The female urethra is short and bacteria, like trout, can swim upstream.

      Women have more frequent bladder infections than men and most women will have multiple bladder infections during their lives.  Consequently, women need to know how to diagnose and promptly treat their own infections in order to avoid dangerous delays and unnecessary expenses.
      Because the female urethra is short it does not constitute a good barrier against the normal bacteria that inhabit the area.  Many of these bacteria have long tails with which they can swim up the urethra and colonize the urinary bladder.  Once the bladder is successfully colonized, infection ensues.
      Infection may occur spontaneously or may be invited by inciting factors such as the trauma of sexual intercourse, the reluctance to empty one’s bladder because of inconvenience, and the inability to fully empty one’s bladder due to scars, age, and having had multiple children.
      The symptoms of bladder infections are local burning, frequency, and urgency but without fever or other systemic manifestations such as chills, sweats, or back pain.  Women can be taught to recognize and treat these symptoms as soon as they arise.  Early treatment is very effective and short, requiring no more than 2 to 3 days of antibiotics.  When treatment is delayed, as happens when one has to wait to see the doctor, the infection becomes harder to treat, requires longer antibiotic courses, may cause bladder hemorrhage, and may even ascend to the kidneys causing fever and a severe illness called pyelonephritis.
      When infection proves recurrent, as happens after sexual intercourse, inability to empty the bladder, or reluctance to empty the bladder because of inconvenience, women can be given preventive antibiotics to avert these infections.  Hence, a woman can take one antibiotic tablet after sexual intercourse or after a long car ride and avoid infection.  Or an older woman with poor bladder emptying can take half an antibiotic tablet each day to supress frequent infections.
      The antibiotics used for urine infections are cheep and widely available.  A good doctor educates the woman on the proper use of these antibiotics during the initial visit and then gives her refills and the responsibility to prevent or treat all subsequent infections.
      Urine cultures, which are expensive, are not necessary in most situations.  They only become necessary if the woman does not respond to the given antibiotic.  Moreover, many elderly women have infected urines by culture but have no symptoms.  These chronic, silent infections cannot be cured and should not be treated because they are normal to these women and because treating them may cause unnecessary harm and no benefit.
      Kidney infections, on the other hand, are different from bladder infections and always require a doctor’s visit because they can become life threatening.  Here, the local symptoms such as burning, frequency, and urgency may or may not be present but women always feel ill with fever, chills, sweats, and backache.  Under such circumstances, it is best to involve the doctor before one starts the antibiotic and let the doctor decide on what constitutes the best course.
      Empowering women to recognize and treat their own bladder infections requires only one doctor’s visit.  During that visit all the necessary education and medications can be given.  Thereafter, the woman becomes her own doctor and only in case of treatment failure will she need to call upon her physician again.