What Is a Urinary Tract Infection (UTI)?
A urinary tract infection occurs when bacteria enters the urethra – the outside point of the urinary tract, where urine comes out of the body. This bacteria can infect, irritate, and inflame the tissues of the urinary tract, spreading up the urethra to the bladder, ureters (tubes that connect the bladder to the kidneys), and even the kidneys themselves.
Mild inflammation of the urethra, sometimes called cystitis, is common, and can sometimes be managed with simple treatment or a short course of antibiotics at home. Left untreated, a urinary tract infection can become very severe.
The first symptoms of a UTI include:
- Pain, especially a burning sensation of the urinary tract when passing urine.
- Urinary frequency: needing to go to the toilet more often than usual, sometimes feeling the urge to go even straight after emptying the bladder.
- Urinary urgency: a sudden strong urge to go the toilet, rather than a gradual awareness of a full bladder.
- Incontinence: sometimes the combination of urinary frequency and urgency means that it’s harder for some of us to get to the toilet on time.
- Unusually smelly or cloudy urine.
A more severe UTI might show some symptoms like:
- Blood in the urine.
- Lower back or abdominal (tummy) pain.
- Feeling generally unwell with flu-like symptoms; sweating, fever, shaking, aches and pains.
Although infections often cause a fever – a high temperature usually over 38°c – sometimes a low body temperature, under 36°c, can indicate that someone is becoming very unwell.
Some people, particularly older adults or those with some degree of cognitive impairment, become very confused and may have changes in their mood and behaviour when they have an infection.
UTIs in Men
Urinary tract infections are less common in men – with longer urethras and the urinary opening (urethral meatus) further from the bottom (anus) than in women, the risk of transferring gut bacteria into the urinary system is lower.
UTIs are uncommon in young men, but become more common with age. One of the reasons older men may suffer UTIs is that benign enlargement of the prostate gland, common in older men, can prevent the bladder from fully emptying, allowing any bacteria present to remain and spread.
Men who have unprotected anal sex are more likely to develop UTIs, as the urinary tract is more likely to be exposed to gut bacteria.
UTIs in Women
UTIs are more common in women than men – female anatomy means that it isn’t too far for bacteria from our bowels to travel to the urinary passage (urethra). That’s why it’s so important to wipe from front to back after using the toilet.
Having sex can also move bacteria around the genitals, and some women find they’re particularly prone to UTIs when they’re more sexually active – this does not mean they have a sexually transmitted disease, just that sexual movement and positions have made it easy for bacteria to travel along the vulva (external female genitals) and enter the urethra. Making sure that genitals are clean before and after having sex, and going to the toilet to pass urine immediately after sex can help avoid or flush away troublesome germs.
UTI in Children, Babies & Toddlers
Urinary tract infections are not uncommon in childhood – they are the cause of around 7% of childhood fevers. Babies are most at risk, but the risk can be reduced by changing nappies straight away when they become soiled, and making sure the baby’s bottom and genitals are very clean. Getting a urine sample from a small child can be difficult, but special sterile pads are available to help get samples from children in nappies.
Children who are not able to describe their symptoms in words may appear to be in pain when passing urine, may be unwell, unusually irritable or lethargic, and have a fever, sometimes with shivering (rigours). Frequency, urgency, and unusual bed wetting or other accidents where the child cannot get to the toilet on time can happen when a child has a UTI. Their urine may also be smelly, cloudy, or even contain blood.
Children can become very unwell very quickly with UTIs, so urinary tract infection symptoms in children should always be assessed by a doctor. If the symptoms are severe, help should be sought urgently. Most cases clear up quickly and easily with early treatment.
Causes of Urinary Tract Infection
A healthy gut contains a wide array of bacteria which live within the bowel without any issues; some of them are even essential to a healthy bowel and body. Some of these bacteria can, however, cause problems when they are introduced to other parts of body – germs from faeces can spread easily on unwashed hands, shared bathroom facilities, and even on clothes. Urinary tract infections are almost always caused when some of the natural gut bacteria enters the urethra and spreads up towards the bladder, ureters and kidneys.
Escherichia coli (E.coli) bacteria, naturally present in the bowel, are the most common cause of UTIs.
