Not just a sex issue: Triggers of urinary tract infections

Every time the words urinary tract infection (UTI) come up, the mind often jumps to one thing: sex. But that’s only part of the story and quite frankly, a misleading one.

You could be minding your own business, going about your day, when out of nowhere, a UTI strikes. Suddenly, you’re in pain, dodging social plans and making urgent dashes to the bathroom. Painful, inconvenient and often misunderstood, UTIs affect millions of people worldwide, and in most cases, sex has little or nothing to do with it.

A UTI is an infection that can affect any part of the urinary system, including the kidneys, bladder, ureters and urethra. 

The symptoms are easy to miss but hard to ignore: a burning sensation when peeing, cloudy or strong-smelling urine, pain in the pelvic area and a frequent urge to urinate even when the bladder is nearly empty. If left untreated, the infection can travel to the kidneys and cause serious complications.

Globally, women are most affected by these infections. According to a 2022 review published in Nature Reviews Urology, over 50 per cent of women will experience at least one UTI in their lifetime, with around 25 to 30 per cent facing recurrent infections within six months of the first. In contrast, only about 12 per cent of men will experience a UTI in their lifetime, but the risk increases with age, especially after 60.

Dr Keagan Kirugo, a urologist, explains that one of the biggest misconceptions about UTIs is their link to sex. “Sexual activity is a risk but does not exclusively cause UTI,” he says. “It is also a misconception that UTI can be transmitted from one sexual partner to another.”

Risk factors

The majority of UTIs are caused by bacteria, particularly Escherichia coli (E. coli), which is found naturally in the intestines. “Bacterial E. coli is the most common cause,” Dr Kirugo confirms. In most cases, the bacteria travel from the bowel to the urethra and multiply in the bladder, leading to infection.

While sexual activity can introduce bacteria to the urethra, many UTIs occur without any sexual contact at all. Factors like poor hygiene, dehydration and even hormonal changes can contribute.

“Poor hygiene significantly predisposes one to urinary tract infections,” Dr Kirugo explains. “Poor wiping technique, for instance, can spread bacteria from the anal area to the urethra.”

Anatomy plays a critical role as well. Women have a shorter and more direct urethra than men, making it easier for bacteria to reach the bladder. “There is an anatomical predisposition, particularly in women, due to a short and relatively straight urethra,” says Dr Kirugo. “Genetic factors also play a role, particularly bladder receptor sensitivity to infection.”

Age also matters. Postmenopausal women are at increased risk due to hormonal changes that cause mucosal dryness, making the urinary tract more susceptible to infection. “Children and the elderly are also at higher risk because of relatively low immunity,” Dr Kirugo adds.

For those with medical devices such as urinary catheters, the risk is even higher. “Every day one has an unfeeling catheter increases the risk of infection due to bacterial colonisation,” he explains. “Avoid long-stay catheters by changing them as advised by a doctor.”

Prevention, fortunately, is often simple and based on healthy habits. Staying hydrated is key. “Hygiene and hydration are your first lines of defence,” Dr Kirugo says. Drinking enough water helps flush bacteria out of the urinary tract before they can cause an infection.

Despite popular belief, probiotics and cranberry pills have limited evidence. “Not really,” Dr Kirugo says when asked if probiotics help. “They are more effective in cases of diarrhoea.” That said, some studies suggest that cranberry extract may reduce the recurrence of UTIs in women prone to infections, although it is not a guaranteed remedy.

It is important to avoid douching and genital sprays, which can disturb the natural bacterial balance of the vulva.

The Centres for Disease Control and Prevention (CDC) emphasise that UTIs are not classified as sexually transmitted infections (STIs). According to the CDC, approximately 80 per cent of premenopausal UTIs are triggered within 24 hours of intercourse, but that does not make UTIs contagious or sexually transmitted.

Treatment often involves antibiotics, but self-medicating is not advised. “Medical attention is best, especially when considering antibiotics, due to the risk of antibiotic resistance,” says Dr Kirugo.

At the end of the day, UTIs are incredibly common, often misunderstood and not necessarily linked to one’s sexual activity.

Understanding the non-sexual causes is not just empowering, it can also help many avoid unnecessary shame, delays in treatment and repeated infections.