Urinary tract infections during pregnancy

Urinary tract infections (UTIs) are particularly common during pregnancy and refer to an infection of the urethra, bladder (cystitis), ureters or kidneys (pyelonephritis).

Infections of the urethra and bladder are known as lower urinary tract infections, and those of the kidneys and ureters as upper urinary tract infections.

The most common cause of UTIs is E.coli, a bacterium found in the bowel. Other agents such as chlamydia, gonococci, viruses or vaginitis can also cause them.

About 15% of pregnant women will have these bacteria in their urine, but will have no symptoms. Approximately 1 in 3 will develop a kidney infection, while 10% of pregnant women will have a lower UTI and 5% will develop one after delivery.

Symptoms of lower urinary tract infections:

  • Burning on urination
  • Painful urination
  • Desire to urinate often (urgency) and frequent passing of urine
  • Lower back pain with pain above pubic bone
  • Increased urination at night (nocturia)
  • High back pain or pelvic pain, fever, chills, nausea and vomiting are more indicative of kidney infection.

What causes urinary tract infections?

Hormonal changes during pregnancy decrease the tone of the ureter (passage between the kidney and bladder), while the valve between the ureter and the bladder becomes temporarily incompetent. This results in the back flow of urine that creates a predisposition to infection.

The weight of the foetus can also compress the bladder causing it to weaken and become congested and therefore also more prone to infection.

Bladder catheterisation during and after delivery can cause additional infections.

In the vast majority of infections, bacteria enter the bladder via the urethra and can then ascend into the kidneys. In women predisposed to urinary tract infections, there are usually gram negative bacteria around the urethral opening.

Bacteria enter the urethra often after intercourse. Whether infection will occur depends on the number and strain of bacteria entering via the urethra, the anti-bacterial properties of the bladder mucosal lining and the immune system of the women.

The following will help minimise the risk of UTIs:

  • Drink enough water to flush out bacteria
  • Wear cotton underwear to absorb moisture and discourage the spread of E.coli from back to front
  • Always wipe from front to back to prevent transmission of bacteria
  • Urinate after intercourse to flush out bacteria
  • Wash after intercourse

What should I do when I have a UTI?

There is an increased risk of premature birth and newborn death associated with urinary tract infections during pregnancy particularly those that involve the upper urinary tract, so it is important not to ignore it if you suspect that you do have a UTI.

Urinary tract infection during pregnancy requires medical intervention for diagnosis and treatment. Urinary alkalinisers and antibiotics that are safe to use during pregnancy are prescribed. It is a good idea to take a probiotic with antibiotics to protect the healthy bacteria found in your body.

You can also try herbal and natural remedies such as cranberry juice, buchu tea and garlic, but avoid uva ursi and golden seal during pregnancy. Homeopathic medicines like berberis vulgaris, cantharis, staphysagria, natrum muriaticum and nux vomica can also be beneficial.

Diet also plays a part – avoid simple sugars, refined carbohydrates, fizzy drinks, full-strength fruit juices, onions and chocolate, and drink plenty of water.

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