 In the studio now for our your health segment tonight is Dr. Madeline Dick Bea-Squachea, clinical assistant professor of obstetrics, gynecology, and reproductive sciences at the University of Maryland School of Medicine and director of urogynecology and pelvic reconstruction at the University of Maryland Medical Center. Doctor, thank you for being with us. Thank you. We're here to talk about something that's very common, can be very painful, and as little discussed, UTIs. What is that? UTI stands for urinary tract infections. It's an infection somewhere in the urinary tract, including the kidneys, ureters, bladder, or the urethra. How common is it? Are there numbers? Is it more women or men? It accounts to about seven to eight million visits to the office every year and a hundred thousand admissions to the hospital a year, so it's very common. It is twice as common in women than in men. How does it typically happen? I mean, obviously, you know, you have an opening in the body and bacteria can get in. Is that what happens? Basically, bacteria can come from the perineum or the area of the genitals or rectum and then it invades through the urethra into the bladder. How does somebody know they have one? What's the first symptom? So symptoms can include urinary frequency, going more than usual to the bathroom, urgency, having to go very quickly to the bathroom and feeling a very uncomfortable burning sensation when you urinate. They can also have a pain in the lower abdomen. Some people can have a fever and some can even have blood in the urine. Is pain the first symptom? It can be anything. Some people have more urgency and frequency and some people have more pain. Every person is different. It sounds like one of those things where getting medical attention quickly is a good idea, but it may not be clear to everybody what's going on initially. So most people, if you're healthy and you increase your fluid intake and the symptoms are not too severe, you can probably clear it on your own, but if the symptoms are severe or they persist for more than three or four days, you should definitely go to the doctor. And especially the first or second time it happens, you want to go to the doctor very quickly because it's very uncomfortable. Everybody makes the same association when I saw on the notes what we were talking about. My first thought was cranberry juice. Yes. Is there anything to that as a cure or preventative for UTIs? So there are a number of things that we use for prevention. Unfortunately, we don't have a great amount of research on this yet and some other research is contradictory, but I always tell my patients to, you know, try everything. So I don't usually recommend cranberry juice because it has a lot of calories and you don't want all that extra sugar. So cranberry tablets, there's also increasing the fluid intake, urinating right after intercourse, and for some women that have recurrent urinary tract infections, meaning that they have more than two in six months or more than three in a year. We also may give antibiotics to take every day for prevention. Preventatively. Or what we call prophylactic. What would the risk factors be in men for this? Unfortunately, I see mostly women, but older men that can have prostatitis or an infection of the prostate and show up with urinary tract infections and anything that could potentially place bacteria that is in the skin or in the rectum in the urethra. Is this the sort of thing where we're generally staying reasonably hydrated, drinking a good amount, not a crazy amount of water, is a good idea for everybody? Yes, definitely. Almost two liters of water a day is plenty. Making sure you have a good hygiene, especially in women, wiping front to back is very important. So you don't bring the bacteria that's in the rectum towards the vagina or the urethra. And having in general a good, healthy lifestyle. Let's take a phone call Baltimore County. This is Erica. Thank you for the call. Go ahead. I'm interested if there is anything in herbs, natural plants to take. Very good. Thank you. Thank you for the phone call. Natural therapies. Like I said, cranberry tablets are good. There's a supplement that's called the manholes is a type of sugar and you can find it as one of the supplements in the pharmacy. That has been also in some studies shown to prevent recurrent urinary tract infections. But that's basically... If an infection is allowed to continue without treatment, what are the potential consequences? So certain patients are more at risk of complications during a urinary tract infections. Patients that are immunosuppressed because they're taking certain medications. Pregnant women, older patients might get then ascending infections, what we call infections that go up from the bladder towards the kidneys. And that can present a dangerous situation because the infection can go into the blood. Let's take a call from Hartford County. This is Joe. Joe, thank you for calling. Go ahead. Thanks Jeff. A 67 year old male been diagnosed with a distended bladder. Been told I don't completely void my bladder. I'm wondering where are the complications or side effects of that malady? All right. Thank you for the phone call. Good luck. You don't treat a lot of men. No, but urinary tension can also happen in women. But both women and men with urinary tension can be more at risk of urinary tract infections because there's more of a volume of fluid that doesn't release all the time and bacteria can then reproduce. It's more of a favorable environment for bacteria to grow. With women in particular, does it matter if you are somebody who takes showers or takes baths and feminine hygiene products? So our women, our bodies that swim in a are very good at cleaning themselves. So we don't need any feminine hygiene products. We just need showers and soap and water is a great thing. If you do do baths and you find that you are having more urinary or vaginal infections, then that should be one thing that you eliminate first. How does somebody know when to see the doctor and once you've seen maybe a family doctor, when you need a specialist? Well, if the symptoms are very severe, if you can't do your regular daily routine, if they have been going on for three or four days and they are not improving, if you have blood in your urine or you have a fever, and if it's an elderly person and they show signs of confusion, those are all signs that you should be seeing a doctor, either family physician or urgent center. If a patient has repeated urinary tract infections, again, more than three in a year or more than two in six months, they should be treated as recurrent urinary tract infections and they can be seen by a specialist such as myself as a urogynecologist or urologist to determine if they have certain risk factors that we can intervene with. Is there any research going on that's of particular interest either in diagnosis, treatment, different antibiotics and so forth? Definitely. We have many institutions that are researching first on the sensitivity of our testing because there are a lot of bacteria that have been shown to not show up in the urine culture sometimes. So we're working on having better testing for bacteria in the urine and we're also working on trying antibiotics that are able to treat resistant infections, which is a very constant struggle for us. So somebody in terms of the testing could have an infection and I guess it's a urine test would come back negative. It may. But it's a bug that's not being tested for. It's less likely. I don't want to say that it's common, but there are some bacteria that may not show up in the urine culture and still give you symptoms and signs of urine infection. Your practice, you also specialized in surgery, pelvic prolapse. Tell me about that. I mean, how much of your practices in different areas? So my practice is probably 30% prolapse in which we help women that have descents in the vagina and uterus, probably 50% incontinence, both urinary and fecal incontinence, meaning that you leak when you don't want to go to the bathroom or there's leaking stool as well. And another, how much did I say? 50 and 30. So the other 20% are. There's no math on this. So the other 20% will be recurrent patients with recurrent urinary tract infections, patients that have interstitial cystitis, which is a pain syndrome in the bladder. Another variety of things. In terms of the surgical work that you do, how's that evolving? So there's kind of a pendulum, right? Before there were no mesh and then everybody was meshed and now most people don't get a mesh for prolapse, but we are finding better and ways of treating prolapse with with better surgeries and more long lasting surgeries. Let's get one more phone call. Howard County, this is Kathy. Kathy, thank you for calling. Go ahead. Yeah, I was just wondering with the retention issue that the other man spoke about. What does she think about catheterization a couple of times a day to relieve the build up? Thank you for the phone call. So there are a number of different ways to treat retention. First and foremost is observation. If a patient does have retention but can reasonably, although not completely empty their bladder and they don't have a problem with urinary tract infections or other complications of it, we can just observe. The other two options would be a catheterizing a number of times a day. You would have to obviously consult with your physician and see what's appropriate. And then there's a nerve stimulator that we can implant to treat retention as well. Doctor, we appreciate your time. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.