bladder takes a lot of effort. And so that's why men typically do not get infections coming from the outside, going backwards, and they can get prostate infections and things like that. But generally speaking, it's not from the outside world. So that's why, generally speaking, it's the women that suffer so much with the urinary tract infections that we're talking about because that tubing is very short and so the bacteria can make it inside very quickly.

BRIAN GOLDMAN: Are we seeing UTIs happen more frequently these days?

PETER LIN: You know what? It's very common. So their estimate is that for women, about 50 to 60% of the women will have a urinary tract infection within their lifetime. And of those, about 25% are going to have recurrent kind of urinary tract infections. So I don't know whether we're seeing more of it. It's just very common to have women have a urinary tract infection. And when women can't get on with their day because they're peeing all the time, that we're going to hear more about it. And therefore, as people become aware of it, they're going to be contacting us. So it may feel like there's increased, but basically it's just a very common condition that people get.

BRIAN GOLDMAN: Why is it important for pregnant women to seek treatment for a UTI?

PETER LIN: Yes. So in pregnancy, basically, we have a lot of pressure in certain areas. Right. So you've got the fetus that's now pushing downwards. So, you know, a lot of the structures are not in the right position. So if you were to get an infection, our biggest worry is that if that infection goes up and then it can get to the kidneys, then we could have a very complicated infection. So a kidney infection would be much more complicated. We would you have to use many more strong antibiotics, for example. And we don't want to expose a pregnant woman to very strong antibiotics. And number two is that the urinary tract infection could trigger in early labor, for example. So it irritates the area. So now it gets every muscle contracting. So your bladder is contracting and perhaps even your uterus, which is, you know, the womb may start to contract and could we trigger sort of premature labor and those kinds of things. So that's why with women, we often check the urine. So we're checking for a couple of things. We're checking for whether there's sugar coming out for sure, whether there is protein leaking out and whether there is white blood cells, which is a sign that there is some infection going on and your army is trying to fight that off. So that's why for pregnant women, every time they go for their examination. They checked their urine for all of those things to make sure that we can catch it before it gets too complicated.

BRIAN GOLDMAN: One of the myths out there is that UTIs are a sexually transmitted disease, which they aren't. But there is an important connection between having intercourse and women getting UTIs. Can you can you break that down for us?

PETER LIN: Yeah. And the problem there is that after sex, they have it. So that's why they're thinking it might be a sexually transmitted because it's around the same time. And so basically it's mechanical. Right. So if you think about it, we're pushing more bacteria into the area. So remember, we sort of have three holes. We have the pee hole at the top and then we have the vaginal hole and then we have your rectum, which is where you go to the bathroom and poo. And so the germs really come from the third hole upwards. And so if we have a lot of mechanical pressure and movement in that area, then we can move the bacteria to the hole and then therefore, it can go up into the bladder. The other thing is that there was studies way back when they were doing ultrasounds and they could actually see during intercourse the penis is actually bumping into the back of the bladder. So in some women that kind of bruises that a little bit and therefore the bladder lining may be a little bit bruised from the back side. So if you think of this as a as a little bag and you're hitting it from the back side, you may actually have a bit of bruising. And that area, the bacteria might be able to stick easier, too. So there's many reasons why we may have increased risk of urinary tract infection afterwards. And so one of the things that people recommend is that, you know, after intercourse, make sure that you go pee afterwards. And that way you sort of flush away anything that might have been pushed into that area so that the bacteria that was pushed into the area are now flushed out as well. Now, we don't need to do douching or any of these kinds of things because we don't have to clean inside. The key thing is just to make sure that people pee and get rid of whatever is in that tubing back out into the outside world.

BRIAN GOLDMAN: Of course, urinary tract infections, you know, people are calling you for appointments. They come to the emergency department for treatment because UTIs cause symptoms. They cause inflammation of the bladder or cystitis. One of the most common symptoms is what we call dysuria, which is intense burning and urination. What other symptoms are there?

