Interview with Dr. Thais Aliabadi, OB-GYN on What Every Woman Should Know About UTIs

UTIs are one of those issues almost everyone has heard of, yet so many of us still mix them up with yeast infections, bladder infections, kidney infections, and all the other things that can happen in that part of the body. The confusion makes sense. The anatomy is close together, the symptoms can overlap, and a lot of women are never actually taught what is where. Dr. Thais Aliabadi and Mary Alice Haney sit down to discuss the differences.

So we wanted to strip it all back and make it simple. What is a UTI really? How is it different from a vaginal infection? Why do some women get them constantly while others almost never do? And what actually helps prevent them?

Table of Contents

• Understanding the basics
• How a UTI actually starts
• Bladder infection versus kidney infection
• Why some women get recurrent UTIs
• When it is not actually a UTI
• What happens inside the bladder
• Prevention strategies that actually make sense
• Sex, hormones, and UTIs
• What doctors look for in recurrent infections
• Special consideration for older women
• Common myths we should stop repeating
• FAQ
• A better way to think about UTIs

Understanding the basics

Can we start with the most common confusion: what is the difference between a UTI, a yeast infection, a bladder infection, and a kidney infection?

Absolutely. The first thing we have to do is separate the vagina from the urinary tract, because those are not the same thing.

A yeast infection or bacterial vaginosis happens in the vagina. Those problems are usually associated with discharge, itching, irritation, or odor.

A urinary tract infection involves the urinary system, which includes the kidneys, the ureters, the bladder, and the urethra. The kidneys make urine, the ureters carry it down to the bladder, and the urethra is the tube urine passes through when we pee.

A bladder infection is a lower urinary tract infection. A kidney infection is an upper urinary tract infection, meaning bacteria have traveled farther up the system and reached the kidneys. That is a much more serious situation.

So even though these areas are physically close to each other, they are different body systems with different problems.

Why is this so confusing for women?

Because the anatomy is compact and most of us were not given a practical explanation of it. In female anatomy, the urethral opening, vaginal opening, and anus are all very close together. That close proximity matters.

The urethra is the top opening. That connects to the bladder.

The vaginal opening is below that. That leads into the vagina, then to the cervix and uterus.

And below that is the anus.

Since these openings are so close together, bacteria can move from one area to another more easily. Add to that the fact that women have a much shorter urethra than men, and it becomes much easier for bacteria to reach the bladder.

How a UTI actually starts

What causes most UTIs?

The most common cause is E. coli, a bacterium that normally lives in the gut. The problem starts when that bacteria gets near the urethra and moves upward into the bladder.

That does not automatically mean an infection will happen. In many cases, when we urinate, we flush bacteria out before it has the chance to stick to the bladder lining.

The issue begins when bacteria attaches to the bladder wall. Once it sticks, it can trigger inflammation. That inflammation is what creates the classic symptoms we associate with a UTI.

So the symptoms are not just because bacteria is present. The symptoms come from the body reacting to bacteria that has latched on and started causing irritation.

What symptoms usually point to a bladder infection?

The classic symptoms include:

• Burning or pain with urination
• Urgency, meaning the sudden need to pee
• Frequency, meaning going far more often than usual
• Only passing a tiny amount each time
• Lower abdominal discomfort or pressure
• Sometimes leaking urine when the urge comes on quickly

If you feel like you are running to the bathroom every few minutes and barely anything comes out, that is a big clue. If urination causes sharp bladder pain, that is another clue.

For a more detailed breakdown of common warning signs and when to get checked, this guide on urinary tract infection symptoms is a helpful companion.

How does bacteria get there in the first place?

There are several very common ways:

• Wiping from back to front
• Dehydration, which means less flushing of the bladder
• Holding urine for long periods
• Sexual activity, which can push bacteria toward the urethra
• Changes in the vaginal microbiome
• Vaginal dryness related to perimenopause or menopause

This is why simple preventive habits matter. Hydration is not just a wellness cliché. It helps physically wash bacteria out. Urinating after sex is not an old wives’ tale either. It helps clear out bacteria that may have been pushed toward the urethra during intercourse.

Bladder infection versus kidney infection

Is a kidney infection also a UTI?

