Let's face it – Urinary tract infections

If you’ve had a urinary tract infection (UTI) before, you’ll know how uncomfortable, distracting and disruptive it can be to your daily life. Individuals of all ages and genders can be affected, though frequency and causes can vary.

Women are more likely to get UTIs

This is because their urethra (the tube that carries urine out of the body) is shorter. This allows bacteria, including those from poo such as E. coli, to travel more easily from outside the body to the bladder, leading to infections.

Urinary Tract Infections (UTIs)

Even though it’s estimated that 50-60% of women will experience at least one UTI in their lifetime¹, it’s not a women’s health subject spoken about as much as it should be.

What is a UTI?

Urinary tract infections are a common type of infection in your urinary system. They can affect your urinary tract, including your bladder (cystitis), urethra (urethritis) or kidneys (kidney infection). Most UTIs begin when bacteria, usually from the skin or rectum, enter the urethra. UTIs may be treated with antibiotics, but they're not always needed².

UTI symptoms: What to look out for

• A strong, persistent urge to urinate: You may feel like you need to go to the bathroom a lot, even if little urine comes out.
• A burning sensation when you urinate: This discomfort can be a sign of irritation in the urinary tract.
• Cloudy urine: This can indicate the presence of bacteria or pus.
• Strong-smelling urine: A noticeable change in the smell of your urine can be a symptom.
• Urine that appears red, pink, or brown: This can be a sign of blood in the urine.
• Pelvic pain: You might experience discomfort or pressure in the lower abdomen, especially around your pelvic area.
• Fever or chills: These can occur if the infection has reached your kidneys, which is more serious.

UTIs in older people

In older people, those with cognitive impairment (such as dementia) and people with a urinary catheter, symptoms may also include changes in behaviour, such as:

• Acting confused or agitated (delirium).
• Wetting themselves more than usual.
• Shivering or shaking (rigors).

If you or a loved one experience any of these symptoms, it’s important to consult a healthcare professional for diagnosis and appropriate treatment as soon as possible.

What can cause UTIs in women?

• Anatomy: Women are more prone to UTIs than men because their urethra is shorter. In men, the longer urethra provides a better barrier against bacteria reaching the bladder.
  
  
• A drop in oestrogen: Oestrogen helps keep the tissues in the vagina and urethra elastic and moist. When oestrogen drops, for example during menopause or after certain cancer treatments, these tissues can become thinner and dry, leading to irritation, and making it easier for UTIs to develop.
  
  Oestrogen also supports healthy bacteria in the vagina and bladder that help fight off infection-causing bacteria. Lower oestrogen levels mean fewer healthy bacteria, making it harder to prevent infections.
  
  
• Personal hygiene: Wiping back to front can transfer bacteria from the anal areas to the urethra. Make sure to wipe front to back. It’s also important to wear clean and appropriate size underwear.
  
  
• Not changing sanitary pads/tampons regularly: For menstruating women, failing to change sanitary products regularly can lead to bacterial growth and potential infections.
  
  
• Use of irritants: The use of perfumed soaps, douches, feminine hygiene sprays, or scented toilet paper can irritate the urethra and lead to inflammation, increasing UTI risk.
  
  
• Urinary tract abnormalities: Structural abnormalities or blockages such as kidney stones can prevent urine flow, increasing infection risk.
  
  
• Conditions that make it difficult to fully empty the bladder: For example, some forms of urinary incontinence can make it hard to empty the bladder, leading to residual urine that can harbour bacteria and cause infections. Conditions that affect nerve function, for example, multiple sclerosis, diabetes, and spinal cord injuries can also lead to problems with bladder control and emptying. Cystocele – a condition that weakens between the bladder and vagina – can also make emptying difficult.
  
  
• Not drinking enough fluids: This leads to less frequent urination, giving bacteria in the urinary tract more time to multiply and potentially cause infection.
  
  
• Suppressed immune system: Conditions or medication that weaken the immune system can increase the chance of infections.
  
  
• Sexual activity: Increased sexual activity can introduce bacteria into the urinary tract due to exposure to bacteria near the urethra. Changes in sexual activity or partners can expose individuals to unfamiliar bacteria. Urinating before and after sex can help flush out any bacteria that may have entered.
  
  
• Use of contraceptives: Spermicides and diaphragms can disrupt the natural vaginal flora, increasing the risk of UTIs. Discussing contraceptive options with a healthcare provider is advisable if UTIs keep occurring.
  