PETER LIN: Yeah, that's the biggest thing. So if you think about an infection in any tubing, it causes swelling of the area. So just imagine if you had an infection of your throat so it would be swollen, it be painful. Every time you swallow, it will hurt like razor blades. Well, the same thing is happening down below. So you have this infection that's now trying to take over the lining of the tubing. So now it irritates the tubing and so therefore, your body thinks that something is there. So let me just try to get it out. So then you'll tend to want to go pee often hoping that you can get rid of that horrible sensation. And that's what women describe. It's like it's like razor blades. So every time you pee, it's like peeing over cuts. And that's what's happening because the area is now inflamed. If the bladder gets inflamed, the wall of the inside the ladder can get inflamed and infected as well. And you don't feel the bladder as much. But then what it does is it causes the muscles of the bladder to contract. And so therefore now you'll have this sort of cramping and then you'll go often and you have to pee. And now you've got razor blades as the urine is coming out through the tubing. And you can understand why people feel so uncomfortable and it's very quick. So once the infection sets in, it doesn't take long for them to have all these horrible symptoms. And that's why people end up calling our office very, very quickly and regularly. And then if they can't get through to us, oftentimes they'll end up in a walking clinic or urgent care center or the hospital even because it's so irritating. The one thing that we do sort of help people separate is, is there any problems with the kidneys? Right. So we talked about that. So we want to make sure that there's no back pain. So your kidneys kind of live halfway up your back. And so therefore, if there's back pain on one side, then we worry if that kidney is infected as well and if there's fever. So whenever we involve the kidney, it's sort of more systemic. I guess if you will see your body is going to have a bigger reaction. So you might have fever, chills, back pain. Now that looks more like a kidney infection, in which case we do definitely have to see that. But if it's just down below where you're going often and it's burning like razorblades, then it most likely is just the infection down below, which is what we normally refer to as you were saying, cystitis, which is inflammation of the bladder or infection of the bladder. And those ones are the ones that are quite easy to take care of.

BRIAN GOLDMAN: And of course, not every patient who who thinks they have a urinary tract infection actually has one. There are other conditions that can masquerade. And what are some of those conditions that you're looking for when you're assessing someone with a urinary tract infection in your clinic?

PETER LIN: Yeah. So it could be other things as well, right? So, you know, if they're talking about frequency, let's say it's a man, right? It could be prostate issues and things like that. As the prostate grows, maybe their peeing pattern is going to be different. So we kind of take a history to figure out is it an infection or not. With women, one of the things that we worry about is a, could it be something else like, for example, chlamydia? Now that one is a sexually transmitted disease, but that particular germ likes to go into the tubing as well and it can cause irritation of the tubing. So you would get that frequency and, you know, kind of burning when you pee, except that particular one when we checked the urine, we can't grow a bacteria. But if we test for chlamydia, we can actually see it in the urine. But we have to order that specific test. Now if you have chlamydia the concern that we have is that that germ can actually spread up into the womenly areas like the uterus and then head up to the tubing and therefore cause inflammation of the tubing that allow the ovary to be connected to the uterus. So now if we effect the tubing, we can actually cause inflammation and scarring in the tubes that would bring the egg to the uterus. So now that becomes more complicated. Now that's a gynecological infection. In other words, infecting not the bladder, but it's actually infecting these other regions. So that's why if we sort of it sounds like urinary tract infection, but then we check the urine and we don't get bacteria coming back, then we start thinking about these things for people that might have a sexually transmitted disease, that might be mimicking or trying to trick us into thinking that's a bladder infection.

BRIAN GOLDMAN: So you can see that it starts to become difficult for patients to decide when they need to come in to get a urinary tract infection treated and when they can ride it out. So what's your advice? Which UTIs require antibiotics and which can be waited out?

PETER LIN: Yeah, I think if you're disturbed by it, I think it's important just to come in and get those samples checked. And especially it's if it's the first time. Okay. You want to make sure it's the right diagnosis. If it's recurring, then I would like to know what kind of germs do you have? Number one, is it a germ in the urine, or do I have to think about these chlamydia as or anything else? So that's why whether it's your first time, we need the diagnosis proper. So we need a sample of the urine or whatever, whether it's the third time this year, in which case I have to think, why are you getting this urine infection? Is it really a urine infection? So that's why the testing becomes important. And then if you keep getting it, should I be checking with an ultrasound to look inside or are there some strange things? So I think for people to try and make a decision on their own, should I go in for this one or not this one? If it's too difficult, then maybe come in. So if it's your first one, come in, let's make sure it's the right thing. If it's your recurrent one, come in so that we can figure out why you keep getting it.

