Question:  Would you think it was an
April Fool’s joke if I suggested you sing
Happy Birthday while you pee?

“How ya doin’ today?” I began with the typical non-question that Americans use so often in greeting. Of course, I expected the call-and-response answer of “Good, how ‘bout you?” To her credit, my good friend Lori doesn’t always play that game. Instead, she declared “not great, suffering with a UTI.” I inquired if she was taking cranberry capsules, and she assured me she was using the supplement and getting better.

Many conversations inspire exploration for posts; this one got me thinking further on the subject of Urinary Tract Infections (UTI). While it may seem inappropriate, it also caused me to recollect one memory that made me laugh. I’ve attended two presentations by urologists within the last few years. Both were women, but they did not share exactly the same recommendations.

One doc said you should always take the time to urinate when the sensation hits. The other said people should learn to hold some urine and not take advantage of every door displaying a “toilet” symbol. So, what do we do?

UTI Basics

The urinary tract system is biologically designed to avoid infection. The bladder and ureters (different than the urethra – see picture) help prevent the back-up of urine toward the kidneys. Additionally, and a key to remember, is that the elimination flow of urine helps wash bacteria out of the body. The volume for a typical adult is approximately 1 ½ quarts/day (more in the day than nighttime). No surprise, our volume depends on food and fluid we consume.

Generally, urine is free of bacteria, virus and fungi. “Sterile” is the word used to describe normal urine, although it does contain salts, other fluids and waste products.

Infections happen when microorganisms, usually bacteria, make their way where we don’t want them. These microorganisms (for instance E. coli) attach and cling to the opening of the urethra (see picture) and worse begin to grow and multiply. Worse still, they can migrate up the body, even to the kidneys.

Women AND Men get UTIs

Anyone – from young to old – can get a UTI. During very active sexual years, young women are quite prone to them. Younger girls often don’t learn, or forget, the importance of wiping “front to back” resulting in infection. But unfortunately, as folks age (perhaps due to immune responses) infections become relatively common.

Men get UTIs despite the fact that little is written about it. With an enlarged prostate gland, or other obstructions to urine flow (like a kidney stone) men too suffer the risk of infection.

Yet, why might men get fewer UTIs? There is controversy as to why women get more inflections than men, but two factors of the male anatomy are an advantage.

1. The male prostate gland produces secretions that slow bacterial growth.
2. The male urethra is longer, protecting against quick bacterial access to the bladder.

Seniors, both men and women, demonstrate a higher frequency of UTIs than those in younger-middle age. There are other reasons, but some of the more commonly cited risks include:

• Reduced immunity
• Diabetes
• Mechanisms that reduce bladder activity (such as nerve issues or medications)
• Use of a catheter
• Enlarged prostate (reducing male urine flow)
• Any abnormities within the urinary tract which obstruct urine flow (like urinary/kidney stones)

Typical Feelings & Treatments

UTIs can cause a wiped-out, shaky, bad-all-over feeling. Not only is being tired a symptom but pain and burning during urination is common. NOT uncommon too is the complaint that one feels the need to urinate, yet only a small amount is passed. If the latter is your only symptom, and comes on suddenly, it’s often suggested to attempt more-than-usual hydration – more fluid. It might remedy this situation within a couple hours.

As mentioned in the beginning, one home, self-help treatment for new or mild cases is cranberry capsules. Be certain not to confuse this advice of supplementation with drinking cranberry juice. The latter could never supply enough of the synergistic elements (such as Proanthocyanidins (PACs), catechin, triterpenoids or perhaps D-mannose) to reduce infection. We always need to check products for the ingredients. Not only do the juices have limited active ingredients, they are loaded with sugar.

“Limited scientific evidence shows that by
consuming 500 mg each day of cranberry dietary supplement,
healthy women who have had a urinary tract infection (UTI)
may reduce their risk of recurrent UTI.”
FDA – statement (2020)

However, even supplements are not as important for reducing infection as the ‘unsung’ tip in sections below.

If an infection is caught soon enough, or within a few days of home remedies not succeeding, a course of antibiotics should work quickly. If the cause is not an obstruction, you may feel better within a few days on the medication.

Frequent Suggestions for Prevention

Aside from what I address below, there are numerous recommendations on preventing a UTI. Some are more appropriate for younger men and women (or even children) but others are equally useful to seniors.

• Drink plenty of water every day.
• Stop or don’t smoke.
• Take showers as opposed to baths.
• Don’t resist the urge to urinate.
• Learn or practice Kegel exercise (search on ‘Kegel’ at linked article.) Surprisingly, “Kegels” are good for both men and women, strengthening the pelvic floor and improving bladder control.  BTW, apparently, Kegel exercises also help men with prostate health. Even PizzazzEE-25 briefly incorporates these motions.

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Two extra steps can be taken to prevent the worsening of an infection while it lasts, or when you begin to suspect one.

1. Drink even more water, AND don’t restrict it at night.
2. Avoid bladder irritants (during infection). These include caffeine, sugary and spicy foods, citrus or excessive vitamin C supplementation and carbonated drinks.

For Women in particular to Avoid UTIs

• Avoid feminine hygiene sprays or scented cleansers. (I am unaware if any of the new all-body products are exempt from the caution, but I doubt it.)
• Wipe from front to back as we teach children. It prevents bacteria around anus from entering vagina or urethra.
• Cleanse the genital area before sexual intercourse, and empty bladder before and after if possible.

The Unsung Prevention Tip

One of the general tips I mentioned earlier is to urinate when you feel the need. But anyone who’s ever experienced a UTI knows that this particular feeling could happen every 15 minutes and yet produce only a few drops. During times of infection, and while waiting for your home remedies or meds to work, it’s best to drink more water regardless, and despite annoying repetitive trips to the rest room. The feeling of constancy will abate.

There is another reason that older folks continue to get UTIs even if there is no intercourse or catheter use. The good news is that there’s an easy and effective way to overcome repeated bouts.

We must FULLY empty the bladder. That sounds easy enough, right? But no, it’s not. Often when folks age, we empty half or so. The trick is time. If you feel ready to stop – don’t. Take more time, perhaps as long as you would need to sing a slow rendition of the Happy Birthday song. Chances are you will release more urine after that.

♫ Happy Birthday to you…… ♫ sung more than once a year

Taking extra time is the most reliable tip to fully empty the bladder. Further, it is advantageous not simply when you have an infection, but always. As a regular habit it can be a preventative solution.

Crede’s Maneuver

While this simple maneuver is usually recommended to start a stream of urine, it can be used to activate the second attempt as well. Both women and men can use it (and it can be accomplished during your bathroom singing of Happy Birthday).

Don’t be surprised if it sounds similar to something you already do naturally, albeit without the fancy medical terminology.

1. While seated on the toilet, place both flat hands on your abdomen below the navel.
2. Firmly push downward 6 times or so, putting pressure on the bladder to stimulate the urge to void. (For women, you can increase the pressure by bending forward at the hips.)
3. Now, place one hand over the other (as shown) above the pubic area. Press firmly inward and downward, helping to compress the bladder and expel more urine.

 

Final Thought

If you come away from this post remembering only to sing Happy Birthday after first peeing, then you have incorporated a big tip to avoiding UTIs into your routine.  It’s the sung, unsung solution.

While it might be a humorous image, I would suggest that when in a public toilet you ‘sing’ silently.

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Resource slide show for readers (not reviewed by drb): UTI Pictures: Bladder Infection Symptoms, Causes, Home Remedies, and More

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Title Image by Freepik – senior women in pain

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