Urinary Tract Infection (UTI)

Overview

By Sarah Maurer

A urinary tract infection, or UTI, is an infection of any part of the urinary system, the group of organs that removes water and waste products from the blood.

Lower urinary tractAbout 95 percent of UTIs involve the lower urinary tract. This includes the bladder (the organ that collects and holds urine) and the urethra (the tube through which urine exits the body). Lower urinary tract infections are also called cystitis. They can be quite painful, but usually don't cause permanent damage.

Sometimes cystitis spreads to the upper urinary tract, causing a more serious infection called pyelonephritis. This can affect the kidneys (the organs that remove excess water and waste products from the blood) and the ureters (the tubes that connect the kidneys and bladder). In acute (sudden, short-term) pyelonephritis, there is a risk that bacteria will enter the blood stream, causing a life-threatening condition called septicemia. Chronic (long-term) pyelonephritis can cause scarring and permanent damage to the kidneys.

UTIs are four times more common in women than in men. This is because women have a shorter urethra, which allows bacteria to spread easily to the bladder. Also, for women the urethra is a shorter distance from the anus, a common source of infection.

While UTIs are less common in men, they tend to be more severe when they do occur.

Causes and Risk Factors

A UTI begins when disease-causing microorganisms enter the urinary tract through the urethra. Usually the body's immune system can fight off these invaders, but if they multiply too quickly, they can overwhelm the body’s natural defenses. The most common cause of UTIs is bacteria called Escherichia coli (E. coli) that lives in the human bowel.

Bacteria often multiply in the urinary tract when a person doesn't urinate frequently enough. (Urination washes bacteria out of the body.) Infrequent urination may be due to a medical condition such as a kidney stone or blockage or simply to personal habits.

Frequent sexual activity also contributes to the development of UTIs, especially for women. The friction of sexual intercourse can push bacteria into the urethra. Nearly 80 percent of UTIs in young women occur shortly after sexual intercourse. Women who use a diaphragm or spermicide for birth control are at especially high risk, as both encourage the growth of excess bacteria.

People with diabetes or conditions that suppress the immune system may have a harder time fighting off harmful bacteria and consequently may experience more UTIs.

Changes in estrogen levels at menopause thin the lining of the urinary tract, which creates small tears in which bacteria can grow.

Pregnant women are at increased risk for pyelonephritis, which increases the chances of premature birth and low birth weight for the baby.

Symptoms

Not all urinary tract infections cause symptoms. Those that don't usually clear up on their own without treatment.

Common symptoms of cystitis include:

  • A strong, urgent need to urinate that persists even when the bladder is emptied
  • Pain or burning during urination
  • Frequently passing small amounts of urine
  • Urine is cloudy, red, pink or brownish
  • Urine has an unusual smell
  • Pain or pressure in the lower belly (women)
  • Rectal and lower abdominal pain (men)
  • Fatigue
  • Fever.

Additional symptoms of pyelonephritis include:

  • Upper back and side pain
  • Fever and chills
  • Nausea and vomiting.

Diagnosis

Upper urinary tractBecause of the risk of complications, it's important to see a doctor promptly if you have signs of a UTI. In most cases your primary care doctor can effectively diagnose and treat this condition.

UTIs are usually diagnosed based on medical history and a lab test called urinalysis. During urinalysis, a urine sample is examined under a microscope to determine the presence of bacteria and white and red blood cells.

For severe or recurrent infections, the doctor may order a urine culture. This involves placing drops of urine into several different mediums. Each medium encourages the growth of a different bacterium. Within a few days, the lab can identify the bacteria causing the infection and test its sensitivity to various antibiotics.

