CONDITIONS

What Is Urinary Tract Infections (UTI)

A urinary tract infection (UTI) is an infection in any part of your urinary system—your kidneys, ureters, bladder, and urethra. Most infections involve the lower urinary tract — the bladder and the urethra. Your urinary tract is how your body gets rid of things it cannot use in the bloodstream, such as salts, toxins, and excess water. Your kidneys filter out these substances and convert them to urine. The urine travels down to your bladder through a pair of narrow tubes known as ureters. The urine then waits in your bladder until you’re ready to urinate. When you go to the bathroom, the urine leaves your bladder through a tube called the urethra and exits your body through the tip of your penis if you’re male, or just above the vaginal opening if you’re female.

You might think, that handling all that waste material, your urinary tract would be filled with germs—but your body’s natural defenses flush most bacteria out of your urinary tract before they cause any problems. However, there may be times when bacteria, viruses, or fungi can overwhelm your body’s normal defenses and cause a urinary tract infection (UTI).

UTIs can happen to anyone, but they are 4 times more common in women than in men. More than half of all women will have a UTI at some point in their lives. About 1 in 5 women who have UTIs when they are young will go on to have recurrent infections throughout their lives. UTIs in men are less common, but can be harder to treat when they do occur, and often lead to recurrent infections.

Most urinary tract infections occur in the bladder or the urethra. An infection in the bladder is known as cystitis. An infection of the urethra is urethritis. Sometimes a urinary tract infection can travel up the ureters and cause a kidney infection. This is known as pyelonephritis. Pyelonephritis is less common than other urinary tract infections, but it can be much more serious. It’s important to treat a urinary infection before it reaches your kidneys. But pyelonephritis can usually be treated successfully if it’s caught early.

What Causes Urinary Tract Infections (UTI)

Most UTIs are caused by bacteria that live in your bowels. The overwhelming majority of UTIs, especially bladder infections, are caused by Escherichia coli (E. coli). However, UTIs may also be caused by other bacteria, such as Chlamydia or Mycoplasma, or by other types of microbes, such as a virus or a fungus. 

Urethra infections in women can sometimes be caused by a sexually transmitted disease, such as herpes or gonnorhea. But you don’t have to be sexually active to get a UTI.

Risk Factors For Urinary Tract Infections (UTI)

The biggest risk factor for urinary infections is your sex. As we mentioned previously, women are 4 times as likely as men to have urinary infections. Doctors believe this is because a woman’s urethra is shorter, and because the opening of the urethra is close to the vagina and closer to the anus than in men. This proximity increases the risk of exposure to bacteria that are naturally present in the vagina and the digestive tract. These bacteria are usually harmless if they stay where they belong, but they may cause trouble if they get inside your urinary tract.

Risk factors for UTIs in women include:

  • Sexual intercourse. Anyone can get a UTI, but UTIs are more common in women who are sexually active. This is especially true if you use a diaphragm or another type of birth control that relies on a spermicidal gel.
  • Menopause. After menopause, the lack of estrogen can put you at increased risk for a UTI.

Risk factors for UTIs in men include:

  • Previous UTI
  • Blockages in the urinary tract, such as kidney stones or an enlarged prostate

Other risk factors for UTIs include:

  • Urinary tract problems. If you are born with a defective urinary tract, or if your urinary tract is blocked by a kidney stone or an enlarged prostate, then your urinary tract may have more trouble getting rid of things that don’t belong, putting you at increased risk.
  • Certain diseases. Diabetes in particular can put you at increased risk for a UTI. So can a weakened immune system, caused by HIV, AIDS, or treatments you take after an organ transplant.
  • Using a catheter. If you need a catheter to help you urinate, that can give bacteria another way in and put you at risk for a UTI.
  • Having had UTIs, especially recurrent UTIs, in the past.

Some people are more likely to have repeat UTIs after their first one. Many of the risk factors for a first UTI are also risk factors for recurrent UTIs. In addition, a first UTI is more likely to lead to recurrent UTIs in men, or in women who had their first UTI during early adulthood.

Diagnosing Urinary Tract Infections (UTI)

When you visit your doctor for a UTI, your doctor will ask about your symptoms and your personal and medical history. Your doctor will also will also ask for a urine sample to check for anything unusual in your urine, such as red or white blood cells, or bacteria. If they find bacteria, they may let the bacteria grow in a controlled environment in a lab for a few days so that the bacteria will be easier to recognize under a microscope. This is called a culture, and it helps the lab know what kind of bacteria are causing your infection, so that your doctor can prescribe the best treatment. 

