Urinary Tract Infections
Bladder Infections • Cystitis • Urethritis • UTI
The Facts
The urinary tract includes the kidneys, bladder, ureters, and urethra. Urinary tract infections (UTIs) are far more common in women than men. Urinary tract infections have different names depending on which part of the urinary tract is infected.
- Cystitis refers to infection of the bladder
- Urethritis refers to infection of the urethra
- Pyelonephritis refers to infection of the kidney
Among newborns, UTIs are more common in boys, but by one year of age, they are 2 to 4 times more likely to occur in girls. The rate of infection is higher for sexually active women (between 16 and 35 years old) than for men.
As many as 50% to 60% of North American women have had at least one UTI in their lifetime. Among seniors, the gender difference in infection rates diminishes, but rates of infection in seniors living at home or in care facilities or hospitals remains high.
Causes
Women are more likely to get UTIs than men. That's because women have a shorter urethra (the tube that carries urine out of the bladder) that's closer to the rectum. This allows bacteria easier access to a woman's urinary tract. After urinating, wiping from the back to the front pushes bacteria from the rectal area towards the urethra, which can lead to a UTI.
Sexual intercourse increases the risk for UTIs because bacteria are spread upward into the bladder. Using diaphragms and spermicides can also increase the risk for UTIs because the normal bacteria around the urethra may be changed, making infection more likely. Women who are pregnant or have diabetes have been reported to have higher rates of UTIs when compared to women who are not pregnant and do not have diabetes.
In addition to bladder infections, men may get infections of the prostate (prostatitis). In fact, bacteria from the prostate can lead to recurrent UTIs in men. For infants and children, UTIs can be associated with particularly narrow urinary tracts, or with a condition where the urine is pushed back up into the kidneys.
In seniors, UTIs are often due to problems with incomplete bladder emptying or bowel incontinence. Conditions that prevent complete emptying of the bladder include urinary tract blockages (especially enlargement of the prostate in men), kidney stones, neurologic diseases (such as stroke or spinal cord injury), certain medications, and having an inserted catheter ( in the case of hospitalized patients).
On very rare occasions, UTIs can be caused by bacteria that have spread from infections elsewhere in the body.
Symptoms and Complications
Common UTI symptoms may include:
- pain or burning during urination
- frequent desire to urinate, often urgently and immediately
- unusual discharge from the urethra
- urine that looks cloudy or smells foul
- pressure in the lower pelvis
- fever, with or without chills
- bedwetting in a person who has normally been dry at night
- nausea and vomiting
Bladder infections (cystitis) often result in urine that's dark and cloudy. In addition to the above symptoms, bacterial prostatitis (infection of a man's prostate gland) can also cause fever, chills, low back pain, and discomfort or pain around the anus or perineal region. In some cases, a kidney infection (pyelonephritis) can follow a bladder infection by a couple of days, causing abdominal pain, flank pain, nausea, vomiting, fever, and chills.
In infants or children, UTIs can cause symptoms such as vomiting or fever and prevent normal weight gain.
Seniors don't necessarily have symptoms that are common to UTIs. Instead, they often have gastrointestinal symptoms including changes in eating habits, or mental signs like confusion. People with catheters or neurologic disorders might only complain of side pains and a fever.
Sometimes, there are large amounts of bacteria in the urine but no obvious symptoms of UTIs. This is known as asymptomatic bacteriuria and it's common in seniors. Pregnant women and kidney transplant patients may also develop this type of infection.
Symptomatic abacteriuria is the opposite: people have UTI symptoms, but bacteria levels in the urine are low. Even with very little bacteria present, a UTI can still be diagnosed.
Making the Diagnosis
Your doctor will consider the symptoms and do a urinalysis. You'll be asked to give a sample of your urine which will be sent to the lab to check for a bacterial infection. You shouldn't collect the first bit of urine that comes out: it already contains bacteria that are normally found on your skin. Wait until midstream to start collecting the sample.
Prostatitis is identified by examining the rectum to see if the prostate gland is swollen and painful. Samples of urine and of discharge from the urethra are sent to the lab to check for infection.
Recurring UTIs might have an underlying cause, and your urinary tract will need to be checked. Ultrasound, CT scan, cystoscopy, and intravenous pyelogram are tests that provide a visual image of the urinary tract, revealing any structural abnormalities.
Treatment and Prevention
Seniors with asymptomatic bacteriuria usually don't require treatment.
For most UTIs, 3 days to a week of antibiotics taken by mouth are the best treatment. Your doctor will help decide how long treatment should last. Before beginning any treatment, make sure that you discuss with your doctor any allergies you may have, previous antibiotic use within the last 3 months, and current prescription and non-prescription medications you are taking.
