■ A relatively short urethra. The position of the urethra makes it subject to fecal contamination and colonization with potentially pathogenic intestinal bacteria that have only a few centimeters to traverse to the bladder.
■ Sexual intercourse. About one-third of urinary tract infections in sexually active women are associated with sexual intercourse. Bladder infections in women often occur from the massaging effect of sexual intercourse on the urethra, which introduces bacteria from the urethra into the urinary bladder. Many women develop their first bladder infections following their first sexual intercourse, a condition referred to as "honeymoon cystitis."
■ Use of a diaphram for contraception. The ring of the diaphragm compresses the urethra and impedes the flow of urine, increasing by two to three times the risk of urinary infection.
Urinary infections are unusual in men until about age 50, when enlargement of the prostate gland compresses the urethra and makes it difficult to completely empty the bladder.
Medical conditions may require insertion of a bladder catheter for periods ranging from several days to months. Bacteria can reach the bladder and establish urinary tract infections both via the catheter lumen and the mucus between the wall of the catheter and the urethra. Pathogens establish a biofilm on the catheter, making it difficult or impossible to kill them with antibacterial medications. The risk of infection increases about 5% each day the catheter remains in place. Paraplegics, individuals with paralysis of the lower half of the body, are almost always afflicted with urinary infections. Since they lack bladder control, paraplegics are unable to void normally and require a catheter indefinitely to carry urine to a container. In the United States, about 500,000 hospitalized patients develop bladder infections each year, mostly after catheterization.
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