People who have more than three urinary tract infections in a year are considered to have ‘recurring’ or ‘recurrent’ UTIs. This might trigger some input and investigations from a GP – from simple hygiene management advice to medical imaging of the kidneys and urinary system to look for any underlying causes or complications. A long-term course of low-dose antibiotics may be used to prevent recurrent infections.
Diagnosing Urinary Tract Infections
A urine sample should be sent which will be examined in a lab for infection markers like white blood cells, blood or protein in the urine. A urine sample will also be tested for ‘culture and sensitivity’; this is where bacteria in the sample are cultivated in the laboratory to help identify which antibiotics are most effective against the particular cause of the infection.
Potential Complications of a UTI
Although most urinary tract infections are easily treated, sometimes they can progress and cause serious complications.
A simple urinary tract infection can progress to the kidneys and cause a serious infection called pyelonephritis, which can become very serious and be harder to treat. Pyelonephritis can cause abscesses within the kidneys, impaired kidney function, and lead to sepsis.
Long-term kidney damage
untreated or recurrent UTIs and pyelonephritis can cause scarring and long-term damage to the kidneys if left untreated. Damaged kidneys can contribute to other serious health problems, including hypertension, heart disease, and serious imbalances in blood chemistry.
When an infection causes a systemic or whole body reaction, it is referred to as sepsis. Sepsis is a life-threatening medical emergency and should be treated immediately. Sepsis usually requires hospitalisation with intravenous fluids, antibiotics, blood tests, and careful observation and management.
Complications in pregnancy
Untreated UTIs in pregnancy can cause significant complications, including premature labour and low birthweight.
having cognitive and behavioural changes associated with an infection, particularly a urinary tract infection, is common in frail and elderly people, especially those with certain other comorbidities. Confusion and infection-related delirium can make people less able to look after themselves, and increase their risk of complications from falls or difficulty in following treatment.
The people most at risk of complications from UTIs include:
- People with suppressed immune systems, for example those on certain chemotherapy or immunosuppressant medications
- Older adults
- People with serious comorbidities (other illnesses) like diabetes or heart failure
- Pregnant women
- People with urinary catheters
People who are unable or unwilling to seek treatment until a UTI becomes very serious are also more likely to have severe or complicated infections.
How to Prevent Urinary Tract Infections
Knowing what makes us at risk of UTIs can help us prevent them. Some simple ways to reduce our risk of developing UTIs include:
- Wiping from front to back after using the toilet or when drying after a bath or shower – this helps reduce the amount of bacteria being swept from the bottom to the urethra.
- Washing before and after sex.
- Peeing straight after sex.
- Avoiding strong scented soaps and bubble baths that might irritate the delicate tissues around the genitals.
- Wearing ‘breathable’ cotton underwear, rather than nylon or polyester which can hold moisture against the skin.
- Avoiding irritants like some spermicidal condoms or lubricants.
- Changing soiled nappies or incontinence pads as soon as possible.
- Drinking plenty of water and making sure you’re peeing good amounts regularly through the day. Allowing the bladder to fully fill and fully empty is good for continence and for flushing bacteria out of the system.
- Good catheter care: people who have a urinary catheter, either a long-term indwelling urethral or suprapubic catheter, or who perform intermittent self-catheterisation for urinary retention or other problems, are usually more at risk of UTIs. Bacteria can colonise the shaft of the catheter and enter the urethra easily. Good catheter care and hygiene can help reduce this risk, and having carers with experience in catheter hygiene can be helpful for people who cannot always manage their own catheter.
The treatment for a UTI can differ depending on the severity of the symptoms, the spread of the infection, and the type of bacteria causing the infection. Sometimes, treatment has to be tailored according to the patient’s wishes and needs, including allergies, other medications, and general health.
People who cannot easily access a pharmacy can use a medication delivery service for their prescriptions. All treatments should go alongside simple hygiene practices and general health advice for avoiding UTIs.
Home Remedies for UTI
There are some simple home remedies that can be used for preventing UTIs, treating mild UTIs, or managing symptoms. It’s always worth remembering that the clinical evidence base for home remedies can be variable, so it’s important to get professional help for UTIs that don’t clear up quickly. Children or people at risk of serious complications from infection should always seek medical advice as a priority.
