Caitlin Whyte (Host): UTIs are quite common, but easy to prevent if you know how to do it. So joining us today with some UTI prevention tips is Dr. Jean Ung, a Urologist and Physician at Duly Health and Care. Dr. Ung, thank you so much for joining us today. To start us off, what exactly is a UTI and what are the common symptoms people should be aware of?

Jean Ung, MD: Sure. So a UTI is actually, so it's a urinary tract infection,   and then otherwise known as a bladder infection.  Sometimes when it's worse than sometimes people will call it a bladder and kidney infection, but basically it is an infection of the urinary tract,   where their, the urine actually builds up bacteria. And so largely the symptoms that a patient will tell their doctor about is that there is burning with urination, or urgency to urinate, or a feeling like they just urinated but they can't get it all out or they want to go again, sometimes even to the point of leakage.  And sometimes even to the point of seeing some darker colored urine or blood in the urine.

Host: You know, I've had friends who kind of get UTIs all the time. I've had some who have never had them. So what are the risk factors that make certain individuals more prone to UTIs?

Jean Ung, MD: Probably the most prone is going to be, say, that women are more prone than men.  And usually sometimes older women more than younger women. So, one of the risk factors is just your anatomy. So, if you think about where the urine exits from your body. For the woman, that urinary tract opening, is a shorter opening, meaning that the actual bladder is closer to the outside of the body.

For the man, there's a longer tube as it travels through the penis, so there's a little bit less risk for them getting a urinary tract infection. And then as women get older, there are a lot of health changes. So sometimes just some medical changes, sometimes medicine that they're on, sometimes other conditions, but also something called menopause, where then the vaginal area gets just more dry, and as that area gets more dry, , the body gets more susceptible to a UTI.

Host: Well, on that note, can you discuss the role of just personal hygiene in preventing UTIs and any do's or don'ts to keep in mind?

Jean Ung, MD: Sure, I think the main do is just hydration. Drinking enough water, and doctors always say water, but the truth is just liquids   to make sure that you build up urine in your body, and then you're flushing it out. So the more times you're flushing your bladder, the better you'll be against protecting against a UTI.

 But other things, people will definitely try different kind of supplements. Biggest supplement that's always talked about is cranberry. And when we talk about cranberry, we always talk about, you know, not the cranberry cocktail that you get when you're going to the restaurant, because that's the sweet stuff. And really, cranberry cocktail is just a bunch of other fruit juices like apple juice. And I always tell my patients, just a little splash of cranberry in there. So true cranberry juice is that 100 percent pure cranberry juice. It's very tart. Most people are not drinking an entire glass of it. So even three ounces of cranberry juice is better than nothing, and people will dilute it so that it tastes a little bit better.

And then because of that, then companies over the counter make all sorts of different kinds of cranberry pills, cranberry tablets, cranberry capsules, cranberry powders. That's probably the most common supplement. There are a lot of other supplements as well too.

Host: Well, that was really my next question. Are there any other dietary choices or over the counter remedies, supplements that may help in preventing UTIs other than that cranberry?

Jean Ung, MD: There are other supplements. So actually there's a lot of suggestion that vitamin C can even help.  We used to think that it was because it would make the urine more acidic but it's actually for some other reasons that it actually binds with different things in the urine, but taking extra vitamin C actually can help to prevent urinary tract infections.

There's another ingredient that's now pretty widely available called D-Mannose,   and it's been studied and it seems to help to prevent   the E. coli UTI, which is actually the most common UTI that most patients get.  And then because of that, then there's a lot of companies that make their own herbal supplements, those are a little harder to, to gauge to know exactly how they help or why they help.

 Hygiene, definitely wiping front to back seems to be something that   makes sense and seems to help. And it does get harder as patients get older.  When you talk to older patients, sometimes they can't reach behind to wipe front to back and they struggle with that.  Incontinence plays a role, so patients who are wearing pads all the time, so then they're always a little bit more wet down there,  that will play a role.

