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Urinary Tract Infections in women in India are very common, yet often left untreated. The culture of silence has got to go!
By Deepa Shankar
It had been a month of happy married life for Srividya Raman*. She had a loving husband, she was adjusting well to married life and back to her job after a European honeymoon. Yet, there was something bothering her. She was unwilling to discuss her problem with anyone and she couldn’t understand why she had to rush to the restroom to urinate every hour or why she felt a painful burning sensation during urination.
Srividya suffered from a Urinary Tract Infection (UTI), which is in fact, sometimes called Honeymoon Cystitis – because of the very high incidence post the honeymoon which is for many Indian women, their introduction to sexual intercourse. Like most Indian women, Srividya was completely ignorant of the possibility and suffered in silence.
Urinary tract infections are usually a bacterial infection that affects any part of the urinary tract (starts from the kidney and ends with the urethra). Infection in the kidney is dangerous and is thankfully very rare, while infection in the urethra is very common and the form that usually affects most women. Urinary tract infections in women are disproportionately high, due to the short urinary passage (urethra) and bacteria from elsewhere getting lodged in it.
E Coli is a bacterium that is very useful in the colon where it produces Vitamin K2 and prevents the establishment of pathogenic bacteria. It is excreted with feces and the anus has a large amount of E Coli. In women the urethra and the anus are fairly close to each other – a recipe for the easy transfer of bacteria!
When E Coli lodges in the urethra, it starts cultivating in the urine and leads to urinary tract infections. Women who, wipe/wash from back to front face high risk of infection, as the bacteria are transferred from the anus to the urethra. The vagina has enough anti-bacterial secretions that protect it from such infections but the urethra is not protected.
In India, urinary tract infections in women often happened for the first time after marriage (not a very relevant demographic now, though), during the initial days of sexual activity, (like in the case of Srividya) when colonic bacteria are transferred more commonly to the urethra. Contrary to common perceptions, public toilets are not the main culprit – however, poor conditions in hospitals do lead to urinary tract infections in women. For e.g., if catheters are not sterilized properly before usage or if there is a delay in inserting a catheter, it can result in urinary tract infections.
Another factor is diabetes, which can alter the chemical composition of urine; the higher sugar level in the urine of a diabetic makes it breeding ground for bacteria. The rising incidence of diabetes among Indian women is therefore a factor, leading to recurrent urinary tract infections in women, because healing is greatly hampered by their diabetes.
In pregnant women, the fluids near the vagina are more than in normal women (said to be boggy); because of the swollen uterus pressing on the bladder, it may not be completely emptied and that too provides a medium for infectious bacteria culture.
Other causes include too many pregnancies leading to weakening of the uterus and not washing spermicidal gels and creams properly after usage. Spermicidal creams kill sperms, not bacteria. They end up serving as breeding ground for bacteria.
Irrespective of how old you are, urinate before and after sex – this flushes out all urine present along with bacteria. Urine has anti-bacterial ingredients but once stagnant, it can also provide a medium for culture. It is not true that urinating after sex reduces your chances of conception. It is also a myth that condoms prevent urinary tract infections in women. Condoms prevent diseases being passed on between the partners, but remember that UTI is caused by bacteria merely changing locations – from anywhere in your own self to your urethra.
Stick to a low-sugar diet and exercise to avoid the risk of diabetes. Among UTI patients, diabetics are the toughest to treat, because they don’t heal easily.
Drink lots of water. It is prescribed that you drink at least 2-3 litres of water every day. The more water you drink, the more you urinate; hence the harmful bacteria are flushed out of the system.
Reduce your salt intake. The high level of sodium in salt stresses the kidney and over the years, the kidney cannot stand this. It decreases the functioning levels of the kidney. This will lead to UTI, among other complications. The advised upper threshold of salt intake is 2 gm per day, while the average Indian ingests 5 gm of salt per day.
Never wipe from back to front. If you wash, wash effectively. Keep the area clean and do NOT leave it wet.
If you recognise the symptoms (frequent urination, burning sensation, sudden fevers) consult a doctor immediately. Many Indian women suffer in silence, feeling ashamed to discuss an intimate problem, but do remember that doctors have seen hundreds of cases like yours! If you are not comfortable going alone, talk to your spouse or a trusted female friend or relative, and get them to go with you to the doctor.
A doctor will usually prescribe an anti-biotic, depending on the type of bacterial infection. DO finish the entire course of anti biotic. Never stop taking the medicine midway, because you feel you have recovered.
Urethra related urinary tract infections in women are usually treated quite easily and there is no reason to suffer discomfort and endanger women’s health by ignoring them.
*Name changed on request
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Neena was the sole caregiver of Amma and though one would think that Amma was dependent on her, Neena felt otherwise.
Neena inhaled the aroma that emanated from the pan and took a deep breath. The aroma of cumin interspersed with butter transported her back to the modest kitchen in her native village. She could picture her father standing in the kitchen wearing his white crisp kurta as he made delectable concoctions for his only daughter.
Neena grew up in a home where both her parents worked together in tandem to keep the house up and running. She had a blissful childhood in her modest two-room house. The house was small but every nook and cranny gave her memories of a lifetime. Neena’s young heart imagined that her life would follow the same cheerful course. But how wrong she was!
When she was sixteen, the catastrophic clutches of destiny snatched away her parents. They passed away in a road accident and Neena was devastated. Relatives thronged her now gloomy house and soon it was decided that she should be married off.
Women today don’t want to be in a partnership that complicates their lives further. They need an equal partner with whom they can figure out life as a team, playing by each other’s strengths.
We all are familiar with that one annoying aunty who is more interested in our marital status than in the dessert counter at a wedding. But these aunties have somehow become obsolete now. Now they are replaced by men we have in our lives. Friends, family, and even work colleagues. It’s the men who are worried about why we are not saying yes to one among their clans. What is wrong with us? Aren’t we scared of dying alone? Like them?
A recent interaction with a guy friend of mine turned sour when he lectured me about how I would regret not getting married at the right time. He lectured that every event in our lives needs to be completed within a certain timeframe set by society else we are doomed. I wasn’t angry. I was just disappointed to realize that annoying aunties are rapidly doubling in our society. And they don’t just appear at weddings or family functions anymore. They are everywhere. They are the real pandemic.
Let’s examine this a little closer.
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