Obstetric & Gynaecology Malaysia


Urinary tract infections (UTIs) are common infections. Many women get them at some point in their lives. These infections can be treated with antibiotics, and symptoms usually can be relieved quickly.

The urinary tract has a lower part and an upper part. The upper part consists of the ureters and kidneys. The lower tract is made up of the urethra and the bladder. 

  • The two kidneys produce urine.
  • The two tubes called ureters carry urine from the  kidneys to the bladder.
  • The bladder stores urine.
  • The urethra carries urine from the bladder out of the body.

Most UTIs start in the lower urinary tract. Bacteria enter through the urethra and spread upward to the bladder. This can cause cystitis, a bladder infection. In some cases, an infection of the urethra called urethritis can develop at the same time.  

Bladder infections are more common than kidney infections. They happen when bacteria get into the urethra and travel up into the bladder. Bladder infection is "cystitis."

Kidney infections happen when the bacteria travel even higher, up into the kidneys. Kidney infection is "pyelonephritis."

Women are more likely than men to get UTIs. 

  • The urethra is shorter and closer to the anus in a woman allowing the bacteria from anus to reach the bladder easily.      Especially so when some woman tend to wipe with tissue from back to front after passing urine
  • The anatomy of women makes them prone to getting UTIs after having sex. 
  • The opening of the urethra is in front, on top of the vagina.                                                                                During sex, bacteria inside the vagina can get into the urethra from contact with the penis, fingers.
  • UTIs tend to occur in women who begin having sex or have it more often. 
  • Using spermicide or a diaphragm for birth control also can cause more frequent UTIs.

Infections also can develop when the bladder does not empty completely. This may be caused by the following:

  • A stone in the ureters, kidneys, or bladder that blocks the flow of urine through the urinary tract.                                       Stones develop when minerals in urine stick together and there is not enough fluid to flush them out.
  • A narrowed tube in the urinary tract that slows the flow of urine.
  • A problem with the nerves or muscles of the pelvis.

You are more likely to get an infection if you

  • have had a UTI before
  • have had several children
  • have diabetes mellitus
  • have obesity
  • on a urinary catheter, a thin, flexible tube that drains urine from the bladder used in women who cannot urinate in the normal way.
  • are going through menopause
  • are pregnant.

If you are pregnant and think you may have a UTI, call your obstetrician. Severe infections can cause problems for both you and your fetus, so it is important to treat UTIs early.

Symptoms of UTIs can come on quickly. One sign is a strong urge to urinate that cannot be delayed (urgency). As urine flows, a sharp pain or burning may be felt in the urethra. The urge to urinate then returns minutes later (frequency). There may be soreness in the lower abdomen, in the back, or in the sides.

If you have a UTI, your urine may have a strong odor, look cloudy, be tinged with blood. Blood in the urine may be caused by a UTI, but it also may be caused by other conditions. See your doctor early if you see blood in your urine.

If the bacteria enter the ureters and spread to the kidneys, symptoms may include

  • back pain
  • chills
  • fever
  • nausea
  • vomiting

If you have any of these symptoms, call your ob-gyn right away. Kidney infections are serious. They need to be treated promptly.

Pain when urinating can be caused by other conditions, such as infection of the vagina or vulva. Tests may be needed to confirm the diagnosis of a UTI. Talk with your doctor about your symptoms.

The diagnosis of a UTI often is made based on symptoms, including pain with urination or frequent urination.

A simple test called urinalysis (UFEME=Urine Full Examination Microscopic Examination) may show if you have a UTI. For this test, you will be asked to provide a urine sample. This sample will be studied in a lab to look for white blood cells, red blood cells, and bacteria. The urine sample also may be grown in a culture (a substance that promotes the growth of bacteria) to see which bacteria are present.

For urinalysis, it is important to provide a clean sample of urine. Your gynae nurse will give you a sterile cup 

Follow these steps:

  • Open the cup and place it at easy reach. Place the cap nearby with the inside lid up. Separate the labia with one hand. With the other hand, clean your genital area with the wipe. 
  • Wipe from front to back and do not touch or wipe your anus.
  • While still holding the labia open, pick up the opened container with your other hand, pass some urine into the toilet, 
  • Catch the last part of the urine that flow in the cup, to prevent the sample from picking up bacteria from your vagina.
  • Place the cap back on the cup.
  • Do not touch the inside of the lid or the cup at any time, to keep the sample from picking up bacteria from your hands.

Your doctor may advised further testing to look at your urinary tract if

  • your infection does not clear up with treatment
  • you have had several UTIs in a short time
  • you have pain, fever, and chills
Your gynae may recommend an ultrasound exam or computed tomography (CT) of the upper urinary tract.

Antibiotics are used to treat UTIs. The type, dose, and length of antibiotic treatment depend on the type of bacteria causing the infection and your medical history. A simple UTI rarely leads to infection of the upper urinary tract.

In most cases, treatment lasts a few days and is very effective. Most symptoms go away in 1 to 2 days. It is very important to finish medication prescribed for a UTI, even after your symptoms go away.

For more severe infections, such as a kidney infection, you may need to stay in the hospital. Severe infections take longer to treat, and you may need medication given through an intravenous (IV) line

There are a number of ways to prevent UTIs:

  • Wash the skin around the anus and the genital area.
  • Drink plenty of fluids (including water) to flush bacteria out of your urinary system.
  • Empty your bladder about every 2 to 3 hours or as you soon as you feel the urge if more than 2 hours have passed.
  • Urinating after sex – this helps, because it helps flush out germs that might get into the bladder during sex. 

Unsweetened cranberry juice and cranberry pills may decrease the risk of getting a UTI. The exact amount of juice or pills needed and how long you need to take them to prevent infection are being studied. Treatment with an estrogen cream or pills is being studied as a way to prevent UTIs in menopausal and postmenopausal women.

If you have three or more UTIs in a year, you have recurrent infection. The first step in treatment is finding the cause. Factors that increase the risk of recurrent infection are

  • a history of UTIs
  • young age at first UTI
  • long-term spermicide use, diaphragm use
  • frequent sex or a new sexual partner

Recurrent infections are treated with antibiotics. 
  • A week or two after you finish treatment, a urine test may be done to see if the infection is gone.
  • Changing your birth control method may be recommended.
  • A single daily dose of antibiotic may be recommended for 6 to 12 months.
  • If you often get UTIs from sexual activity, your gynae may recommend you take a single dose of antibiotic within an hour after each time you have sex.