To prevent the infection from returning, it's important to take all of your medication until the end of the prescribed period. Your doctor may also suggest certain medications that relieve pain to help ease the burning that occurs when you urinate.
Very serious infections – such as a severe kidney infection – may require an intravenous drip of antibiotics. Aside from standard antibiotic treatment, children with UTIs may be checked for urinary tract abnormalities.
Treatment for prostatitis often lasts for 4 to 6 weeks. If the infection returns after that, long-term antibiotic therapy may be an option.
In women, recurring UTIs are usually caused by new bacterial infections. Recurrent UTIs are defined as having 3 or more UTIs within one year (or 2 or more in 6 months). In such cases, your doctor may recommend preventative medication to be taken daily or after sexual intercourse. During pregnancy, women are routinely screened for bacteria in their urine. Prompt treatment of UTIs is important. Up to a third of untreated cases lead to kidney infections, which can cause premature labour and low birth-weight babies.
Some strategies for preventing UTIs are:
- urinating immediately after intercourse to clear out any bacteria that may have entered
- not using the diaphragm as a means for birth control – choose other birth control measures (women with recurring UTIs should also avoid spermicides, which can increase the risk of recurring UTIs)
- good toilet habits: women should wipe from front to back, to prevent bacterial spread from the anus
- drinking plenty of fluids to flush bacteria out from the bladder
- not holding in urine for long periods, as this gives bacteria more opportunity to multiply in the bladder
- taking showers rather than tub baths
- washing the skin around the vagina and anus daily
- not using deodorant sprays or feminine products such as douches in the genital area that could irritate the urethra
- post-menopausal women may benefit from using vaginal estrogen
While waiting for the antibiotics to take effect, drink plenty of fluids to ease your discomfort, but avoid anything that can irritate the bladder, such as coffee, alcohol, soft drinks with caffeine, citrus juices, and spicy foods, until the infection has cleared.
[references]
- Engel J. The Complete Canadian Health Guide: Revised edition. University of Toronto, Faculty of Medicine. Toronto: Key Porter Books, 1999:540-542.
- Mullenix TA, Prince RA. Urinary tract infections and prostatitis. Pharmacotherapy: A pathophysiologic approach. 4th Edition. 1999:1779-1794.
- Orenstein R, Wong ES. Urinary Tract Infections in Adults. Am Fam Physician 1999;59:1225-1234, 1237.94.
- Levy J, Pusey C, Singh A. Fast Facts: Renal Disorders. Oxford, UK: Health Press Limited; 2006.
- National Kidney Foundation: Urinary Tract Infections http://www.kidney.org/atoz/content/uti.cfm. Accessed October 5, 2009
- Koda-Kimble MA, Young LY, Kradjan WA et al. Applied Therapeutics. The Clinical Use of Drugs: Eighth Edition. New York: Lippincott Williams & Wilkins, 2005:64-1 - 64-22.
- Society of Obstetricians and Gynecologists of Canada (SOGC). SOGC Clinical Practice Guideline: Recurrent urinary tract infection. http://www.sogc.org/guidelines/documents/gui250CPG1011E.PDF. (Accessed 21 April 2011)
- Nicolle, L. Infectious diseases: Urinary Tract Infection. Retrieved from the e-Therapeutics database on February 17, 2015
- Mazzulli, T. Diagnosis and management of simple and complicated urinary tract infections. The Canadian Journal of Urology. 2012; 19 (Supplement 1): 42 - 49
- Shaikh, N et al Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J 2008:27(4):302
- Hooton T, et al. Acute uncomplicated cystitis and pyelonephritis in women. Up to Date. Wolters Kluwer. Last updated November 21, 2016. Accessed November 26, 2017.
- Overview of Urinary Tract Infections (UTIs). The Merck Manual for Consumers. Last updated July 2021. Accessed February 21, 2022. Available at https://www.merckmanuals.com/en-ca/home/kidney-and-urinary-tract-disorders/urinary-tract-infections-utis/overview-of-urinary-tract-infections-utis
- Urinary Tract Infection. Centers for Disease Control and Prevention. Last reviewed October 6, 2021. Accessed February 21, 2022. Available at https://www.cdc.gov/nhsn/pdfs/pscmanual/7psccauticurrent.pdf
- Bacterial Urinary Tract Infections. The Merck manual for Healthcare Professionals [Online]. Last reviewed Jul 2021. Accessed February 22, 2022. Available at https://www.merckmanuals.com/en-ca/professional/genitourinary-disorders/urinary-tract-infections-utis/bacterial-urinary-tract-infections