BRIAN GOLDMAN: And if they are treated with antibiotics, the symptoms usually go away quite quickly, don't they?

PETER LIN: Yeah, they're quite quick. And so if the antibiotic is the correct one, in other words, able to kill off that germ, then you know, people next day, you know, they start saying that it starts feeling they're feeling more human again and they can function again. And then the key is to make sure that you finish off the antibiotics for the whatever days, three days, five days, whatever it's been prescribed for. And we do try to keep it as short as possible, but not too short that you're only taking one dose of, you know, something that's supposed to be seven days, right? Because we don't want to have the situation where the germs become a little bit strong against it. So sometimes when we say it's a seven day course and you only take two days of it, then what happens is that you kill off the ones that are susceptible to that antibiotic. But then now you're allowing the ones that are kind of still hanging around to grow. And so that's one way that we can generate this antibiotic resistance if people don't finish the amount of medication that they're supposed to.

BRIAN GOLDMAN: A few years ago, cranberry juice and cranberry pills were all the rage for treatment. What about now?

PETER LIN: Yeah. So cranberry juice is interesting. I actually looked that up at one point thinking like, is there something to it? Because we always say that. And I used to tell people it changes the p.h. Of your urine and so therefore the bacteria have a harder time. So actually people have been looking at cranberry juice and it turns out that it changes how the bacteria sticks. So in other words, E. Coli bacteria needs to stick to the tubing or stick to the bladder wall. And so it turns out there are some things in the cranberry juice itself that may block that sticking. So the sort of the the part that the bacteria uses, the stick gets plugged up and so therefore it might not stick, which means that it may be a better prevention thing. So let's say you find yourself getting these recurrent things, you take cranberry juice ahead of time, then you might be able to prevent the bacteria sticking. So that's why the studies that say, can you treat it urinary tract infection, they're not so good because the bacteria is only stuck in, it's already infected and invaded and so therefore it might be better as a prevention. Having said that, I still tell patients if you want to, you can drink cranberry juice if you like it. And I think what that does is also it increases ah, fluid intakes which usually when they drink cranberry juice, they'll flush it down with water, which is great because now they're drinking more and then that gives you more urine to flush out the area.

BRIAN GOLDMAN: More recently, we heard about a vaccine for urinary tract infections that right now is in front of of Health Canada. Health Canada is going to decide whether or not to approve it. What do we know about that?

PETER LIN: Yeah, so this is interesting. It's actually been around for quite a while. So it's been in other countries and it's been approved, you know, to be used in women. Basically what it does is that they take four of the most common bacteria that cause urinary tract infection and they kill them with heat. So they're inactivated with heat so they're not alive anymore. And then they put it into a suspension and then you spray that under your tongue and you do that every single day for three months. And at the end of three months, they sort of looked over a year. How does that protect somebody? And so the whole idea is that if I give you, you know, the the the bad guy, what the bad guy looks like that maybe your body will build an immune system and antibodies and those kinds of things against it. Now, really where we want to put it is down below. But I mean it's very hard to get anything down below inside that way. So that's why the quickest way to access your body is under your tongue. And so the thought is your immune system will recognize that build some antibodies so you'll have some armies that could then go and recognize these germs and the results or, you know, like the group that we. Was treated, 56% did not have any more recurrence. Verses the people not treated was 25%. So it's double. But then still lots of people are getting infections still. So this is really reserved for the people that get that recurrent urinary tract infection and their definition, as I was saying, it's a three or more within a year or two within the last six months. And so the study had just been published in the New England Journal. And the thought is, is that if this works, at least even for those 50% of the people, then they do not have to go on antibiotics, you know, over and over again. And then maybe that's good for them because they don't keep getting infected. Number two is that we might get less antibiotic resistance because they don't have to keep taking lots of antibiotics. And so that's why this might be a good strategy in that we teach the immune system how to kill off the germs. And if this one gets approved and it works, there are other people working on different ways so that maybe we can get that number higher. So instead of just 50 something percent, we might get it to 80 or 90%. And so I think this is another, you know, field that people are saying, how can we make sure that these women don't have to suffer recurrent infections? And then more importantly, how do we make sure that we don't cause antibiotic resistance? Because each time we give them a batch of antibiotics, we may be generating these superbugs that then can affect other people and therefore cause problems for other patients. So it's really a strategy to help the individual patient, but also help the system as well to keep that antibiotic resistance down.