If you have repeat or recurrent infections, your doctor may perform other tests on your urinary tract, such as: 

  • Imaging tests, such as computed tomography (CT) or ultrasound or, to make a picture of your urinary tract and look for blockages or other structural problems that might be causing your problems.
  • A cystoscopy, which involves using a long, narrow scope to look inside your urethra and your bladder.
  • Urodynamic testing, to see how well your urinary tract works—such as how well your bladder holds urine and how thoroughly it empties when you urinate. Urodynamic testing is usually done by a urologist, who is a doctor who specializes in conditions that affect the urinary tract.

Symptoms of Urinary Tract Infections (UTI)

Symptoms depend on the type of urinary tract infection. Specifically:

  • A urethra infection may cause a burning sensation when you urinate.
  • A bladder infection may cause you to feel pressure in your pelvis or discomfort in your lower abdomen. You may have to urinate often, or you may feel like you have to urinate but nothing comes out. Urinating may be painful, or your urine may be cloudy, dark, or foul-smelling, and it may contain blood.
  • A kidney infection may cause nausea, vomiting, chills, and high fever. You may also feel a pain in your side or your back, below your ribs.

If you use a catheter, a fever may sometimes be the first noticeable symptom of a UTI.

Prognosis

Most UTIs are not serious, if they are found and treated early. However, UTIs can be more serious if they happen frequently, or if they spread to the kidneys. If you suffer from frequent UTIs or recurrent kidney infections, you may need to see a urologist. Recurrent kidney infections can lead to permanent damage or scarring in your kidneys, which may lead to: 

  • Chronic kidney disease
  • High blood pressure
  • Kidney failure

If you’re pregnant, a UTI can be a serious problem. UTIs in pregnant women are more likely to reach the kidneys. A UTI can also lead to complications in your pregnancy, including an early birth or a child with a low birth weight.

A UTI that develops suddenly without warning can be very serious, or even life-threatening, especially if the infection gets into your bloodstream.

UTIs in men are often symptoms of another illness. In particular, acute bacterial prostatitis may be life-threatening if it isn’t treated.

Living With Urinary Tract Infections (UTI)

Because untreated UTI can cause serious complications, it’s important to get a UTI treated by a doctor. But while you are waiting for the treatment to work, there are steps you can take to help yourself feel more comfortable. These include:

  • Drink plenty of water to dilute your urine and help flush the infection out.
  • Avoid caffeine, alcohol, and citrus juices, as they may irritate your bladder.
  • Use a warm (not hot) heating pad on your abdomen to relieve bladder pressure or discomfort.

Screening

Because of the increased risk of bladder infections and premature birth, doctors often screen pregnant women for UTIs during the first trimester. Some doctors also screen patients with diabetes for UTIs. There are no guidelines for UTI screening in healthy people. 

Screening tests for UTIs include:

  • Urine dip, in which a dipstick coated with chemicals is dipped into a urine sample to check for blood, pus, bacteria, or other substances that don’t belong in the urine.
  • Microscopic urinalysis, in which the urine is examined under a microscope.

These tests are often performed for other reasons, and may discover a UTI while looking for a different problem, or as part of routine care.

Prevention

Drinking plenty of fluids can help reduce your risk of UTIs. Water is often best, though cranberry juice may also be especially helpful. The more you drink, the more regularly you urinate, which can help flush out harmful bacteria from your urinary tract.

Specific advice that can help prevent UTIs in women include:

  • Always wipe from front to back when you use the toilet. Wiping from back to front, especially after a bowel movement, may bring bacteria from your backside that doesn’t belong anywhere near your urinary tract.
  • Go to the bathroom shortly after you have sex. It also helps to drink a glass of water as well.
  • If you use a spermicidal gel, you may want to switch to a different type of birth control.
  • Avoid products that may irritate your urethra, such as douches and deodorant sprays.

Common Treatment

The usual treatment for a UTI is antibiotics. Which antibiotic you take and how long you take it will depend: 

  • Your overall health
  • The severity of the infection
  • The type of bacteria that caused your infection
  • Whether you’ve had other UTIs in the past
  • Whether you’re pregnant

For a simple UTI if you’re mostly healthy, your doctor may only recommend a 1- to 3-day course of treatment. But if there are complications, the antibiotics may be for two weeks or longer. Antibiotics used to treat UTIs include:

  • Sulfamethoxazole-trimethoprom (Bactrim, Septra)
  • Amoxicillin (Amoxil, Augmentin)
  • Nitrofurantoin (Furadantin, Macrodantin)
  • Ampicillin
  • Ciprofloxacin (Cipro)
  • Levofloxacin (Levaquin)

Your doctor may also prescribe a pain medication to numb your bladder until the infection clears up, so that it won’t hurt when you urinate.

