If you are pregnant, you’re probably very familiar with the minor discomforts that can accompany your growing bump. Needing to empty your bladder more often, getting up a couple of times in the night for a wee and a dull ‘heaviness’ over your pubic bone are all common during pregnancy. However, sometimes these symptoms are more severe than the usual pregnancy irritations and can indicate a urinary tract infection (UTI).

What is a urinary tract infection?

The urinary tract consists of two kidneys, one on either side of your abdomen. The kidneys make urine which drains into the bladder through tubes called ureters. The bladder stores the urine until it passes out through the urethra when you have a wee.

A UTI occurs when bacteria get into the urine and may cause;

  1. Asymptomatic bacteriuria – this is where there are bacteria in your urine but you have no symptoms.
  2. Cystitis (bladder infection) – this is where the bacteria have infected the bladder. Typical symptoms are burning or stinging when you pass urine, and a dull ache in your lower abdomen.
  3. Pyelonephritis (kidney infection) – this may occur as a complication of asymptomatic bacteriuria or cystitis.

How does it happen?

Urine infections are caused by bacteria, usually from the bowel, entering the urethra and travelling up to the bladder. Pregnant or not, UTIs are 14 times more common in women than men. This is because;

  • The urethra is shorter in women and opens nearer to the back passage.
  • In women, the lower third of the urethra is continually contaminated with bugs from both the vagina and the rectum.
  • Women tend not to completely empty their bladders allowing bacteria to multiply.
  • Bacteria can enter a woman’s bladder during sex.

Is it more common in pregnancy?

A lot of women never suffer with urine infections until they are pregnant and because of this most people assume UITs are more common in pregnancy. However, this isn’t strictly true. Studies have shown that the prevalence of UTIs is equal amongst pregnant and non-pregnant women.

However, remarkable changes occur in the structure and function of the urinary tract during pregnancy. Because the volume of blood increases during pregnancy, the kidneys have to work harder and therefore produce more urine. At the same time, the increase in progesterone during pregnancy makes the ureters relax and lose some of their tone. These two factors can cause ‘urinary stasis’, a condition where the urine does not move as freely and stays in the bladder longer than usual.

This means that, although pregnancy itself does not cause more UTIs, it can increase the likelihood of bacteria developing into more serious infections.

What are the signs and symptoms?

Symptoms vary depending on the type of infection.

Asymptomatic bacteriuria has no symptoms at all and is usually only picked up by a chance urine test.

Cystitis has several symptoms which include;

  • Passing urine more frequently but only managing a few drops
  • Burning or stinging when you do pass urine
  • Aches in your lower abdomen
  • Slightly raised temperature

Pyelonephritis is uncommon but can occur as a complication of cystitis. Symptoms include;

  • Pain in the side of your abdomen over your kidney
  • High fever
  • Nausea and vomitting
  • Diarrhoea
  • Blood in your urine
  • Feeling generally unwell

What are the dangers in pregnancy?

If left untreated, the bacteria which cause cystitis can travel up to the kidneys causing pyelonephritis. This has been associated with premature labour, low birth weight, pre-eclampsia and maternal anaemia.

Dr Rory Symons, GP,says, “I would always recommend to any woman who has symptoms of frequency, pain on micturition(passing urine), blood in the urine, fever or loin pain that they seek urgent medical advice. Untreated UTIs can lead to pre-term labour and premature rupture of membranes.”

What is the treatment?

UTIs are normally treated with antibiotics. Dr Symons says, “Cephalexin or Amoxicillin are most commonly used although there are others which are just as safe.”

Paracetamol can also be taken to reduce any fever or aches and pains associated with a UTI.

Some over-the-counter remedies are suitable to take during pregnancy and you can discuss your options with the pharmacist.

Cranberry juice can relieve the symptoms of cystitis by preventing the bacteria from sticking to the bladder wall.

Can I do anything to prevent it?”

Traditional advice is to drink plenty of water at the first signs of a urine infection to help flush out the bladder. However, there is no proof that this is of any benefit and some doctors feel that it only makes more frequent (and painful) trips to the toilet.

However, it is thought that drinking plenty of water when you don’t have a urine infection can help prevent cystitis from occurring by flushing out the bladder on a frequent basis.

Urine checks during pregnancy

Routine urine tests are usually done in early pregnancy and treatment is advised if any bacteria are found, even if you have no symptoms.

You will usually be asked to bring a urine sample with you to each antenatal checkup but this is normally only checked for protein and glucose. However, if any bacteria are found during initial tests, regular checks will be made throughout your pregnancy.

If you do develop signs of cystitis, a urine sample will normally be tested to either confirm or rule out the diagnosis.