Urinary Tract Infections (UTIs) in pregnancy

A urinary tract infection (UTI) is a common bacterial infection. However, the physiological changes of pregnancy increase your susceptibility to developing one. Knowing what to look out for and getting treatment promptly is important, as an untreated UTI can progress to more serious complications.

What is a UTI?

Your urinary tract includes your kidneys, which make urine; the ureters, which are the tubes connecting your kidneys to your bladder; the bladder, which stores urine; and the urethra, which is the tube through which urine leaves your body.

UTIs are almost always caused by bacteria. Most commonly, a UTI involves the bladder and urethra. However, the infection can spread up through the ureters to the kidneys, where it can become more serious.

Why does pregnancy increase your risk?

During pregnancy, your body undergoes hormonal and structural changes that can increase the risk of a UTI.

• Hormonal changes: Elevated pregnancy hormones relax the smooth muscles of the urethra and bladder walls. This slows urinary flow and prevents the bladder from emptying completely, causing urine to pool.
• Anatomical pressure: As your baby grows, the expanding uterus exerts direct pressure on your bladder and ureters, altering the urinary tract angle and further inhibiting complete emptying.
• Dehydration: Early pregnancy symptoms like morning sickness or an altered sense of taste can reduce your fluid intake, leading to concentrated urine that encourages bacterial growth.
• Anatomy and intimacy: Because the female urethra is short, bacteria have a shorter distance to travel to the bladder. Normal physical activities, including sexual intercourse, can sometimes introduce bacteria into the urinary tract.

What are the UTI symptoms during pregnancy?

Frequent urination is a normal part of pregnancy. However, because muscle relaxation can sometimes mask typical UTI pain, you should contact your care team immediately if you experience any of the following:

• A burning sensation or pain when passing urine
• Frequently passing only small amounts of urine
• An urgent feeling that you need to pass urine immediately after emptying your bladder
• Cloudy, dark, or unusually strong-smelling urine
• Lower abdominal or lower back pain
• Difficulty starting to urinate

How is a UTI diagnosed?

This standard test involves capturing the middle portion of your urine flow rather than the very beginning. This helps flush away any naturally occurring external bacteria or skin cells, preventing sample contamination and making the test more accurate.

Can I reduce my risk of a UTI?

There are some simple daily habits you can adopt to help reduce your risk of developing a UTI.

• Stay hydrated: Drink plenty of water. Aim to drink enough so your urine stays a pale, light straw colour.
• Practice good hygiene: Always wipe from front to back after using the toilet to keep bacteria away from your urinary tract.
• Post-sex hygiene: Physical intimacy is safe and normal during pregnancy. To clear any bacteria that may have moved near the urethra, make it a habit to urinate shortly after sex and rinse the area with warm water.
• Choose breathable fabrics: Wear loose clothing and cotton underwear. Avoid douching, bubble baths and scented hygiene products, as these can cause irritation.

What is the UTI treatment during pregnancy?

If you are diagnosed with a UTI, your doctor will prescribe antibiotics. They will choose an antibiotic that is safe to take during pregnancy and is appropriate for treating the particular type of bacteria causing the infection.

You must finish the entire prescription, even if your symptoms resolve early. Untreated UTIs can migrate upwards into the kidneys, causing a severe infection known as pyelonephritis. This requires urgent hospitalisation and increases the risk of serious complications, including premature labour or birth.

If you are experiencing any changes in your urinary habits, please do not hesitate to contact your midwife or obstetrician to arrange a simple urine test