  
• Tight clothing: Wearing tight-fitting clothing or synthetic underwear can create a warm and moist environment that encourages bacterial growth. Opting for loose-fitting clothing and breathable fabrics can help.
  
  
• Improper use of catheters: For those who require catheterisation, improper hygiene during insertion or maintenance of the catheter can lead to infections. Following strict hygiene protocols is essential.

UTI diagnosis

Your doctor may recommend urine analysis (urinalysis). This is a quick, non-invasive test, where you collect a small amount of urine in a container. It’s then checked for signs of infection, such as bacteria, blood or pus. If bacteria are found, you may also have a test called a urine culture, which is a more specific test used to diagnose UTIs and other infections by identifying the bacteria causing the infection.

Chronic (long-term) UTI diagnosis

Unfortunately for some individuals, UTIs don’t go away and can have a big impact on your quality of life. Chronic UTIs can be caused by bacteria entering the lining of the bladder. Short-term antibiotics don’t work, so you might be treated with antibiotics that you take for a long time.

It can be difficult to diagnose chronic UTIs due to urine tests not always picking up the infection, as symptoms can be similar to other conditions.

If you’ve been treated for a UTI but you still have symptoms, speak to your GP about chronic UTIs and ask to be referred to a specialist.

UTI treatment

Doctors often divide UTIs into ‘uncomplicated’ and ‘complicated’ infections.

Uncomplicated: Your urinary tract is normal and you’re otherwise healthy. This makes your UTI easier to treat with short-term antibiotics, which eliminate the bacteria causing the infection. You’ll be prescribed antibiotics based on the type of bacteria found in your urine and your medical history. You should take all your prescribed antibiotics, even if you start to feel better², as this helps stop the infection returning. Bladder infections tend to fall into this category.

Complicated: You have another condition that makes your UTI harder to treat, for example you’re pregnant or have recurring UTIs that can’t be controlled with typical antibiotics, problems with kidney function or a weakened immune system due to HIV, steroid use or another cause³. Kidney infections tend to fall into this category. If you have a complicated UTI, you may need IV antibiotics and must take antibiotics for a week or more⁴.

If your doctor thinks you have a UTI, they may do a urine test, although it’s not always needed. They might also:

• Offer self-care advice and recommend taking a painkiller.
• Give you a prescription for a short course of antibiotics.
• Give you a prescription for antibiotics, but suggest you wait for 48 hours before taking them in case your symptoms go away on their own².

Over-the-counter pain relief can help reduce any discomfort or pain, additionally a urinary analgesic may be recommended to relieve burning during urination.

Drinking plenty of water can help flush bacteria from your urinary tract, while attending a follow-up appointment will help check whether the infection has been completely treated.

Treatment for UTIs that keep returning (recurrent UTIs)

If your UTI comes back after treatment, or you have 2 UTIs in 6 months, a GP may:

• Prescribe a different antibiotic or prescribe a low-dose antibiotic to take for up to 6 months.
• Prescribe a vaginal cream, gel, tablet, pessary, or ring containing oestrogen, if you are in perimenopause or have gone through the menopause.
• Prescribe tablets that treat the infection and stop it from coming back.
• Refer you to a specialist for further tests and treatments².

Treatment you can try yourself to ease symptoms:

• Take paracetamol up to 4 times a day to reduce pain and a high temperature².
• Rest and drink enough fluids so you pass pale urine regularly during the day.
• Avoid having sex.
• Some people take cystitis sachets or cranberry drinks and products every day to prevent UTIs from happening, which may help. But there's no evidence they help ease symptoms or treat a UTI if the infection has already started².

Always consult with a healthcare professional for a proper diagnosis and treatment plan tailored to your specific condition.

How to prevent UTIs

• Wipe front to back when you go to the loo.
• Keep your genital area clean and dry.
• Drink plenty of fluids, particularly water.
• Wash the skin around your vagina with water before and after sex².
• Quickly replace soiled nappies or incontinence pads.
• Avoid using scented soap.
• Don’t hold your urine in if you need to go.
• Take your time to fully empty your bladder when urinating.
• Avoid tight, synthetic underwear, such as nylon.
• Avoid lots of sugary food and drinks, as they may encourage bacteria to grow.
• Avoid condoms or a diaphragm or cap with spermicidal lube on them. Try non-spermicidal lube or a different type of contraception.
• Evidence suggests⁵ probiotics (beneficial bacteria – particularly the Lactobacillus group) can help prevent recurrent UTIs in women by keeping the urinary tract healthy and free from harmful bacteria. However further research is needed into this.

