Urinary Tract Infections

A urinary tract infection (UTI) is an infection that you can get anywhere in your urinary system. UTIs can strike your bladder, urethra (the tube where urine leaves your body), prostate (in men), ureters (the tubes that connect your kidneys to your bladder) and kidneys. They are more likely to affect women, but anyone can get them.

If you have a UTI, you might notice:

• A strong, persistent urge to urinate (pee)
• Frequently urinating small amounts
• Feeling the need to urinate when your bladder is empty
• Pain or burning when you urinate
• Cloudy urine
• Bloody urine, which can look red, pink or brown
• Urine that has a strong smell
• Lower abdominal or pelvic pain/discomfort
• A feeling of pressure in your pelvis

In some cases, you could experience fatigue, fever, chills, pain in your lower back or the side of your back, nausea or vomiting, but these symptoms are more likely a sign of a kidney infection.

Symptoms of UTIs aren’t the same for everyone, and not everyone will have all of these symptoms.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), bladder infections (cystitis) are the most common type of UTI. Kidney infections (pyelonephritis) and prostate infections aren’t as likely, but they are more serious.

UTI causes and risk factors

Normally, your kidneys make urine when they filter your blood. Your urine contains waste products and extra water, which moves through your urinary tract and out of your body when you urinate. Usually, this process works smoothly and stays free of infection, but a range of different factors can influence your risk of getting a UTI:

• Bacteria: Most of the time, you get a UTI when bacteria enter the urinary tract. It’s usually Escherichia coli (E. coli), which is found in your digestive system. Bacteria can spread from your rectum to your urethra and cause an infection there. Or it can travel from the urethra into your bladder and the rest of the urinary system. Sometimes, bacteria from your hands or skin can cause UTIs.
• Sexual activity: During sex, bacteria from the genital area can enter the urethra and the urinary tract. Getting UTIs from sex is common in women.
• Urinary tract abnormalities: If you have structural abnormalities or blockages such as kidney stones, urine can’t flow properly. When urine is blocked and doesn’t leave your body as it should, bacteria are more likely to grow.
• A weakened immune system: Certain medical conditions such as diabetes or HIV/AIDS or taking immunosuppressive medications can make you more likely to get UTIs. That’s because your immune system plays an important role in fighting off infections in your body.
• Hormonal changes: The hormonal fluctuations you experience during pregnancy or menopause can change your urinary tract, making it more susceptible to bacterial overgrowth and infection.
• Age: Older adults and young children are at higher risk.
• Poor hygiene practices: Wiping from back to front after you use the toilet can bring bacteria from the anal area to your urethra. Young children who are toilet training and people with conditions like Alzheimer’s disease and dementia may get UTIs due to poor hygiene.
• Not emptying your bladder completely: Leaving urine in your bladder can increase your risk of UTIs.
• Using a catheter: Having a catheter increases your risk of UTIs. That’s because catheters can introduce bacteria into the urinary tract and provide an environment where they may grow.
• Post-menopausal changes: After menopause, hormonal changes make your vaginal walls thinner and decrease your levels of natural protective bacteria.
• A history of UTIs: People who have had UTIs in the past are at higher risk of having them again.
• Anatomy: In people with vaginas, the urethra and the anus are closer together than they are for people with penises, and the opening of the urethra is close to the bladder. That makes it easier for bacteria from the bowel to reach the urinary tract. Therefore, about 20% of women will have at least one UTI in their lifetime.
• Birth control methods: Using spermicides can change the bacteria that live in your vagina and make UTIs more likely. Using a diaphragm or an unlubricated condom can also increase your risk.
• Sexually transmitted infections (STIs): The germs that cause herpes, gonorrhea, chlamydia and mycoplasma can also infect the urethra.
• Urinary procedures: If you’ve recently had a urinary tract exam or surgery, your risk of having a UTI is higher.
• Genetic or familial risk: Certain genetic traits have been shown to make some people’s urinary tract cells more susceptible to infection, so increased risk for UTI’s may run in some families.

How UTIs are diagnosed

If you think you might have a UTI, you’ll want to call  a health care provider. Your provider can offer personalized advice and treatment based on your symptoms and medical history. Getting diagnosed and treated quickly can help you get better faster and reduce your risk of problems.

Your provider will likely take these steps to diagnose a urinary tract infection:

• Medical history review: Your provider will ask you about symptoms such as how often you are urinating, whether you feel urgency to urinate, if you have pain or discomfort during urination and if you have any signs of infection like fever or chills. They may also ask you about previous UTIs or other medical conditions.
• Physical exam: They may check for signs of infection and any tenderness or pain in the lower abdomen, back or pelvic region. They may also check your genitals.
• Urinalysis: You will probably be asked to provide a urine sample for testing. At the lab, they will check your urine for bacteria, white blood cells (which are signs of an immune system response), red blood cells and abnormalities. They may also figure out the specific bacteria causing the infection. This is called a urine culture, and it can help your provider choose the best antibiotic for treatment.
• Cystoscopy: If you have UTIs often, your doctor may want to look inside your urethra and bladder with a tiny camera called a cystoscope.
• Additional tests: In some cases, further tests may be needed to figure out what’s causing your UTIs. For example, imaging tests such as an MRI, ultrasound or CT scan can check the urinary tract for abnormalities or blockages (like kidney stones). You may also need extra evaluation if the infection has spread to your kidneys or other parts of your urinary tract.