Yes, but it is a different category. A bladder infection is a lower UTI. A kidney infection is an upper UTI.

Kidney infections often happen when a bladder infection is ignored or not treated promptly. The bacteria builds up in the bladder, then travels through the ureters and reaches the kidneys.

And once it gets there, people can become very sick.

What are the signs that a UTI may have reached the kidneys?

This is where the situation becomes much more serious. Symptoms of a kidney infection can include:

• Fever
• Chills
• Nausea or vomiting
• Severe pain in the back or side
• Feeling acutely ill

Many women with kidney infections end up needing emergency care. This is not something to push through at home.

If you want to understand how lower urinary infections can spread upward and why prompt treatment matters, this overview of pyelonephritis and kidney infection explains the progression well.

Why some women get recurrent UTIs

Why do some women get UTIs all the time while others never seem to get one?

There is no single answer. It usually comes down to a mix of anatomy, hormones, habits, microbiome balance, and genetics.

Risk factors include:

• Sexual activity
• Vaginal dryness
• Perimenopause and menopause
• Frequent antibiotic use
• Dehydration
• Holding urine too long
• Constipation
• Spermicide use
• Certain contraceptive methods

But there is also a genetic piece. Some women appear to have bladder receptors that make it easier for bacteria to attach. Two women can be exposed to the same amount of bacteria, and one develops repeated infections while the other does not. That difference can come down to how readily the bacteria can stick to the bladder lining.

What role does the vaginal microbiome play?

A huge one. This is one of the most important parts of the conversation.

The vagina, urethra, and bladder share an ecosystem. When the vaginal environment is healthy, it helps protect against harmful bacteria. When that environment is disrupted, UTI risk rises.

A healthy vagina is rich in lactobacilli. These bacteria help keep the vaginal pH acidic, which discourages harmful organisms from taking over. When lactobacilli decrease, colonization by bad bacteria can go up.

That shift can happen because of:

• Oral antibiotics
• Douching
• Spermicide
• Low estrogen in perimenopause or menopause
• Recurrent vaginal infections

So if someone keeps treating repeated UTIs but never addresses the vaginal ecosystem, they may keep going in circles.

For women in midlife, this link between estrogen loss, vaginal tissue changes, and recurrent urinary infections becomes especially important. This article on UTIs in menopause goes deeper into that connection.

When it is not actually a UTI

Can something else feel like a UTI?

Yes, and this is where women can get misdiagnosed repeatedly.

One important example is endometriosis involving the bladder or pelvic tissues. These patients may have urgency, frequency, and pain with urination, especially around their period. It can feel exactly like a bladder infection.

But the difference is in the testing. If it is a true infection, the urine culture should grow bacteria. If symptoms keep happening and the culture is repeatedly negative, we need to think beyond UTI.

This is why reflexively prescribing antibiotics every time urinary symptoms appear can be such a mistake. Repeated antibiotics can wipe out the microbiome and make the overall problem worse.

What test actually confirms a UTI?

A urine culture.

And ideally, it should be done before starting antibiotics. That way we know whether bacteria is truly present and, if it is, what kind of bacteria is causing the problem.

The sample should be collected midstream in a sterile cup. That means starting to pee, letting the first portion go into the toilet, and then catching the urine partway through. This helps reduce contamination from bacteria sitting on the skin outside the urinary opening.

That small detail matters. If the sample is not collected properly, the result can be less useful.

What happens inside the bladder

How does E. coli stick to the bladder?

This is where the science gets interesting. E. coli uses tiny structures on its surface to grab onto receptors in the bladder lining. If it does not attach, it can often be flushed away. If it does attach, it stays put, multiplies, and sparks inflammation.

That inflammatory process brings in immune cells and chemical signals. Those changes irritate local nerves and create the sensation of burning, pressure, urgency, and pain.

Sometimes, if an infection is ignored, bacteria can create a protective layer called a biofilm. Think of it as a shield that makes the bacteria harder to eliminate. In other cases, bacteria can hide within cells. That is one reason symptoms can go away temporarily, then come roaring back days or weeks later.

This is why early diagnosis matters. The longer an infection sits untreated, the more complicated it can become.

