UNDERSTANDING URINARY TRACT INFECTIONS

Maria Goma, 24 is your typical female, beautiful and trendy but recently Maria has been dashing in and out of the toilet.
Which can be a total nuisance.

Her friends tell her it’s because she might be pregnant; so she buys a testing kit, does a test and finds she is not pregnant. Believing all is clear she tells her mother who suspects a Sexually Transmitted Disease  (STD).

 For fear of gossip, her mother doesn’t take her to the clinic but instead gives her herbs. Her condition does not improve but she tolerates the symptoms and  life goes on. Three years down the line she is hospitalized because her kidneys have stopped functioning well.
The cause of the constant toilet dashing? A Urinal Tract Infection (UTI).

The above scenario may be fictitious but it is a reality in Zambia. Urinary Tract Infection (UTI) is a common infection women suffer from, but it is also the least understood.

African culture has made it practically a taboo to discuss anything to do with the genitals ;women will rarely tell anyone when they notice something amiss down there.

“It’s embarrassing for me to tell my friends that my vagina itching, smelling or feeling uncomfortable.”  says Sheba Saili.

She says women rarely discuss such issues with each other; so it is even harder to do so with a health worker who is considered a stranger.

UTI is associated with multiplication of micro-organisms in the urinary tract. The urinary tract is the body’s filtering system for removal of some of the body wastes.

 It affects both women and men. However, it is more common in women because, among other factors, they have a shorter urinary tract which makes it easier for micro-organisms to invade the lower urinary tract.

The lower urinary tract includes the urethra and the bladder. Whereas the upper urinary tract includes the ureters and the kidneys.

 Urine is excreted from the kidneys through the ureters into the bladder and out of the body through the urethra.
 It is important to note that UTI is not necessarily sexually transmitted like syphilis, gonorrhoea, or herpes.

However, UTI can be facilitated by infections of the genital tract during sexual intercourse.

The micro-organisms derived from the fecal reservoir (i.e. the bowels) cause UTI; specifically the bacteria called E.coli, which account for about 75% of all cases of UTI.

Ndola Central Hospital Consultant Obstetrician and Gynaecologist Sebastian Chinkoyo says the urinary tract, like the respiratory and digestive tracts, ends on the body surface,  exposed to the outside, and therefore can never be sterile throughout its length.

However, when the tract is anatomically and physiologically normal, and the local and systemic defence mechanisms intact, micro-organisms are confined to the lower end of the urethra.

There are various factors that predispose women to UTI.  As mentioned earlier, UTI is not an STI but can be caused by certain habits that women have with regards to hygiene of the areas surrounding their genitals.

Dr Chinkoyo says the proximity of the genitals and the anus means bacteria can easily be exchanged between the two areas.

"Women should make sure they wipe from front to back because doing it the other way round can contaminate the genital area with the bacteria E.coli which can then go into the urethra and up into the bladder."

E-Coli Bacteria

He also warns women against holding urine in their bladder for too long as this can cause bacteria to multiply because urine is a good culture medium.

"When the bladder is emptied regularly bacteria has no time to grow and cause infection."

Dr Chinkoyo further advises women to change sanitary towels, pads and even tampons regularly since these can be a source of infection of the urethra when soiled.

“Women should also wash their hands before handling pads or tampons to prevent contaminating them”, Dr Chinkoyo says.

He further elaborates that UTIs can also possibly be facilitated by use of disinfectants, deodorants and certain toilet preparations.

Pregnant women are more at risk of developing UTI partly due to hormonal changes that occur in their bodies that affect the urinary tract, and partly due to mechanical pressure of the pregnant womb on the urinary tract.

"Women who suffer from diabetes (sugar disease) are also prone to UTI because of impaired natural defence mechanisms"

The Doctor also mentioned that UTIs have been reported in newlywed women because sexual intercourse may cause minor trauma to the urethra and force genital bacteria into the bladder.

 He says this type of UTI is referred to as Honeymoon Cystitis. “The urethra is right next to the vagina, thus certain positions can cause trauma to the urethra,” he says.

Dr. Chinkoyo said common surveys suggest that about 50% of women suffer symptoms of UTIs sometime during their adult lives.


The main symptom that women should look out for is the intense desire to pass urine even after the bladder has been emptied. Women also feel burning (scalding) pain in the urethra when urinating.
Another symptom, though less common, is the presence of blood in the urine. This may be caused by severe infection of the bladder and kidneys or by bilharzia.

When women notice anything amiss when passing urine or just in general they should not hesitate to go to the clinic or hospital for medical attention.

The procedure for managing UTI is very simple;

"the woman simply needs  to submit a urine sample which is taken to the laboratory for what is called Microscopy, Culture and Sensitivity (MCS). This means the urine is examined under a microscope then incubated so that the causative bacteria can grow and be identified."

“It should be noted that when collecting urine the doctors want the midstream sample of urine as the initial stream may contain bacteria from the lower part of the urethra and genitals. Using this urine can lead to the test results being misleading,” Dr Chinkoyo said.

The identified bacteria are tested for their sensitivity to different types of antibiotics such as Ampicillin, Septrin, Nitrofurantoin, Ciprofloxacin and others. The appropriate antibiotic is then prescribed.  In addition a fluid intake of at least 2 litres per day will help eliminate the bacteria from the urinary tract by ensuring regular voiding.

Women should not feel ashamed to discuss anything that they think is wrong with their bodies. Diseases like UTI, if untreated, can lead to destruction of the kidneys resulting in kidney failure.

Diagram illustrating a UTI and its progression

Sometimes women can tell that there is something wrong but they keep silent. This is not helpful go to a clinic get yourself checked out.

It is vital to also adopt preventive measures like daily fluid intake of at least 2 litres, regular emptying of the bladder (3 hour intervals by day and before going to bed), ensuring complete emptying of the bladder at all times(,as well as before and after intercourse.)

A home remedy that might help is drinking cranberry juice.

 Maria considered her symptoms to be embarrassing and therefore did not seek medical attention until she developed complications.

Do not let that be you.