UTI in pregnancy: How to tell & treatment options

What is a urinary tract infection?

What are the different types of urinary tract infections?

• Cystitis (bladder infection): This is the most frequent form of UTI, caused by bacteria that infect the bladder. Common symptoms include painful urination, discomfort in the lower abdomen (suprapubic area), and sometimes blood in the urine.  
• Urethritis (urethra infection): This infection involves the urethra, the tube that carries urine from the bladder to outside the body. It may cause a burning sensation during urination and discharge from the urethra.  
• Pyelonephritis (kidney infection): This is a more severe form of UTI that affects one or more kidneys (the upper urinary tract). Symptoms may include fever, chills, back pain, nausea, and vomiting. This type of UTI generally requires more intensive treatment.  
• Ureteritis (ureter infection): This is a rare form of UTI where the infection impacts the ureters, the tubes that carry urine from the kidneys to the bladder. It may cause pain along with other common UTI symptoms. 
• Asymptomatic Bacteriuria: This occurs when bacteria are present in the urine but don’t cause symptoms. It is commonly observed in people with conditions such as diabetes or pregnancy and in the elderly. Asymptomatic bacteriuria is not an infection and does not usually require treatment. However, treatment may be recommended in pregnancy to reduce the risk of UTI and kidney infection.  

Symptoms of UTIs during pregnancy: How to tell

• Painful or burning sensation during urination 
• Feeling like your bladder is full, even after you have urinated  
• Frequent urination 
• Incontinence or urinating before you reach the toilet 
• Cloudy or foul-smelling urine 
• Blood in the urine 
• Lower abdominal or pelvic pain 
• Fever and chills 
• Nausea 
• Vomiting 
• Back or flank pain 

Common causes of UTIs

• Bacterial infection: Escherichia coli (E. coli), a bacterium usually found in the intestines, is a common cause of UTI. It can move to the urethra and trigger an infection. Other bacteria may also cause UTI. 
• Hormonal changes: Increased levels of progesterone during pregnancy relax the muscles in the urinary tract, causing slower urine flow and inadequate bladder emptying. This facilitates bacterial growth, increasing the risk of infection.  
• Increased urinary tract stasis: The growing uterus can put pressure on the bladder and ureters, slowing urine flow and causing urine retention. This stagnant urine promotes the growth of bacteria. 
• Weakened immune system: Pregnancy alters the immune system, reducing the body’s ability to fight infections. This increases the chances of UTIs.  
• Sexual activity: Sexual intercourse can introduce bacteria into the urethra, heightening the risk of UTIs during pregnancy, especially for women who are vulnerable to frequent infections.   
• Urinary catheters: If a catheter is inserted during pregnancy (if there is difficulty with urination), it can introduce bacteria into the urinary tract. 
• Dehydration: Pregnant women may not consume enough fluids, causing dehydration, lowering urination frequency, and allowing bacteria to build up in the bladder, elevating the risk of infection.  
• Pre-existing conditions: Pregnant women with diabetes, kidney issues, or a background of recurrent UTIs are at a greater risk of developing a UTI.   

Complications of UTIs during pregnancy

• Preterm labour: If left untreated, UTIs can heighten the risk of early labour, causing a premature birth. 
• Kidney infection (Pyelonephritis): If a urinary tract infection spreads to the kidney, it may lead to a kidney infection, causing serious complications like sepsis. Pyelonephritis can be extremely harmful to both mother and baby and may necessitate hospitalisation and intravenous antibiotic treatment.  
• High blood pressure (Pre-eclampsia): in some cases, UTIs may be associated with a higher risk of developing pre-eclampsia, a pregnancy complication characterised by high blood pressure and organ damage.  
• Increased risk of postpartum infection: If UTIs are not completely treated during pregnancy, they may increase the chances of developing infections after delivery. 

Is there a risk to my baby?

How are UTIs diagnosed?

1. Medical history and symptom assessment: A healthcare provider will inquire about the patient's symptoms, which may include sensations of pain or burning during urination, an increased frequency of urination, the presence of cloudy urine, or pelvic discomfort.
2. Urine sample collection: A urine sample is obtained for analysis to detect the presence of bacteria, white blood cells, or red blood cells, all of which may indicate an infection. This analysis is typically conducted through a urinalysis.
3. Urine culture: a collected urine sample can be cultured in a laboratory. This process facilitates the identification of the specific bacterial strain responsible for the infection and assists in determining appropriate antibiotic treatment.
4. Imaging studies: In certain instances, such as cases of recurrent UTIs, imaging studies including ultrasound may be used to investigate structural abnormalities within the urinary tract.

How do you treat a UTI while pregnant? Treatment at home

1. Antibiotics: To address the infection, a doctor will prescribe antibiotics deemed safe for use during pregnancy. It is essential to complete the entire course as directed to ensure the complete eradication of the infection. 
2. Hydration: It is advisable to consume a substantial amount of water to assist in flushing out bacteria from the urinary tract. A daily intake of at least 8 to 10 glasses of water is recommended. 
3. Frequent urination: It is important to empty the bladder regularly to prevent the accumulation of bacteria. Patients should avoid retaining urine for extended periods. 
4. Avoidance of irritants: Individuals should refrain from using irritants such as scented soaps, douches, or bubble baths, as these products may exacerbate the infection. 
5. Good hygiene: It is important to wipe from front to back following the use of the toilet to minimise the risk of bacterial spread to the urethra.

When to seek a doctor’s appointment?

Telehealth with an online doctor for UTI treatment

• Telehealth appointments: Connect with an experienced doctor to discuss your symptoms, the health practitoner will assess your condition and provide professional advice on treatment and management. 
• Instant scripts: If treatment is required, the online GP can provide online prescriptions. These can be collected at your local pharmacy or ordered online with same-day pharmacy delivery options. 
• Doctor’s referrals: Should your doctor identify the need for further investigation or specialist care, they can issue a referral for diagnostic tests or a consultation with a specialist. 
• Medical certificate online: If your condition requires you to rest at home, Hola Health’s online doctor service can provide a same day medical certificates for work or school and multi-day medical certificate online tailored to your situation. 

When to seek urgent medical attention?

1. Severe pain or discomfort: This includes intense pelvis or lower abdominal pain that does not alleviate.
2. High fever: A fever exceeding 101°F (38.3°C) accompanied by chills may suggest the presence of a kidney infection.
3. Nausea and vomiting: These symptoms may indicate a more serious infection, such as pyelonephritis, which is a kidney infection.
4. Hematuria: The passage of a significant amount of blood in the urine, or if the urine appears dark and cloudy, warrants immediate medical evaluation.
5. Signs of dehydration: Inability to retain fluids or feelings of weakness and dizziness should prompt a consultation.
6. Complications during pregnancy: Pregnant individuals who experience UTI symptoms may face complications, including the risk of preterm labour if left untreated.

Can I prevent UTIs?

1. Hydration: It is advisable to consume a substantial amount of water to facilitate the elimination of bacteria from the urinary system. 
2. Regular urination: Individuals should refrain from retaining urine for extended durations; it is important to empty the bladder promptly upon experiencing the urge to urinate 
3. Good hygiene: It is essential to wipe from front to back after utilising the toilet to impede the introduction of bacteria into the urethra. 
4. Personal cleanliness: Maintaining cleanliness in the genital area is vital. The use of products that may irritate, such as scented soaps or bubble baths, should be avoided. 
5. Attire choices: Selecting loose-fitting garments and cotton underwear is recommended to decrease moisture accumulation, particularly during hot months, thereby lessening the likelihood of bacterial proliferation.