Prevention strategies that actually make sense

What should we do when the first symptoms show up?

Do not ignore them. If symptoms strongly suggest a UTI, get checked early and get a urine culture if possible before starting treatment.

Waiting too long gives bacteria more time to attach, multiply, and become harder to eradicate.

What are the everyday habits that lower risk?

The foundation is surprisingly practical:

• Stay hydrated
• Do not hold urine for long stretches
• Urinate after sex
• Address constipation
• Avoid unnecessary antibiotics
• Support the vaginal microbiome
• Treat vaginal dryness when present

Constipation is often overlooked. If stool sits in the rectum, it can increase bacterial colonization nearby. Since the distance between the anus and urethra is short, that matters.

What about probiotics?

They can be part of the strategy, especially in women who need antibiotics or who have recurrent infections that seem tied to microbiome disruption.

Systemic probiotics may help support vaginal balance, and there are also vaginal probiotic approaches now being used in some cases. They are not a magic fix, but they can be useful when the issue is clearly tied to repeated disruption of healthy vaginal bacteria.

Does cranberry help?

Yes, but the nuance matters. Cranberry is for prevention, not cure.

Certain cranberry compounds can interfere with the bacteria’s ability to latch onto the bladder wall. If bacteria cannot stick, it is more likely to be flushed out. But once a full infection is established, cranberry is not enough to treat it.

The form matters too. Juice is not the most reliable option because the concentration can be too low and sugar content can be high. A standardized supplement is usually what is discussed for prevention.

What about D-mannose?

D-mannose works on a similar concept but through a different route. It ends up in the bladder, where bacteria may bind to the D-mannose instead of attaching to the bladder wall. Then the bacteria can be flushed out with urination.

For women with recurrent infections, cranberry and D-mannose may both be used preventively because they work differently. But again, this is prevention. They are not a substitute for treatment once symptoms are severe and a real infection is established.

And like anything else, they are not for everybody. D-mannose can upset the stomach in some people. Cranberry supplements may interact with blood thinners. So it is worth reviewing medications and health history first.

Sex, hormones, and UTIs

Does peeing after sex really help?

Yes. It is one of the simplest and most helpful habits for women who are prone to post-intercourse UTIs.

Sex can move bacteria from the area around the anus closer to the urethra and even into it. Urinating afterward helps flush out bacteria before it can attach to the bladder lining.

It does not guarantee prevention every single time, but it absolutely helps lower risk.

Why do UTIs often get worse in perimenopause and menopause?

Because estrogen matters more than most people realize.

As estrogen levels drop, vaginal tissues become thinner, drier, and less elastic. Lactobacilli also decrease, which means the vaginal pH becomes less protective. At the same time, the urethral opening can lose elasticity and become more vulnerable.

Put all of that together and bacteria has an easier time colonizing the area and moving into the urinary tract.

This is why vaginal dryness is not just a comfort issue. It can directly affect recurrent UTIs.

How does vaginal estrogen help?

Vaginal estrogen can restore moisture, elasticity, and support the local environment that healthy bacteria need. It can improve the tissues of the vagina and the tissues around the urethra as well.

Different forms exist, including tablets, rings, and creams. Cream is often preferred because when it is applied vaginally, some reaches the outer tissues too. In very dry patients, a tiny amount can also be applied externally around the urethral area to help restore tissue quality.

This can be a game changer for women with recurrent UTIs in midlife.

For anyone navigating dryness, irritation, painful sex, or urinary symptoms related to hormone changes, this resource on menopause and vaginal dryness is worth reading alongside the UTI discussion.

What about vaginal laser treatments like MonaLisa Touch?

For the right patient, they can help with vaginal dryness and tissue atrophy. The goal is not cosmetic tightening. The real use is improving tissue health in women with estrogen-related atrophic changes.

By improving blood flow, elasticity, and tissue quality, these treatments may also help lower recurrent UTI risk in some women. That makes sense when we remember that healthy vaginal and urethral tissue is part of the body’s natural defense system.

What doctors look for in recurrent infections

If a woman keeps getting UTIs, what needs to be evaluated?

We need to step back and ask why.