Patients with recurrent UTIs may be referred to a urologist, a physician who specializes in treating diseases of the urinary tract. The urologist can perform imaging and mechanical tests to determine the underlying cause of the infections, including:

  • Bladder and kidney ultrasound – This imaging test uses reflected sound waves to create pictures of the urinary tract and organs. It's used to check for blockages, stones, inflammation or other underlying structural issues.
  • Voiding cystourethragram – A catheter is passed up the urethra into the bladder and a liquid contrast medium (dye) is injected. X-rays are then taken of the bladder both while it's full and during urination. This test shows whether the bladder is emptying completely during urination.
  • CT scan – The patient is placed inside a special type of X-ray machine that creates three-dimensional images of body structures, including the urinary tract.
  • MRI – This imaging procedure uses radio waves and a strong magnetic field to create three-dimensional images.
  • Radionuclide scan – A small amount of a radioactive chemical is injected into the patient's blood. A special camera is then used to image the blood as it passes through the kidneys.
  • Urodynamic testing – These tests check mechanical function of the bladder and sphincter muscles. They're especially good at detecting issues caused by nerve damage.
  • Cytoscopy – A small tube with a camera in its end is inserted from the urethra into the bladder.

Treatment

Urinary tract infections are treated with antibiotics, a class of medications that kill bacteria. The type of antibiotic prescribed depends on which bacteria cause the infection. Though most people feel better within one or two days of beginning antibiotics, it's important to finish the entire course. In cases of severe infection, intravenous antibiotics may be administered at the hospital.

People with UTIs may also benefit from certain analgesics (pain killers) that numb the bladder and help make urination more comfortable. These are available both in prescription form and over the counter. Discolored urine is a common but harmless side effect.

Patients can also promote healing by drinking plenty of water and avoiding coffee, alcohol and other substances that irritate the bladder. Applying a warm heating pad to the stomach may help relieve abdominal pain.

In most cases, cystitis clears up completely following a course of antibiotics. However, recurrence is a problem. About one in five young women who has a UTI will have another within a year, and about 3–5 percent of women experience them several times a year. In men, disease-causing bacteria can "hide" in the prostate tissue, causing inflammation and recurring infections.

Prevention

There are many steps you can take to reduce your risk of a UTI:

  • After a bowel movement, wipe from front to back to avoid moving bacteria from the anus toward the urethra.
  • Try to avoid holding your urine for extended periods of time. Go to the bathroom as soon as you feel the urge.
  • Women should pass urine soon after sex to flush away bacteria that may have been pushed into the urethra. Drinking a full glass of water afterwards doesn't hurt either.
  • Stay well hydrated. Drink 6-8 glasses of clear liquids each day.
  • Avoid douches and feminine hygiene sprays because these can irritate the urethra.
  • Women with recurrent UTIs may want to consider switching their form of birth control. Diaphragms, spermicides and condoms containing spermicide can all promote bacterial growth and provoke frequent infections.
  • Take showers instead of tub baths.
  • Wear cotton underwear and loose-fitting pants or skirts.
  • If you're approaching menopause, ask your doctor about hormone replacement therapy.
  • If you experience recurrent UTIs related to sexual intercourse, ask your doctor about antibiotics to be taken after sex.
  • Results of a 2012 meta-analysis (analysis of previous studies) suggest that drinking cranberry juice may help prevent UTIs, especially in women who experience recurrent UTIs.

Sources

  • "Urinary Tract Infection." Mayo Foundation for Medical Education and Research, 2012. http://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/basics/definition/con-20037892. Accessed May 31, 2014.
  • "Urinary Tract Infection." University of Maryland Medical Center, 2012. http://umm.edu/health/medical/reports/articles/urinary-tract-infection. Accessed May 31, 2014.
  • "Urinary Tract Infection fact sheet." Womenshealth.gov, 2012. http://womenshealth.gov/publications/our-publications/fact-sheet/urinary-tract-infection.html. Accessed May 30, 2014.
  • "What I need to know about urinary tract infections." National Kidney and Urologic Diseases Clearinghouse, National Institutes of Health, 2013. http://kidney.niddk.nih.gov/kudiseases/pubs/uti_ez/. Accessed May 31, 2014.