D-Mannose is a type of sugar available as a supplement, which has had some good results in clinical trials showing that it can be effective in reducing recurrence of UTIs in people prone to them. D-mannose is not recommended in pregnancy.
Cranberry juice has been used to help prevent UTIs for many years, and there are some active ingredients in cranberries which do seem to inhibit bacterial growth in the urinary tract. It’s important to get unsweetened cranberry juice, as there are a range of cranberry juice drinks available which contain very little actual cranberry juice and a lot of sugar and sweeteners. Some studies have cast doubt on the efficacy of cranberry juice, so it’s best not to rely on this method.
Apple Cider Vinegar
Apple cider vinegar has been touted as a remedy for a wide variety of health problems. Some studies have shown that apple cider vinegar does, in laboratory conditions, inhibit the growth of some of the bacteria that commonly cause UTIs. There is not, however, a lot of clinical evidence to show that it works in UTIs in people. Apple cider vinegar, taken orally at manufacturer-recommended doses, is not harmful, but it should not be used as an alternative to medical treatment.
Like apple cider vinegar, adding lemon juice to your daily diet may have some health benefits, but there is not enough clinical evidence to recommend this as an alternative to medical treatment when needed. Lemon juice as a management option for kidney stones is undergoing further research.
Medicine for Urinary Trace Infections
Antibiotics are very commonly given for UTIs – usually a short (3-7 days) course of an oral antibiotic works for mild to moderate infections. Some antibiotics commonly given for UTIs include ciprofloxacin, fosfomycin, cefalexin, nitrofurantoin, and trimethoprim. The right antibiotics depend on the specific bacteria that are causing the infection, and antibiotic guidelines change according to ongoing medical research and best evidence.
More serious UTIs, especially where the kidneys are involved or where someone is rapidly becoming more unwell may need intravenous antibiotics. This usually means admission to hospital for monitoring and treatment.
Mist Pot CIT
Mist Potassium Citrate – ‘Mist Pot CIT’ is an old treatment to relieve the symptoms of a UTI. It reduces the acidity of the urine, which helps alleviate some of the burning sensation of peeing when you have a UTI. It does not treat the UTI, only the symptom.
Should I See a Doctor for a UTI?
Some mild cystitis – stinging when you pee that doesn’t last more than two days and doesn’t have any other symptoms might be manageable at home, just by staying drinking plenty of water and following basic hygiene, hydration and health advice. Some people – people with serious underlying health conditions, frail elderly adults, young children or those who take medications which can affect the immune system – should have a low threshold for visiting a doctor for any condition, and seek medical advice quickly.
A doctor may be able to assess and begin treatment for UTI symptoms online or by telephone, or can use this service to triage and recommend further investigations like urine samples, or face-to-face assessment. People with recurrent UTIs or who are prone to becoming particularly unwell when they develop infections should see their doctor.
UTIs in Pregnancy
Pregnancy can increase the likelihood of developing a UTI – an altered immune system response during pregnancy and the physical changes and pressure on the urinary system from the growing uterus and fetus make UTIs more common during pregnancy. Pregnancy hormones also encourage relaxation of some of the muscles that control urination, so the risk of UTIs in pregnancy is relatively high.
Urinary tract infections in pregnancy are fairly common, and usually easily treated. However, they can lead an to infection in one or both kidneys, called pyelonephritis, which can become very serious and cause complications in pregnancy if left untreated. UTI symptoms in pregnancy should always be assessed by a medical professional and early treatment is key to avoiding risks.
Having Sex When You (or Your Partner) Have a UTI
A UTI is not a sexually transmitted disease – it is usually caused by bacteria that live naturally in the gut, which only causes problems when it moves to the urinary tract. Although it is not a sexual transmitted infection, sexual activity – repeated movements around the genitals, can cause infections or can exacerbate an existing UTI. Having a UTI can also make you feel unwell and uncomfortable, so avoiding sex until after the infection settles down is advisable.
UTI symptoms can sometimes be related to other infections that can be sexually transmitted, so practicing safe sex and having regular check-ups, especially if you change partners, is important.
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