URINARY TRACT INFECTIONS PREGNANCY

• What is a urinary tract infection?

  Most people use the phrase urinary tract infection (UTI) to refer to a bladder infection — that is, a bacterial infection that causes inflammation in your bladder, often triggering symptoms such as a frequent urge to urinate and a burning sensation when you pee. This condition, also called cystitis, is fairly common among sexually active women between 20 and 50.
  
  But bacteria can infect any part of the urinary tract. The urinary tract starts at the kidneys, where urine is made. It continues through tubes called ureters to the bladder, where urine accumulates until you're ready to pee. And it ends with the urethra, a short tube that carries urine outside your body.
  
  An infection occurs when bacteria from your intestinal tract travels from your rectum up your urethra to your bladder, where it can cause cystitis or just continue to multiply in your urinary tract without causing any symptoms (a condition called asymptomatic bacteriuria). In either case, the bacteria may continue to travel up the ureters and cause a kidney infection, a serious condition that can lead to premature labor and other complications.

• Does pregnancy make me more likely to get UTIs?

  Being pregnant makes you more susceptible to urinary tract infections of all kinds. Higher levels of the hormone progesterone relax the muscles of the ureters, causing them to stretch out. Your growing uterus may compress the ureters, making it difficult for urine to flow through them as quickly and freely as it normally does. And later in pregnancy, the baby presses on your bladder, making it hard to empty it completely when you pee. The upshot of these changes is that it takes longer for urine to pass through your urinary tract, giving bacteria more time to multiply and take hold before being flushed out.
  
  This is why your practitioner will test your urine for bacteria during your first prenatal visit, whether you have symptoms or not. If this initial test is negative, your chances of developing a UTI later in pregnancy are small. But if you're among the 5 to 7 percent of pregnant women who do have bacteria in their urine, you'll be treated with antibiotics to clear it out. If this kind of infection were left untreated, you'd have a 30 percent chance of developing a kidney infection during your pregnancy.

• What are the symptoms of cystitis?

  Symptoms of a bladder infection (cystitis) vary from woman to woman but may include:
  
  - Pain, discomfort, or burning when urinating (and possibly during sexual intercourse)
  - Pelvic discomfort or lower abdominal pain (often just above the pubic bone)
  - A frequent or uncontrollable urge to pee, even when there's very little urine in the bladder
  - Foul-smelling urine
  - Cloudy urine
  - Blood in the urine (usually hard to see with the naked eye)
  - Since the frequent urge to pee is common during pregnancy, it may be hard to know for sure whether you have cystitis, especially if your symptoms are mild. If you think you might have an infection, be sure to call your healthcare provider so your urine can be tested and a definitive diagnosis made. Untreated cystitis puts you at high risk for getting a kidney infection while you're pregnant, so it's important not to delay treatment.

• What are the symptoms of a kidney infection?

  Signs that the infection has spread to your kidneys (and that you need medical attention immediately) may include:
  
  - A high fever (often with shaking, chills, or sweats)
  - Pain in your lower back or in your side just under your ribs, on one or both sides, and possibly in your abdomen
  - Nausea and vomiting
  - Puss or blood in the urine (may be hard to see with the naked eye)
  
  With a kidney infection you may also have some of the symptoms of cystitis. A kidney infection is the most common serious medical complication of pregnancy. It can lead to premature labor and other problems, so you need to be seen and treated right away.

• What if I get a UTI while I'm pregnant?

  If you develop cystitis during your pregnancy or you test positive for bacteria in your urinary tract at your first prenatal appointment, you'll be given a seven- to ten-day course of oral antibiotics. (A number of antibiotics are safe to take during pregnancy.) If you've been having cystitis symptoms, the antibiotics will probably relieve them within a few days, but it's really important to complete the entire course of treatment anyway, in order to get rid of all of the bacteria in your urinary tract.
  
  After treatment, you'll be tested again to make sure the infection is gone. Repeat urine cultures should then be done at regular intervals throughout your pregnancy to be sure you don't get infected again. Up to 40 percent of pregnant women who get one UTI will develop another infection. If you keep getting bladder infections, you may be put on a constant low dose of antibiotics until you give birth to prevent the infections from recurring.
  
  If you develop a kidney infection during pregnancy, you'll be hospitalized so you can receive antibiotics intravenously and be monitored for signs of premature labor. After you're cured, you'll be tested frequently and may be given preventive antibiotic treatment for the remainder of your pregnancy, as you'll be at risk for getting another kidney infection.

• What can I do to avoid getting an infection?

  Take these steps to minimize your chances of getting a UTI:
  
  - Drink plenty of water, at least eight 8-ounce glasses a day.
  - Don't ignore the urge to pee. And empty your bladder completely when you urinate.
  - After a bowel movement, wipe yourself from front to back to prevent bacteria in the stool from getting near the urethra. Keep your genital area clean with mild soap and water. Clean your genital area and pee before and after sexual intercourse.
  - Drink cranberry juice. Studies show that cranberry juice can reduce bacteria levels and discourage new bacteria from taking hold in the urinary tract. (Drinking cranberry juice won't cure an existing infection, though, so if you're having symptoms, you still need to see your practitioner right away to get a prescription for antibiotics.)
  - Avoid feminine hygiene products (sprays or powders) and strong soaps that can irritate your urethra and genitals and make them a better breeding ground for bacteria. And don't use douches during pregnancy.
  - Wear all-cotton underwear and cotton-crotch pantyhose.