Overview
A urinary tract infection (UTI) is a bacterial infection that develops in any part of the urinary tract (kidneys, ureters, bladder, urethra). It is much more common in women than men; about half of women experience at least one UTI in their lifetime.
Most infections occur in the bladder (cystitis) and urethra. Infections involving the upper urinary tract (kidneys - pyelonephritis) are more serious and require urgent treatment.
Symptoms
Lower urinary tract infection (cystitis/urethritis):
- Frequent or urgent need to urinate
- Burning, pain when urinating (dysuria)
- Passing small amounts of urine
- Foul-smelling urine
- Cloudy or pink-red (bloody) urine
- Lower abdominal pain, pressure
- Waking at night to urinate
- Feeling of incomplete emptying
Upper urinary tract infection (pyelonephritis/kidney infection):
- High fever, chills
- Flank and back pain
- Nausea, vomiting
- Weakness
- Cystitis symptoms also present
Different symptoms in the elderly and children:
- Confusion, agitation (in the elderly)
- Loss of appetite, incontinence
- Fever, refusal to feed, irritability in infants
Causes
The most common cause is Escherichia coli (E. coli) bacteria (80-90%). Other bacteria: Klebsiella, Proteus, Enterococci.
Bacteria usually:
- Reach the urinary tract by traveling up through the urethra from the bowel
- Can spread after sexual intercourse
- Can be introduced via catheters
Risk Factors
In women:
- Anatomy (short urethra)
- Sexual activity
- Some birth control methods (diaphragm, spermicides)
- Menopause (decreased estrogen)
- Pregnancy
General:
- Conditions blocking urine flow (stones, enlarged prostate)
- Bladder dysfunction
- Use of catheters
- Diabetes
- Weakened immune system
- History of recurrent infections
- Inadequate water intake
- Holding urine for long periods
- Hygiene habits
Complications
- Recurrent infections
- Kidney infection (pyelonephritis)
- Kidney damage, permanent kidney failure
- Sepsis (life-threatening)
- Preterm birth and low birth weight during pregnancy
- Urethral strictures in men
When to See a Doctor
- If you have UTI symptoms
- If symptoms last more than 2 days
- Fever, flank pain, vomiting and other serious symptoms
- Blood in urine
- Any urinary complaint during pregnancy
- Urinary complaint in a male patient (always take seriously)
- Suspected UTI in a child
- Frequently recurring UTIs (more than 3 per year)
Diagnosis and Treatment
Diagnosis:
- Urinalysis (leukocytes, nitrites, bacteria)
- Urine culture (definitive diagnosis + antibiotic sensitivity)
- Blood tests (in upper tract infection)
- Imaging: Ultrasound, CT (in complicated cases)
- Cystoscopy (in recurrent cases)
Treatment:
- Simple cystitis: 3-7 day antibiotic course (trimethoprim-sulfamethoxazole, nitrofurantoin, fosfomycin, ciprofloxacin)
- Pyelonephritis: 7-14 day antibiotic course (intravenous in hospital if needed)
- Plenty of fluids
- Pain relievers (phenazopyridine if needed)
- In pregnancy: Safe antibiotics (amoxicillin, cefuroxime)
- In recurrent cases: Long-term low-dose antibiotic prophylaxis
Prevention
- Drink 2-2.5 liters of water per day
- Do not hold your urine; urinate frequently
- Wipe from front to back after the toilet (for women)
- Urinate after intercourse
- Prefer cotton underwear
- Avoid heavily perfumed hygiene products
- Prevent constipation
- Avoid tight pants
- D-mannose, cranberry juice may help
- Topical estrogen cream after menopause
- Discuss your birth control method with your doctor