Dear Doctors: In a recent column, you explained that women can develop repeated urinary tract infections, even with careful hygiene. What about men? Can they also get UTIs? If so, what causes them, and are cranberry supplements helpful for men as well?
Dear Reader: It's true that discussions of urinary tract infections (UTIs) tend to focus on women. UTIs occur far more often in women than in men. Data show that up to 60% of women will have at least one UTI in their lifetimes. That number is far lower for men, about 10% to 12%. This is due, in large part, to the differences in female and male anatomy.
The primary pathogen involved in UTIs is E. coli. The bacteria live in the intestines. E. coli exits the body in stool and can enter the urinary tract through the urethra. The urethra is the tube urine travels through from the bladder to exit the body. How close the urethra is to the rectum in women increases the chance of bacterial transfer, even with vigilant hygiene. The length of the urethra also plays a role. In women, it is just 3 to 4 centimeters long. The urethra in men is much longer, about 18 to 20 centimeters. Other factors also impact the frequency of UTIs in women. The physical changes associated with pregnancy can contribute. The hormonal changes of perimenopause and menopause is another possibility. Anatomical anomalies and vaginal and urinary microbiome composition also affect their chances.
That said, it is possible for men to develop UTIs. Urine helps flush bacteria from the urinary tract. But some conditions can narrow the urethra, such as an enlarged prostate. This can impede the flow of urine. It can keep the bladder from emptying completely. The remaining urine creates an environment favorable to bacterial growth. Other factors that can increase UTI risk include kidney stones, cystitis, catheter use and diabetes.
Although the pathways to UTI differ in women and men, some symptoms are similar. They can both have urinary urgency. Difficulty starting a stream and repeated urge to go are other common symptoms. A burning sensation, a weak stream and a sensation that the bladder remains full can also be shared signs. In men, these symptoms can also come from prostate issues. That means prostate health is often checked, in addition to testing the urine for bacteria.
Treatment depends on the primary cause of the UTI. For a bacterial infection, patients are often prescribed antibiotics. When the cause relates to the prostate, medications to improve urine flow or prostate inflammation may be needed. Physicians will also assess whether a procedure to manage an obstruction of the urethra might help. Cranberry products can be helpful in some cases. Cranberry is believed to interfere with the ability of E. coli to bind to the urinary tract lining. But in cases where residual urine in the bladder is the breeding ground for bacteria, cranberry products may not be as effective.
Recurrent UTIs in men are possible, but not common. If these begin to occur, it is important to see your healthcare provider as another condition may be involved.
(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
