danger of urinary tract infections for women heats up in summer
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changing hormones during perimenopause and menopause, like the drop in estrogen levels, causes changes to the tissue in the vagina, so there's less protection against pathogenic bacteria from colonizing.
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the summer’s balmy heat is like an invitation to enjoy the outdoors and go for a swim or bike ride. but for women, it acts as the perfect environment for cystitis, a urinary tract infection (uti). as many as 50 to 60 per cent of women will have a uti at some point in their lives.
for those women experiencing perimenopause and menopause, hormonal changes can heighten the risk.
what is a urinary tract infection?
first, what exactly is a uti? it’s a bacterial infection that can happen anywhere in the urinary system—the kidneys, ureters, bladder and urethra. the most common uti affects the bladder, which can give people typical symptoms of having to urinate frequently, burning with urination, and some minor abdominal cramping and pelvic pain. essentially, bacteria ascend into the urinary tract from the urethra to the bladder.
in some cases, urinary tract infections can go right up to the kidney, leading to more serious symptoms like fever, back pain, nausea and vomiting, where people may need to be hospitalized.
while men can contract utis, women are more susceptible. anatomical differences, for example, with mainly shorter urethras in women and proximity to the anus, make it easier for bacteria like e. coli to reach the bladder.
dr. zain chagla, head of infectious diseases service at st. joseph’s healthcare hamilton in hamilton, ont., says a one-time uti can clear on its own in a couple of days with the body’s natural mechanisms. the mainstay of treatment is antibiotics, although there’s concern about over-prescribing and antibiotic resistance, outlined by a retrospective study published in the journal life in 2024.
but dr. chagla gets most concerned when utis are recurring. not only pain and discomfort, but they can also lead to kidney damage and the risk of other infections.
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when symptoms persist, get checked out
“persistent burning with urination that’s not clearing after a couple of days, or challenges with getting urine out so they’re retaining urine and not able to void appropriately or having to go quite frequently. those are bigger signs to get checked out, especially if they’re persistent,” he says, noting that symptoms can also signal other underlying issues. blood in the urine can be a sign of cancer or kidney stones, and having to urinate frequently can be a sign of diabetes.
“when i see women with recurrent urinary tract infections, we go through everything from the bottom up,” he explains. “so is there good hygiene? is wiping adequate? are people constipated, which can cause some issues? sometimes with sexual activity, the trauma of sex can lead to bacteria going into the vaginal cavity.”
drinking enough water matters even more in the heat
why is summer more problematic?
in his practice, dr. chagla sees women experiencing more challenges during the summer than the winter because of a common culprit: dehydration.
“people may be more dehydrated in the summer than they are during the winter, increasing the risk of utis from the fact that they’re low on essentially what is protective, that flushing motion.”
rather than bacteria climbing up the urinary tract, the constant urinary flow out of the urinary tract pushes the bacteria out with it. if you disrupt that flow, there’s a greater chance of bacteria establishing themselves in the urinary system.
“it’s good motherhood advice, but there’s really good clinical data that staying hydrated, drinking a litre and a half a day of fluids, is a very powerful intervention in reducing recurrence risk,” he says, adding that three water bottles or about six cups of water is recommended.
he also points out that travelling to hotter climates can also increase the risk for uti during the trip. people again may not be paying attention to hydration, and partners can be more sexually active on vacation.
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challenges of changing hormones
further, women who are perimenopausal and menopausal are at higher risk. perimenopause is the transition period of fluctuating hormones that leads to menopause, which is defined as the time when a woman has stopped menstruating for 12 months. difficulty with body temperature regulation, for example, is a contributing factor. women who have hot flashes and more body sweat promote the growth of bacteria in the urinary and perianal region.
as well, changing hormones during this life transition, like the drop in estrogen levels, causes changes to the tissue in the vagina, so there’s less protection against pathogenic bacteria from colonizing.
“women often lose some of that protective layer that is part of the hormonal changes in the vagina. we see that very commonly,” dr. chagla says.
“it may have its own symptoms that mimic urinary tract infections—pain with urination, discomfort with wiping, pain with sex—but also, that loss of the layer changes the bacteria and may increase the risk of urinary tract infections.”
in these cases, topical estrogen applied to the vagina is an effective intervention in preventing urinary tract infection, particularly recurrent ones, he notes.
he comes back to the importance of staying hydrated, especially in summer heat. “it’s persistence in continuing to do it. because again, the second you lose that persistent voiding and being able to flush the urine out intermittently is where that protection lingers.”
for those who don’t make six cups of water a daily habit, super-hot days contribute to more water loss than cooler days, so be persistent.
“that’s a really simple, effective, easy intervention to prevent urinary tract infections.”
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