Anyone who has had a urinary tract infection (UTI) knows that they are the absolute worst, but most aren't aware of how alarmingly easy they are to get. Urinary tract infections are caused when bacteria enters into the urinary tract through the urethral opening and multiplies, causing an infection (1). Our body is pretty good at keeping bad bacteria out, but certain things can make our defences fail, and once the bacteria settles in and starts multiplying... you’re in trouble. So, how do you get a UTI?
How do you get a UTI 1: The Urinary Tract
The urinary tract is made up of 4 main parts (in descending order):
- kidneys (x2)
- ureters (x2)
Most UTIs take place in the lower part of the urinary tract starting with the urethra (small tube that our pee comes out of). Once they've set up camp there, they work their evil way up into in your bladder (small organ that collects and stores urine). As they’re lower in your body, it means they’re closer to the outside world, so the bacteria has a shorter distance to travel.
If the bacteria gets further up, it can affect the ureters (narrow tubes that drain urine from the kidneys into the bladder), and the kidneys themselves turning into a full blown kidney infection.
A kidney infection is the most serious type of UTI and comes with the most serious symptoms (e.g. back pain, nausea, high fever). As a general rule, the further up this chain, the worse it is (2).
How do you get a UTI 2: What causes urinary tract infections
The bacteria responsible for this horrible plight is usually escherichia coli (E. coli), though other bacteria can be responsible. The problem is that E. coli is commonly found in our gastrointestinal tract so it comes out when we poo, which is pretty darn close to our urethras.
The proximity of your anus and urethral opening is what gives E.coli a super easy opportunity to set up base camp in the urethra and ruin our lives.
- This is why it’s important for you to wipe front to back!
People say that sex causes UTIs, but this isn’t quite right. Sex is a risk factor, because it can lead to bacteria in the urinary tract, but sex itself doesn’t cause urinary tract infections. And you don’t have to be sexually active to get a urinary tract infection.
All women are at risk just because of their anatomy, and some more than others just based on how your beautiful self is built (e.g. shorter urethra, or a narrower space between your two lower exits).
How do you get a UTI 3: The comprehensive list
So UTI causes are really the things that cause bacteria to enter, linger, and multiply. Here’s a comprehensive list for your reading pleasure (and horror!):
- Sex – it’s still the highest risk factor. In fact, almost 80% of premenopausal women with a UTI have had sex within the previous 24-hours (3). You can read more about UTIs and sex here.
- Sexually transmitted infections – because the female urethra is close to the vagina, sexually transmitted infections (STIs), such as herpes, gonorrhea, chlamydia, and mycoplasma, can cause an infection in your urethra (1). You can read more about STIs and UTIs here.
- Not peeing – peeing after sex is definitely a good habit to get into because it helps flush the bacteria out of the urethra so it doesn’t continue traveling up the tract. But the same goes for that long road trip where no one wants to stop to let you pee. It’s worth it - stop and pee and save yourself the misery! Urine is the ticket for the bacteria to get out of there, but it’s also a nice breeding pool given a high amount of glucose and proteins (7). So let the pee flow!
- Birth control– does the whole world want us to get pregnant or something!? Spermicides and diaphragms can irritate some girls, creating a more hospitable environment for bacterial infections. Planned Parenthood advises that if you feel your vagina getting sore or irritated it could be that you’re sensitive to the method you’re using (8). Of course, birth control pills have also been attributed to an increased risk of UTIs given the impact on hormone levels (9, 10), so it’s helpful to know that there isn’t a perfect approach for everybody.
- Sexual positions – you can use your imagination here, but any behaviour that potentially enhances the transfer of bacteria from your anus to your vagina increases the chance of getting a UTI. Stay wild, for sure, but be aware of what’s causing infections for you and take preventative measures to help.
- New sexual partners – often with new sexual partners comes new sexual frequency – additional contact, friction, maybe some adventurous positions…you get the idea. It’s not their fault, UTIs are not contagious. And I’ve heard too many stories of relationships ending prematurely due to a stupid UTI. So make sure you are both informed, taking the appropriate preventative measures, and keep that blossoming romance going!
- Insulation and contamination– tight fitting clothes (I’m looking at you chaffing g-string!) is not doing you any favours here. Restrictive clothing contains ‘everything’ in one area. If you’re sweating it’s even worse because the wetness adds to the mixing. Loose fitting cotton clothes are the ideal preventative outfit (6), but of course that’s only realistic some of the time. It also helps to make sure you’re changing any hygienic products or underwear regularly to keep it fresh down there!