That evaluation often includes:

• Checking for constipation
• Reviewing antibiotic exposure
• Assessing vaginal dryness and hormone status
• Looking for recurrent yeast infection or bacterial vaginosis
• Reviewing contraceptive methods such as spermicide use
• Considering kidney stones or catheter use
• Making sure symptoms are truly caused by infection

In some women, recurrent infections happen mainly after sex. In those cases, a physician may use a very small dose of antibiotic after intercourse for a limited period. That approach can reduce repeat infections while the other underlying factors are being addressed.

But even when we use that strategy, we still want to fix the bigger picture and not rely on antibiotics alone.

When should a woman be referred to urology?

If recurrent infections continue despite doing all the right things, it may be time to look deeper.

That can mean checking for:

• Kidney stones
• Structural issues
• Bladder lesions or polyps
• Other bladder pathology

At that point, seeing a urologist can help rule out problems that gynecologic management alone will not catch.

Special consideration for older women

Why can UTIs be especially dangerous in elderly women?

Older women often have severe untreated tissue atrophy from longstanding estrogen loss. They may also present differently. Instead of the classic burning and urgency, they may have subtle symptoms or no obvious urinary symptoms at all.

Sometimes the only sign is confusion or a sudden change in mental status. Because of that, infection can be missed until it has already moved beyond the bladder.

If bacteria reaches the kidneys or enters the bloodstream, the situation can escalate quickly into serious illness, including sepsis.

That is why the threshold for testing should be low in older adults, especially when there is a sudden unexplained change in behavior or cognition.

Common myths we should stop repeating

Do only women get UTIs?

No. Men can get them too. But women get them much more often because the female urethra is shorter, which makes it easier for bacteria to reach the bladder.

Are UTIs caused by poor hygiene?

No. Hygiene habits matter, but recurrent UTIs are not simply a cleanliness issue. Hormones, sex, genetics, hydration, microbiome shifts, constipation, and anatomy all play a role. Some of the most meticulous women still get UTIs.

Does cranberry juice cure a UTI?

No. Cranberry may help prevent some infections, but it does not cure an active one.

Can we always feel a UTI?

Usually, but not always. Pregnant patients and elderly women may not have the textbook symptoms.

Do UTIs only happen because of sex?

No. Sex is one risk factor, but not the only one. Hormonal changes, dehydration, constipation, microbiome imbalance, tissue dryness, and even certain physical activities can contribute.

FAQs

What is the fastest way to know if urinary symptoms are really a UTI?

The best way is a urine culture collected before antibiotics are started whenever possible. Symptoms can suggest a UTI, but only culture confirms whether bacteria is actually present.

Can a yeast infection turn into a UTI?

No. A yeast infection is a vaginal issue, while a UTI affects the urinary tract. They are separate problems, though disturbances in the vaginal environment can increase UTI risk.

Should every woman take cranberry or D-mannose every day?

No. These are generally considered for women with recurrent UTIs, not for everyone. If you rarely or never get UTIs, daily prevention supplements are usually unnecessary.

Is it normal to pee often if we drink a lot of water?

Yes. Frequent urination from high fluid intake is different from UTI urgency. With a bladder infection, the urge is often sudden, uncomfortable, and associated with pain, pressure, or burning.

When should a UTI feel urgent enough for emergency care?

If there is fever, chills, vomiting, severe side or back pain, major weakness, or confusion, that raises concern for a kidney infection or more serious spread of infection and should be evaluated urgently.

A better way to think about UTIs

The biggest takeaway is that UTIs are not random and they are not all the same. A bladder infection is not the same as a kidney infection. A vaginal infection is not the same as a UTI. And recurrent symptoms should not be brushed off without proper testing.

When we understand the anatomy, the microbiome, the role of hormones, and the mechanics of how bacteria attaches to the bladder, prevention starts to make much more sense.

Hydrate. Do not hold urine forever. Pee after sex. Respect vaginal dryness. Do not take antibiotics casually. And if symptoms keep coming back, ask why rather than just repeating the same cycle.

That is how we move from confusion to actually protecting ourselves.

This article was created from the video Ask Dr. A: What Every Woman Should Know About UTIs | SHE MD for Dr. Thais Aliabadi’s website.