Patients that get a lot of yeast infections or have other vaginal issues.  But then intercourse seems to play a role too. So the sexually active woman and man   can get the UTI more easily. So there's a lot of discussion about hygiene in terms of urinating after intercourse, which kind of helps to cleanse the bladder and the urethra after that event.

Host: Yeah, I'd love to get into that a bit more, that connection between sexual activity and UTIs. What are some of those precautions besides, you said, maybe peeing   after intercourse? Is there anything else we can keep in mind?

Jean Ung, MD: Yeah, I think that's the main thing. I've definitely had patients who come and ask, should they shower before or wash before? Should the man wash before?  And there's less data about that.  There is some thought that the   uncircumcised man does have a little bit more bacteria, and so that relationship, sometimes there's a little bit more UTIs.   Vaginal dryness, so when there is painful intercourse, and then, you know, there's, there's some pain or discomfort or even burning from that afterwards,   that can make a woman a little bit more prone to a UTI. But I think the main thing that's always been talked about is that urinating after sex.  There's less data to really say is there anything that you can do before sex to prevent the UTI.  And then if we get into more specific details obviously then the concept of anal sex is going to be something that is a higher risk for a UTI in that sense just because of the extra bacteria that comes from the colon.

Host: Hmm. Interesting. Thank you. Well, for those of us who experience those reoccurring UTIs, we have a lot of tips and tricks, you know, to deal with it in the moment, but are there any additional steps that can be taken to prevent future occurrences? Again, especially for those who kind of keep dealing with this.

Jean Ung, MD: Yeah, I'd say definitely for patients that keep dealing with it, and when we say keep dealing with it, they talk about getting more than two or three UTIs over a six month period of time. Truth be told, if you get one UTI a year, there are a lot of care places that you can go to to get an evaluation and treatment, and most patients, if they need an antibiotic and they start an antibiotic within less than a day, they're feeling a lot better.

But then there are patients, if they're getting a lot of UTIs, they can check with their doctor, because there are some medicines that they can take prophylactically  sometimes before sex or right after sex.   For other patients,  that will work, and there are some medicines that are even low dose antibiotics and sometimes medicines that are not.  I think most doctors are eager to try to not just give too many antibiotics,   and even taking that cranberry pill and that D-Mannose pill,   after sex or when they think an early UTI is coming on and really drinking a lot of fluids and taking some pain reliever for the bladder,   really can help and sometimes those patients don't end up needing antibiotics for their UTI.

Host: Great. Well, as we wrap up our episode today, Doctor, when should someone seek out medical attention for a suspected UTI? You know, you're feeling those symptoms, maybe you just run to the grocery store, but how do we know when it may be that next step to go to the doctor's office? And then what treatments are typically recommended for UTIs there?

Jean Ung, MD: Yeah, so I think that the severity of the UTI really will determine how quickly a patient ends up and most of the time then they'll end up at some kind of urgent care place because when it hurts enough when they're urinating today, they can take some   acetaminophen, they can take some ibuprofen, there's an over the counter medicine that's called phenazopyridine.  Some of the brand names are things like Azo, and Cystex, and Uristat. But it helps their pain, and then they can drink a lot of water, they can drink some of that cranberry juice.  But if they don't get better, then usually within a day or two, most patients are looking for that urgent care team that can evaluate them.

Usually a urine analysis is checked, so they do a urine sample and the doctor and the nurse check that. And if it looks suspicious for a UTI, then the team will usually give the patient some antibiotics.  Most of the time, within a day or two on the antibiotics, they're feeling better, so most patients don't need much more than a week of antibiotics, and then they can get back to normal very quickly.

 I think otherwise, then patients, when they're going repeatedly to these places, then they start being directed to the urologist, let's say, for any other evaluation to see if there's any other reason or any other treatments that can be done to help prevent UTIs further.

Host: We've gone over a lot today, Doctor. Thank you so much for being with us. And thank you for listening. If you found this podcast helpful, please share it on your social channels and check out our full podcast library on your favorite podcast app or at dulyhealthandcare.com. This is Duly Noted, a Health and Care podcast from Duly Health and Care.