Practicing good hygiene habits, alongside regular urination and hydration, can significantly reduce the risk of developing UTIs. If UTIs keep happening to you and are becoming a concern, speak to a healthcare professional for further assessment and guidance.

UTIs and cystitis: What’s the difference?

‘Urinary tract infection’ is a broad term that refers to infections occurring anywhere in the urinary tract, which includes the kidneys, ureters (tubes which transport urine from the kidney to the bladder), bladder, and urethra.

Cystitis is a specific type of UTI – an inflammation that occurs only in the bladder, which can result from infectious or non-infectious causes.

Did you know? A pharmacist can help with UTIs and cystitis.

You can speak to a pharmacist about treatments. They can:

• Offer advice on things that can help you get better.
• Suggest the best painkiller to take.
• Provide the same UTI treatment as a GP, if it's suitable for you. Some pharmacies offer a cystitis management service. They may be able to give antibiotics if they're needed⁶.
• Tell you if you need to see a GP about your symptoms².

Find a pharmacy here.

Important: Potential complications

If left untreated, a UTI can spread through your urinary tract to your kidneys (pyelonephritis) and cause sepsis, which is a life-threatening response to infection.

How do I know if my UTI has developed into a kidney infection?

You may notice a change or worsening in symptoms such as:

• Pain location: While cystitis typically causes pain and discomfort in the lower abdomen, a kidney infection often results in pain in the back, sides, or groin.
• Fever and chills: Developing a high fever, chills, or sweating can be a sign of a kidney infection.
• Nausea and vomiting: Feeling nauseated or experiencing vomiting can indicate the infection has spread to the kidneys.
• Severe pain: The pain associated with kidney infections is often more severe and persistent than that of cystitis.
• Fatigue: Increased tiredness or feeling unusually weak.
• Changes in urine: While cystitis can lead to painful urination, a kidney infection may cause your urine to become cloudy, have a strong odour, or contain blood.

If you suspect that your UTI has developed into a kidney infection, it's important to seek urgent medical attention promptly for proper diagnosis and treatment.

What is urosepsis?

Urosepsis is a serious condition where a UTI spreads to the bloodstream, causing widespread inflammation. It requires immediate medical treatment and can be fatal if not treated properly⁷.

Common signs of urosepsis:

• High fever or low body temperature.
• Rapid heart rate.
• Rapid breathing or difficulty breathing.
• Confusion or altered mental state.
• Extreme pain or discomfort, often in the lower back or abdomen.
• Decreased urine output.
• Weakness or fatigue.
• Chills or shivering.
• Clammy or sweaty skin.
• A general feeling of being unwell⁸.

If you suspect urosepsis, it's crucial to seek emergency medical attention immediately, as it can rapidly become life-threatening.

Please note: While the basic treatment for UTIs typically involves antibiotics for both men and women, the approach can differ slightly for men due to anatomical differences and potential underlying causes. Men may require a longer course of antibiotics compared to women, and healthcare providers often investigate further to rule out complications such as prostate issues or urinary tract obstructions.

Read more: Urinary tract infections in men.

Also, the treatment of UTIs in children can differ from that in adults, primarily in terms of antibiotic selection and dosage. If you’re concerned about anything, contact a medical professional as soon as possible for assessment and treatment.

It's important for anyone experiencing symptoms of a UTI to consult a healthcare professional for an accurate diagnosis and appropriate treatment plan tailored to their specific needs. UTIs can lead to various complications if not properly treated. If you’re showing signs of a kidney infection or urosepsis, seek urgent medical attention immediately.

Discover more information on other important women’s health topics here.

References

1. An introduction to the epidemiology and burden of urinary tract infections – National Library of Medicine
2. Urinary tract infections – NHS
3. Antibiotics for UTI treatment – WebMD
4. Bladder infection vs. UTI: How to tell which one you have – Healthline
5. Probiotics for prevention of recurrent tracts infections in women – National Library of Medicine
6. Cystitis – NHS
7. What is urosepsis? – WebMD
8. Urinary tract infections – The Urology Foundation