Symptoms of a UTI always need to be checked by a health care provider, but it’s especially important to seek care and treatment for:

• Fever associated with UTI symptoms
• Severe or worsening symptoms
• Recurring UTIs or symptoms that don’t improve with antibiotic treatment
• Symptoms in children, pregnant women or adults over age 65
• Underlying health conditions that could be a factor

How UTIs are treated

Sometimes UTIs go away on their own, but since they are almost always caused by bacteria, you’ll usually need antibiotics to treat them. Rarely, viruses or fungi can cause UTIs. If you have this type of UTI, your doctor may prescribe antiviral or antifungal medications.

To choose an antibiotic, your doctor will consider how severe the infection is, your medical history and any antibiotic allergies or intolerances. They will also want to consider antibiotic resistance (when certain bacteria strains no longer respond to certain antibiotics).

Doctors often prescribe these antibiotics for UTIs:

• Trimethoprim-sulfamethoxazole (Bactrim, Bactrim DS)
• Nitrofurantoin (Macrodantin, Macrobid, Furadantin)
• Fosfomycin (Monurol)
• Cephalexin
• Ceftriaxone  (IV antibiotic, not usually part of outpatient treatment)

Your doctor might prescribe fluoroquinolones such as ciprofloxacin (Cipro) or levofloxacin for a kidney infection or a complex UTI. They aren’t usually prescribed for simple UTIs.

You’ll probably feel better within a few days, but taking antibiotics as directed and finishing the entire prescription is important, even if your symptoms improve. Otherwise, the infection can return.

Along with antibiotics, these steps can help:

• Pain relievers: Over-the-counter (OTC) pain relievers such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) can help reduce pain, fever and symptoms until the antibiotics take effect. Be sure to check with your provider before taking any medication. You may also want to put a warm heating pad on your abdomen for pain relief.
• Drink more fluids: Drinking plenty of water and other fluids can help flush bacteria out of your urinary tract so you can heal. Water is the best choice, but you can also drink non-caffeinated fluids such as herbal tea or unsweetened 100% cranberry juice (not cranberry juice cocktail, which contains sugar). Cranberry juice has been shown to help decrease the risk of developing a urinary tract infection, but it isn’t a substitute for antibiotics and you shouldn’t rely on it for treatment if you are having symptoms. Don’t drink alcohol, citrus juices or caffeinated drinks, until you recover. They can irritate your bladder.
• Urinary pain relievers: In some cases, your provider may recommend or prescribe urinary pain relievers (analgesics), such as AZO or Pyridium, to help with the discomfort or burning sensation you may feel during urination. These medications provide relief while the antibiotics work to eliminate the infection, but they only relieve symptoms. They are not a substitute for antibiotics.
• Follow-up tests: After you finish taking your antibiotics, your provider may want to see you to make sure that the infection was successfully treated. They will most likely test another urine sample to make sure the bacteria that caused your UTI is gone.

UTIs are very common. If you’ve had one before, you may recognize the symptoms. But it’s not a good idea to diagnose and treat yourself. It's important to check with your health care provider for advice and treatment based on your overall health and your specific infection.

If you get frequent UTIs, your provider might recommend:

• Low-dose antibiotics that you take for a long time
• A single dose of an antibiotic after you have sex
• Antibiotics you take at the first sign of an infection
• Vaginal estrogen therapy, if you’re post-menopausal

Untreated or frequent UTIs can cause complications such as kidney infections or an infection that spreads to the bloodstream. Young children, people with diabetes, people with weakened immune systems or people who get UTIs frequently should seek care quickly. They may need specialized testing because of their higher risk of complications.

More serious UTIs might need intravenous (IV) antibiotic treatment in a hospital. Getting treatment for a UTI if you’re pregnant is very important, since you’re at higher risk of delivering a low birth weight or premature baby.

Tips for preventing UTIs

You can’t totally avoid UTIs. But you can take these steps to make it less likely you’ll be infected:

• Stay hydrated and drink plenty of water. Urinating helps flush bacteria out of the urinary tract.
• Wipe from front to back after using the toilet to keep germs from the anus away from the urethra.
• Urinate before and after sexual activity. If you can’t urinate, wash the genital area with warm water.
• Urinate as soon as you need to. Don’t hold your urine for a long time.
• Take showers rather than baths.
• Wear loose-fitting clothing and cotton underwear.
• Don’t use feminine hygiene products such as douches, sprays or powders. They can disrupt the natural balance of the urinary tract.
• When you have your period, change pads and tampons frequently.
• Consider taking probiotics or cranberry products such as 100% unsweetened cranberry juice or supplements. They may help protect against UTIs. Your health care provider can tell you about the pros and cons of supplements.

If you’re taking these steps and you’re still getting UTIs frequently, call your provider. There might be underlying causes or risk factors that are causing your infections.

UTIs can be uncomfortable or even painful, but they usually respond to treatment and clear up quickly. By taking steps to prevent UTIs, you can minimize your odds of getting them. However, if you notice any symptoms, call your provider so you can get treatment started right away.