Urinary Tract Infection – UTI

The urinary system is the body’s main way to remove waste and extra water.   It normally includes:

• Two kidneys to filter blood,
• Two ureters: tubes that transport urine from the kidneys to the bladder,
• One bladder to hold the urine, and
• One urethra to carry urine from the bladder out of the body.

Urinary tract infections (UTIs) occur when you get an infection within this system, called a urinary tract. Most UTIs occur in the lower urinary tract, when bacteria get into your urethra and travel up to your bladder. These bacteria can irritate the lining of your bladder and urethra.

UTIs are the second most common type of infection in the U.S. and account for more than 8 million doctor visits each year. You can get a UTI at any age, but they are more common at some ages than others.  About 10 in 25 women and 3 in 25 men will have symptoms of a UTI during their lifetime. Even though men are generally less likely to get a UTI compared to women, they are more likely to get another one because bacteria can hide inside a man’s prostate. Most UTIs are not serious, but some can lead to serious problems like kidney infections.

About 2.5% of all children will get a UTI, which is most common in children younger than 5 years old. Girls and women are most likely to get a UTI during puberty, as well as after menopause. Women may also get more UTIs following sexual activity. Men 70 years of age and older, and older post-menopausal women, are both at higher risk for UTIs.

Other risk factors for getting a UTI include having:

• Kidney stones.
• An indwelling catheter (a hollow tube that drains urine from your bladder into a bag outside your body).
• Vesicoureteral reflux (in which urine goes backwards from the bladder toward the kidney).

Although a bladder infection is not a medical emergency, a higher risk for getting a UTI complication, including kidney infection, exists for:

• Pregnant women.
• People with diabetes.
• People with kidney problems (kidney stones or blockages).
• Older adults.
• Men with enlarged prostates.
• People with incomplete bladder emptying and/or urinary retention.
• People with indwelling catheters.

To reduce your risk of getting a UTI:

• Drink plenty of water.
• Urinate often.
• Don’t hold urine in.
• Keep your genital area clean.
• Take showers rather than baths.
• Empty your bladder before and after sex.
• After using the toilet, women should wipe from front to back, especially after a bowel movement, to keep bacteria from entering the urethra.
• Wear cotton underwear and loose-fitting clothes, so that air can keep the area around the urethra dry. Avoid tight-fitting jeans and nylon underwear, which can help bacteria grow.
• Avoid feminine hygiene sprays.
• Switch to a new form of birth control if you are a woman who has trouble with UTIs. Using a diaphragm or spermicide for birth control can increase bacteria growth that causes UTIs. So can unlubricated condoms or spermicidal condoms.

Some people with a UTI may have few or no symptoms. Symptoms can differ depending on what type of UTI you have.

The usual symptoms of a lower tract UTI (a urethra infection, also called urethritis, or a bladder infection, also called cystitis) include:

• Pain or burning when you pass urine.
• Urine that looks cloudy, bloody, or that smells bad.
• Pressure in your lower stomach.
• An urge to go to the bathroom often.
• Needing to urinate, but not being able to pass much urine.
• Feeling tired, weak, or confused.

Upper tract UTIs (kidney infection, also called pyelonephritis) are more serious and should be treated right away. Symptoms include the same as with a lower tract UTI, along with:

• Pain in your upper back or sides near the rib.
• Chills
• Fever greater than 101.5 degrees F
• Nausea
• Vomiting

1. Medical History. Tell your health care provider about your symptoms, how long you’ve had them, and how they affect your everyday living. Bring a list of your over-the-counter and prescription drugs. Tell your provider about any past and current health problems and about your diet, including how much and what kinds of liquids you drink during the day and night.

2. Urinalysis. A sample of your urine is taken to test for infection or blood. This test looks for white blood cells, red blood cells, bacteria, and/or other chemicals such as nitrites in your urine. A proper urinalysis can pinpoint an infection and a urine culture can help your health care provider choose the best antibiotic for treatment. In older adults, a urinalysis might show the presence of bacteria even though the person has no symptoms. Treatment should be given only to individuals who have symptoms in addition to bacteria.

If a person has recurrent UTIs, additional tests may be performed to determine if the person’s urinary tract is normal. These tests, performed in a health care provider’s office, outpatient center, or hospital by a specially trained technician, include:

1. Kidney and bladder ultrasound. This procedure produces images that can show abnormalities in the kidneys and bladder.

2. Voiding cystourethrogram. X-rays are taken of the bladder and urethra while the bladder is full and during urination (voiding). This test can show abnormalities of the inside of the urethra and bladder, and can also determine whether the flow of urine is normal when the bladder empties.

3. Computerized tomography (CT) scan. Three-dimensional (3-D) images can provide clearer, more detailed views to help the health care provider understand the problem.

4. Magnetic resonance imaging (MRI). MRI machines use radio waves and magnets to produce detailed pictures of the body’s internal organs and soft tissues without using X-rays. Anesthesia is not needed, but light sedation may be used for people with a fear of confined spaces. As with CT scans, MRIs can provide clearer, more detailed images.

5. Radionuclide scan. This imaging technique relies on the detection of small amounts of radiation after injection of radioactive chemicals. Special cameras and computers create images of the chemicals as they pass through the kidneys, providing information about kidney function. Because the dose of the radioactive chemicals is small, the risk of causing damage to cells is low.

6. Cystoscopy and Urodynamics. In cytoscopy, a hollow tube called a cystoscope is inserted into the urethra (the tube that carries urine out of the body) and then into the bladder. The lens in the cystoscope allows a doctor to examine the bladder lining. In urodynamics, a series of tests measures lower urinary tract function. These tests reproduce a person’s voiding patterns to help identify any underlying problems. One of the most important measurements obtained is the pressure inside the bladder and kidneys.

Antibiotics are the most common treatment for bacterial UTIs. A urine test and/or urine culture at the doctor’s office can confirm if you have a UTI and can help your doctor pick the best antibiotic for you.

Additional treatment may include pain medication and localized heat for pain relief. A topical vaginal estrogen cream may be prescribed for post-menopausal women with recurrent UTIs.