BRIAN GOLDMAN: And when you do see patients in the clinic, what do you recommend to them to try to reduce their chances of having another urinary tract infection down the road?

PETER LIN: Yeah, that's really the most important thing. And I and I usually draw my silly diagrams and say, Here is the pee hole and here's the vagina hole, and then here's the hole for the bum. And unfortunately, the germs actually come from your bum hole forward to your people. So therefore, if you were to wipe forward, you would actually bring the bacteria right to the front door of where you urinate and right to that little short tubing. So that's why we'd like people to wipe backwards. So push it away. We tell people. So front to back, you push it away. The other thing is that if there is a moisture layer between those holes, then the germs have a pathway to get there. So therefore, if you're sweating a lot. So that's why they're saying cotton underwear, it'll sort of absorb the sweat as opposed to letting the sweat sit on your skin because with the sweat sits on your skin again, you have a pathway for the germs to move forward and sort of migrate to the bad area and no tight clothing for the same reason. And also no sort of sitting in tubs because the tub again provides a water layer that may go forward. And the same thing with wet swim year. So let's say you just went swimming and then now you just sit there with your wet swim year on or swimsuit on. Then you're providing that path to connect it out. And then after intercourse, of course, flushing out the tubing by buying drink lots of water. And peeing is a good idea. And I've started putting in, you know, don't sit on cold surfaces and don't hold in your piece. And the reason for that is when you hold in your pee, you tend to contract the area down below. When you sit on cold surfaces, you also contract your buttocks down below. And every time you contract, you actually create a little bit of a vacuum, I guess, if you will. And so if there's any germs around that tubing, you'll end up sucking it inside the tubing. And of course, finally is drinking lots of water. So that way your urine, there's lots of it to basically flush out that area. So you can imagine if you only pee twice a day, then there's more chance for the bacteria to come into that space versus if you're peeing four or five times a day where you're washing away that area. And so therefore bacteria will have less of a chance to come in and invade that little short tube.

BRIAN GOLDMAN: Lots of great information there. Dr. Peter Lin, thanks once again for speaking with me on The Dose.

PETER LIN: Thank you, Brian, and thanks for all your good work.

BRIAN GOLDMAN: Dr. Peter Lin is a Toronto based family physician and the house doctor on CBC Radio One. Here's your dose of smart advice. Urinary tract infections or UTIs are generally caused by bacteria and can involve any part of the urinary system, most commonly the bladder causing cystitis. Symptoms include frequent or urgent urination and intense burning when you pee. There may or may not be a fever. Women are at greater risk of developing a UTI than are men. Other causes of cystitis include side effects of medications or radiation therapy. Hygiene products and spermicide jelly can also irritate the bladder. The way to confirm a UTI is by providing a urine sample that can be examined under a microscope or sent to a lab for cultures to identify the bacterium and the most appropriate antibiotic. Serious health problems can result if a UTI spreads to the kidneys. Some cases. Our hospitalization as well. Sexually transmitted diseases can also cause symptoms similar to a UTI. I seek health care advice. If you have symptoms of a UTI or for any symptom that is severe or concerning, including fever and severe pain in the flanks. Besides antibiotics, other things you can do to feel better include drinking plenty of fluids and taking acetaminophen or ibuprofen. You can also help prevent UTIs by urinating after sexual activity. Taking showers instead of baths and by minimizing doing sprays or powders in the genital area. Cranberry juice has not been shown to be effective as a treatment for an existing UTI. A vaccine that could lower the risk of frequent infection is awaiting approval by Health Canada. If you have topics you'd like discussed or questions answered, our email address is thedose@cbc.ca. If you like this episode, please give us a rating and review wherever you listen. The dose was produced this week by Stephanie Dubois. Our senior producer is Colleen Ross. The Dose wants you to be better informed about your health. If you're looking for medical advice, see your health care provider. I'm Dr. Brian Goldman. Until your next dose.

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What should I know about UTIs?- Transcripts

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