If you get a lot of UTIs, your doctor may prescribe additional treatments, such as long-term antibiotic treatment for 6 months or longer, self-screening with a home urine test, or taking a short course of antibiotics whenever you have symptoms. If your UTIs happen after sex, your doctor may prescribe an antibiotic to take one dose every time you have sex. If you’ve been through menopause, topical estrogen taken inside your vagina may help. 

Severe UTIs may need to be treated in a hospital with intravenous antibiotics. 

For urinary infections in men, doctors may look for an underlying cause, such as a kidney stone or an enlarged prostate, and treat that first.

Complementary and Alternative Treatment

Cranberry juice is the most commonly cited non-medical treatment for UTIs and there is scientific evidence to back this up. Drinking 100% unsweetened cranberry juice is best. Scientists presented a definitive report in 2010 at the American Chemical Society in Boston that within eight hours of drinking cranberry juice, the juice could help prevent bacteria from developing into an infection in the urinary tract. Researchers believe that cranberries contain substances that prevent infection-causing bacteria from adhering to the wall of the urinary tract—which helps protect an infection from taking hold. However, these studies suffer from a number of limitations—they have used a wide variety of cranberry products, from cranberry juice concentrate, cranberry juice cocktail, to cranberry capsules, and have used different dosing regimens. Further research is required to clarify unanswered questions and provide more definitive answers about specific benefits. What is understood is that cranberry juice and extract can be especially beneficial for women who have frequent UTIs. However, be sure to see a doctor if symptoms persist.  Avoid cranberry juice if you take anticoagulants (blood thinners) such as warfarin, since cranberry juice may increase your risk of bleeding. 

Other alternative treatments that are sometimes used for UTIs include: 

  • D-mannose, a sugar found in cranberries, blueberries, apples, and even birch trees. Some people believe that d-mannose can attract E. coli bacteria and flush it out of your system.
  • Probiotics to support vaginal health in women, and digestive health in men and women.
  • Vitamin C from supplements or from fruits and vegetables, particularly citrus fruits
  • Apple cider vinegar
  • Cod liver oil, or other sources of vitamins A and D
  • Homeopathic remedies, such as cantharis, berberis, sarsaparilla, staphysagria, and pulsatilla
  • Baking soda to make your urine less acidic so that it doesn’t burn when you urinate

Always talk to your doctor about any medicines you take, including complementary and alternative medicines, as they may have side effects or cause drug interactions with other medicines you take.

Care Guide

While you are waiting for the antibiotics to work, there are steps you can take to help yourself feel more comfortable. Specifically:

  • Drink plenty of water
  • Avoid caffeine, alcohol, and citrus juices
  • Use a warm (not hot)
  • Wear cotton underwear and loose-fitting pants or skirts

Drinking plenty of water, cranberry juice, and other fluids can also help prevent recurrent UTIs.

Specific advice that can help prevent UTIs in women include:

  • Always wipe from front to back when you use the toilet
  • Go to the bathroom shortly after you have sex
  • If you use a spermicidal gel, try a different birth control
  • Avoid douches and other products that may irritate your urethra

When To Contact A Doctor

Call your doctor if you have signs or symptoms of a UTI, including: 

  • Pain or a burning sensation when you urinate.
  • Pressure in your pelvis
  • Discomfort in your lower abdomen
  • Frequent urination, or feeling like you have to urinate but can’t
  • Cloudy, dark, or foul-smelling urine
  • Blood in your urine

Call your doctor right away if these symptoms start suddenly and worsen quickly, or if you have signs of a kidney infection, such as: 

  • Nausea and vomiting
  • Chills
  • High fever
  • Pain in your side or your back, below your ribs

Questions For Your Doctor

Your primary care doctor can treat most simple UTIs. If you are pregnant, you may prefer to be treated by your obstetrician. If you have a severe or recurrent UTI, you may need to see a urologist. Your primary doctor can refer you to a urologist, or you can use an online directory to find one; the Urology Care Foundation provides a searchable database.

 

Questions For A Doctor

When you go to see your doctor, it’s good to have a list of the questions you’d like to have answered. Take a moment to write down some of the things you want to know. Your questions for your doctor might include some of these:

  • What tests do I need?
  • What treatment do you recommend?
  • What should I do if this infection comes back?
  • Are there symptoms I can watch for?
  • Do you have any advice to prevent a future infection?
  • Is there anything else I should know about urinary tract infections?

Resources

Other useful resources to help you learn about UTIs and take charge of your treatment can be found at:

National Kidney and Urologic Disease Information Clearinghouse—provides information on topics related to kidney and urinary tract disease, organized A to Z

National Institute of Diabetes and Digestive and Kidney Diseases

The Urology Care Foundation

To find a Urologist:

The Urology Care Foundation provides a searchable database.

You can also find a searchable state-by-state directory.

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