How are UTIs and incontinence connected?

We spoke with urologist, Dr Elayne Ooi from Swan Urology in Western Australia, about how to identify, prevent and manage urinary tract infections (UTIs) and the link with bladder control health.

Words by Megan Breen.

People of all ages and stages of life can get urinary tract infections, but they are more common in women, people using continence aids or catheters, and children in nappies or learning to use the toilet. This is due to bacteria — often from the bowel — entering the urinary tract through the urethra (tube that empties wee from your bladder) and infecting the lining of the urinary system. While they are usually straightforward to treat, their symptoms can be confusing—especially when they overlap with other conditions.

If caught early, mild UTIs can often be managed with increased fluid intake and over-the-counter products such as urinary alkalisers (eg Ural or Citravescent), which help reduce the burning sensation when you wee.

More severe or complicated infections may require antibiotics. If you experience recurring UTI symptoms, see your health professional to check for underlying causes.

What is a urinary tract?

The urinary tract is made up of a series of organs which remove waste from your body. The body creates urine in your kidneys, transports it via thin tubes called ureters to the bladder where it is stored before draining it via the urethra when you go to the toilet.

UTIs and urge incontinence

“Once infected, irritation from the bacteria sparks inflammation in the bladder, which triggers the symptoms of a UTI that many people may recognise: a stinging or burning sensation when weeing, the sudden and overwhelming need to go to the toilet (urinary urgency), and the feeling of never quite emptying the bladder,” Dr Ooi explains.

“Instead of the usual interval of three to four hours between bathroom trips, someone with a UTI might need to go every five to ten minutes (urinary frequency),” Dr Ooi tells Bridge. “Leakage, known as urge incontinence, can also happen because the irritated bladder contracts on its own, which should resolve once antibiotic therapy has been initiated.”

What causes UTIs?

According to the Urology Society of Australia and New Zealand, urinary tract infections affect 1 in 3 Australian women and 1 in 5 Australian men in their lifetime, with roughly 25% experiencing recurring infections.

The incidence of UTIs in younger males aged 15-50 years is less than 1% and these patients should undergo further assessment to find an underlying cause such as obstruction or stagnant urine.

“Women are more prone to UTIs because their urethra is shorter, which means gut bacteria (from your poo) don’t have far to travel to reach the bladder once they get into the urethra,” she explains. "This is why wiping from front to back is important for reducing the risk of bacteria from poo entering the urethra—it is particularly important to teach this to young children."

"While there are common reasons why UTIs occur, some people are more susceptible than others," says Dr Ooi.

"Some people may get UTIs because their bladder lining doesn’t provide strong enough protection against bacteria or their bladder doesn’t empty properly."

“When you have a condition which means the bladder doesn’t fully empty, wee sits in the bladder for too long, which gives bacteria more time to grow and invade the bladder lining, making infections more severe and sometimes harder to clear,” she says.

Factors that can affect bladder emptying include weak bladder muscle, hidden pockets in the bladder, pelvic organ prolapse, a blockage or something foreign (such as an eroded sling or stones) in the urinary tract or neurological conditions such as multiple sclerosis or spinal cord injuries.

How does gut bacteria enter the female urinary tract?

1. Bacteria from your bowel can enter your bladder through your urethra causing a urinary tract infection (UTI). Wiping from front to back after you have been to the toilet helps prevent bacteria from your poo entering your urethra.

2. Doing a wee flushes any bowel bacteria out of your bladder and urethra. This is why it is important to wee after sexual activity.

3. By staying hydrated and weeing regularly throughout the day, you can help maintain the balance of healthy bacteria in your bladder and reduce the chance of a UTI.

Is it a UTI or chronic incontinence?

“Ideally, a UTI should be confirmed using a urine culture to prove the infection and to determine the type of bacteria present to ensure the correct antibiotic is prescribed — rather than linking bladder irritability, pain and incontinence to a UTI and prescribing unnecessary antibiotics,” says Dr Ooi.

“If the urinary urgency and urge incontinence is truly due to a UTI, it is typically acute and should resolve quickly, within a day or two, once treated with antibiotics,” explains Dr Ooi. “If someone has chronic bladder symptoms and incontinence or if the symptoms persist after treatment, it may indicate a resistant bacteria or another condition entirely, such as bladder cancer, overactive bladder or interstitial cystitis, which is also called painful bladder syndrome.”

It is important to get your symptoms checked

"Preventative measures can be very effective for people who get recurrent UTIs. But if you’ve tried several of these approaches and you’re still getting symptoms, or if your symptoms never fully settle after antibiotics, it may be a sign that the problem isn’t a UTI at all," explains Dr Ooi.

“It’s important to go back to your doctor for further investigation, as ongoing bladder symptoms can be caused by other conditions that need investigation and different treatment.”

Recognising a UTI

Symptoms include:

burning when you wee
frequent weeing
feeling as if you can’t fully empty your bladder.

When to seek help

Some mild, uncomplicated UTIs may resolve on their own within a few days, but this is less likely if you have an underlying condition affecting your bladder or immune system. If your symptoms don't improve within a few days, or you develop back pain, fever, chills or blood in your urine, see a doctor promptly — these can be signs the infection has spread to your kidneys or is developing into sepsis.

Preventing recurring UTIs

"Prevention remains a cornerstone of bladder health," advises Dr Ooi. "If you can stop bacteria entering and settling in, you can prevent it from multiplying and causing symptoms."

These are Dr Ooi’s top prevention tips for people who experience recurrent UTIs. Many of these simple lifestyle changes can be tried before needing specialist care. It is always important to check with your healthcare provider before implementing any changes in your medication, supplements or vitamins as they may interact with other treatments or medication you are taking.

For post-menopausal women: vaginal oestrogen is often recommended. It helps restore the health of vaginal tissues, encouraging the growth of ‘good’ bacteria, which in turn reduces the risk of harmful bacteria taking hold.

Hiprex (methenamine hippurate) is a commonly used option. Taken alongside high-dose vitamin C, it works by making the urine more acidic, which creates an environment where bacteria struggle to survive. Used regularly it can help prevent infections from taking hold. Treatment is usually continued for 6-12 months, and sometimes longer.

Cranberry: in high-dose, concentrated form may also help prevent bacteria from sticking. Make sure to discuss this with your GP or pharmacist as cranberry can interact with prescription medications such as warfarin.

Hydration is important: drinking at least 1.5 litres of water daily helps flush out bacteria before they can settle in.

Change continence pads or wet underwear regularly: cleaning and changing underwear are crucial, because sitting in dirty materials increases bacterial exposure and can trigger a cycle of recurring infection.

Good bathroom and sexual hygiene practices: wiping front to back and urinating after intercourse can reduce bacterial spread.

Underwear choices matter: breathable fabrics lessen moisture, making it harder for bacteria to thrive.

If you need more information about UTIs and incontinence, call the National Continence Helpline for free, confidential advice from a nurse continence specialist. Call 1800 33 00 66, Mon-Fri 8am-8pm AEST/ADST.