Urinary Tract Infection

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(UTI; Lower UTI)

Definition

A urinary tract infection (UTI) is an infection in any part of the urinary system. Most UTIs start in the lower urinary tract in the bladder or urethra. The urethra is the tube that carries urine out of the body. A UTI can also include an infection in the upper urinary system, including the kidneys.

There are different names for infections in different parts of the urinary system, including:

Urethritis—an infection in the urethra
Cystitis—bladder infection
Pyelonephritis—kidney infection

The infection may also occur in the tube connecting the bladder to the kidney. All of these infections are considered to be UTIs.

The Urinary Tract

Causes

UTIs are caused by bacteria that most often come from the digestive tract or rectal area. The bacteria cling to the opening of the urethra and begin to multiply. If the infection is not treated right away, bacteria may move up the urinary system to the kidneys.

Most infections are caused by a type of bacteria called E. coli. E. coli normally lives in the colon. The bacteria may move from the rectal area to the urethra.

UTIs can also be sexually transmitted. This type of infection usually does not spread past the urethra. Both partners need to be treated.

Risk Factors

Factors that may increase your risk of developing a UTI include:

Sex: female—the rectum and urethra are fairly close to each other in women, making infection more likely
Being sexually active
Using a diaphragm for birth control
Menopause
Diabetes
Kidney stones
Enlarged prostate
Weak immune system
Abnormalities of the urinary system, such as vesicoureteral reflux or polycystic kidneys
Paraplegia or quadriplegia
Sickle-cell anemia
History of kidney transplant
Bladder catheter in place, or recent device inserted into the urinary system
Pregnancy

Symptoms

If you have any of these symptoms, do not assume they are due to a UTI. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:

Frequent and urgent need to urinate
Passing small amounts of urine
Pain in the abdomen or pelvic area
Burning sensation during urination
Cloudy, bad-smelling urine
Increased need to get up at night to urinate
Leaking urine
Fever and chills
Nausea and poor appetite

An infection in the kidney can be more serious. Call your doctor right away if you have symptoms of a kidney infection, such as:

Bloody urine
Low back pain or pain along the side of the ribs
High fever and chills

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will also be done. A sample of your urine will be tested for blood, pus, and bacteria.

In general, children and men are less likely to get UTIs. Their infections are more likely to be caused by structural problems of the kidneys, bladder, or tubes. As a result, children and men may need more testing to determine the cause of a UTI.

Treatment

UTIs are treated with antibiotic drugs. Standard medical care for a UTI includes taking antibiotics for three days. You will probably start to feel better after a day or two. It is important that you continue to take the entire course of medication, even if you feel better.

You may have your urine checked after you finish taking the antibiotics. This is to make sure that the infection is truly gone. If you have recurrent infections, you may be referred to a specialist.

The infection may cause pain and spasms in the bladder. Your doctor may recommend a medication called Pyridium. It may turn your urine, and sometimes your sweat, an orange color.

Severe UTIs may need a strong initial dose of antibiotics. You may be given antibiotics through an IV or an injection.

Prevention

Here are some steps you can take to keep bacteria out of your urinary tract:

Drink plenty of liquids, especially water.
Include cranberry juice in your diet. Some studies suggest cranberry juice may help prevent UTIs.
Urinate when you feel the need and do not resist the urge.
Empty your bladder completely and drink a full glass of water after having sex.
Wash genitals daily.
If you are a woman, always wipe from the front to the back after having a bowel movement.
Avoid using douches and feminine hygiene sprays.

RESOURCES

Urology Care Foundation http://www.urologyhealth.org

National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov

CANADIAN RESOURCES

Canadian Urological Association http://www.cua.org

Women's Health Matters http://www.womenshealthmatters.ca

References

Acute cystitis in adults. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated August 31, 2012. Accessed September 11, 2012.

Car J. Urinary tract infections in women: diagnosis and management in primary care. BMJ. 2006;14;332.

Cranberry. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthLibrary. Updated February 1, 2011. Accessed September 11, 2012.

Jepson RG, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD001321.

Sheffield JS, Cunningham FG. Urinary tract infection in women. Obstet Gynecol. 2005;106:1085-1092.

Urinary tract infections in adults. American Urological Association Foundation website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=47. Accessed September 11, 2012.

Urinary tract infections in adults. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/utiadult. Updated May 24, 2012. Accessed September 11, 2012.

12/5/2007 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Pohl A. Modes of administration of antibiotics for symptomatic severe urinary tract infections [review]. Cochrane Database of Systematic Reviews. 2007(4). DOI: 10.1002/14651858.CD003237.

5/6/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Barbosa-Cesnik C, Brown MB, Buxton M, Zhang L, DeBusscher J, Foxman B. Cranberry juice fails to prevent recurrent urinary tract infection: results from a randomized placebo-controlled trial. Clin Infect Dis. 2011;52(1):23-30.

Revision Information

Reviewer: Adrienne Carmack, MD
Review Date: 09/2012 -
Update Date: 00/92/2012 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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