- Menopause– yet another reason to look forward to this joyous life stage. After menopause, a decline in circulating estrogen causes changes in the urinary tract that make you more vulnerable to infection (1).
- Urinary tract abnormalities– you can’t help this, but some people are born with a quirk where their urinary tract doesn’t allow urine to leave the body normally, messing up the natural flushing out system and increasing the risk of UTI (1).
- Blockages in the urinary tract – similar to #9, kidney stones or enlarged prostates can trap urine in the bladder too. Guys don’t get many UTIs when they’re younger because their urethra is longer and hangs off the body, away from the other stuff. But when they get older and their prostates may enlarge and the risk increases, evening the scales a bit. Sorry guys!
- Constipation – the pressure on your urinary tract can cause urine to not empty all the way, another way that bacteria can linger and multiply. Remember from #3, getting the pee out is key!
- Catheters – UTIs are a super common hospital condition, with more than a million cases in hospitals and nursing homes each year in the US (4). A catheter is a tube that allows urine to drain out of the bladder and collect in a bag. This is adding complications to the body’s drainage system – a pipe within a pipe – which leads to a higher risk of infection due to unsanitary insertion, irregular backup of urine etc. (5).
- Weak immune system– we’re still relying on our bodies as the first and best defense against infection-causing bacteria. When our immune system is weak, so are our defenses. This might be because of other health issues (e.g. diabetes), or maybe an extra epic weekend that leaves you contracting every common cold and infection known to humankind.
- Recent medical procedure– a surgery or exam of the urinary tract or nearby area with medical instruments can increase the risk of bacteria and infection. Kind of gross to think of, but hospitals are dirty places, despite all the hand sanitizer hanging from the walls.
- Pregnancy – lots of changes happen to the body during pregnancy, and the urinary tract is no different. The uterus sits directly on top of the bladder, and as it grows, its increased weight can block the drainage of urine from the bladder. If you’ve read this far, you know that’s a bad thing (11). But congrats if you’re pregnant! That’s exciting!
- Antibiotics – the greatest irony of all. The things doctors give us to kill the bacteria also makes it stronger and harder to kill. It’s a big problem as bacteria can bounce back, causing reinfection, one of the reasons why recurrent urinary tract infections are so common. It’s an important issue for anyone who relies on antibiotics to manage their urinary tract infections. And it’s a big issue worldwide. The Public Health Agency of Canada has called it one of the biggest health risks facing the country (12).
- Urinary tract infections– I hate to say it, but once you’ve had one UTI, you’re at risk of getting another one. It’s just how the body works. Antibiotics don’t help, but the body is also just more prone to irritation and infection after it’s happened before. This risk is higher if you got your first UTI before the age of 15.
So as you can see, it’s ALL about the bacteria and the different ways it enters your system and multiplies, causing an infection. Preventative measures should focus on keeping the bacteria OUT, and supporting this process with a healthy immune system, lots of hydration, and general behavioural adjustments to give yourself the best chance against the bacteria warriors.
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(1) "Urinary tract infection (UTI).” Mayo Clinic, Mayo Foundation for Medical Education and Research.
(2) FACEP, Jerry R. Balentine DO. “Urinary Tract Infection Treatment, UTI Symptoms & Home Remedies.” MedicineNet.
(3) Rodriguez, Diana. “The Link Between UTIs and Sex.” EverydayHealth.com , 29 Oct. 2010.
(4) Sobieszczyk, Magdalena E. "Urinary Tract Infections." Columbia University
(5) "Catheter-Associated Urinary Tract Infection." CDC, Centre for Disease Control and Prevention.
(6) “8 Most Common Causes Of UTIs.” Prevention, Prevention, 2017.
(7) Rettner, Rachael. “Urinary Tract Infection: Causes, Symptoms & Treatment.” LiveScience, Purch, 14 Aug. 2017.
(8) “Is the Diaphragm Safe? | See If the Diaphragm is Right for You.” Planned Parenthood.
(9) Takahashi, MD M. “Bacteriuria and Oral Contraceptives.” JAMA , American Medical Association, 18 Feb. 1974.
(10) Dienye PO, Gbeneol PK. Contracep on as a risk factor for urinary tract infection in Port Harcourt, Nigeria: A case control study. Afr J Prm Health Care Fam Med. 2011;3(1), Art. #207, 4 pages. doi:10.4102/phcfm.v3i1.207.
(11) “Urinary Tract Infection During Pregnancy: Symptoms & Prevention.” American Pregnancy Association , 10 Mar. 2017.
(12) Brownell, Claire. "Super Bugs: They're a Health and Economic Crisis and There's No Cure In Sight." Financial Post, December 3 2016.