This topic is about urinary
tract infections in teens and adults. For information about infections in
babies and young children, see the topic
Urinary Tract Infections in Children .
What is a urinary tract infection?
Your
urinary tract is the system that makes urine and
carries it out of your body. It includes your
bladder and kidneys and the tubes that connect them. When germs get into this
system, they can cause an infection.
Most urinary tract
infections (UTIs) are
bladder infections. A bladder infection usually is not
serious if it is treated right away. If you do not take care of a bladder
infection, it can spread to your kidneys. A
kidney infection is serious and can cause permanent
damage.
What causes urinary tract infections?
Usually,
germs get into your system through your urethra, the tube that carries urine
from your bladder to the outside of your body. The germs that usually cause
these infections live in your large intestine and are found in your stool. If
these germs get inside your urethra, they can travel up into your bladder and
kidneys and cause an infection.
Women tend to get more bladder
infections than men. This is probably because women have shorter urethras, so
it is easier for the germs to move up to their bladders. Having sex can make it
easier for germs to get into a woman's urethra.
You may be more likely
to get an infection if you have diabetes or
you are pregnant. The chance that you will get a bladder infection is higher if
you have any problem that blocks the flow of urine from your bladder. Examples
include having kidney stones or an enlarged prostate gland.
For
reasons that are not well understood, some women get bladder infections again
and again.
What are the symptoms?
You may have an infection
if you have any of these symptoms:
You feel pain or burning when you
urinate.
You feel like you have to urinate often, but not much
urine comes out when you do.
You have pain in your lower belly.
Your urine is cloudy, looks pink or red, or smells bad.
You have
pain on one side of your back under your ribs. This is where your kidneys
are.
You have fever and chills.
You have nausea and
vomiting.
Call your doctor right away if you think you have an
infection and:
You have a fever, nausea and vomiting, or
pain in one side of your back under your ribs.
You have diabetes,
kidney problems, or a weak immune system.
You are older than 65.
You are pregnant.
How are urinary tract infections diagnosed?
Your
doctor will ask for a sample of your urine. It is tested to see if it has germs
that cause bladder infections.
If you have infections often, you
may need extra testing to find out why.
How are they treated?
Antibiotics
prescribed by your doctor will usually cure a bladder infection. It may help to
drink lots of water and other fluids and to urinate often, emptying your
bladder each time.
For urinary symptoms such as pain or burning, there is a medicine you can buy without a prescription. Phenazopyridine (such as Azo-Gesic, Azo-Standard, and Uristat) can relieve these symptoms. But phenazopyridine doesn't treat the infection, so you'll still need an antibiotic.
If your doctor prescribes antibiotics, take
the pills exactly as you are told. Do not stop taking them just because you
feel better. You need to finish taking them all so that you do not get sick
again.
Can urinary tract infections be prevented?
You may be able to
help prevent these infections.
Take time to empty your bladder as much as possible when you urinate.
If you are a sexually active woman, make it a point to urinate shortly after having sex.
If you are a woman past menopause who is having repeated UTIs, using vaginal estrogen may help.
Bacteria that enter the
urethra and travel up the
urinary tract are the usual cause of
urinary tract infections (UTIs). Bacteria that
normally live in the
large intestine and are present in feces (stool) are
the most common source of infection. Sexual intercourse may move bacteria
into the urinary tract, especially in women.
Catheters, which are small, flexible tubes inserted
into the bladder to allow urine to drain, are a common source of bacterial
infection in people who are in hospitals or who live in long-term care
facilities.
Sometimes bacteria traveling through the blood or
lymph system cause kidney or bladder
infections.
Kidney stones, an
enlarged prostate in men, and structural problems in
the urinary tract can contribute to UTIs by limiting the body's ability to
eliminate urine completely.
Women who have repeated UTIs may have inherited genes that make them more likely to get these infections.
Symptoms
Symptoms of a
urinary tract infection (UTI) may include:
Pain or burning when you
urinate.
An urge to urinate frequently but usually passing only
small amounts of urine.
Pain
in the lower belly.
Urine that looks cloudy, is pink or red, or smells bad.
Pain in the flank, which is felt just below the rib cage and above the waist on one or both sides of the back.
Fever and
chills.
Nausea and vomiting.
Some people have bacteria in their urinary tract without
having any symptoms. This is called
asymptomatic bacteriuria.
Asymptomatic bacteriuria may lead to infections that cause symptoms, but in
many cases it does not. It usually goes away without treatment.
Several
other conditions, such as vaginal infections or irritable bladder, cause
symptoms similar to those of a UTI. Your doctor may evaluate your health for
one or more of these if you have urinary symptoms, depending on your medical
history and how well you respond to treatment for a UTI.
What Happens
Urinary tract infections (UTIs) typically occur when bacteria from the rectal area
enter through the
urethra and
travel up the
urinary tract to the bladder or kidneys.
Typically, UTIs cause urinary symptoms, such as pain or burning during
urination. Some mild bladder infections may go away on their own within a
couple of days. Most UTIs clear up quickly with antibiotics. The amount of
time required to cure the infection and the need for urine tests will vary with
the location (bladder or kidneys), frequency, and seriousness of the infection.
Kidney infections and UTIs that are
complicated by other factors require longer
treatment.
Complications of UTIs are not common but do occur.
Serious complications can include permanent kidney damage and widespread
infection (sepsis ), which can be life-threatening. The risk is
greater if the infection is not treated or if the infection does not respond to
antibiotics.
Some people have many UTIs. They are often new infections (recurrent UTIs), but they can also be the same infection coming back (a relapse). A rapid relapse
usually means that treatment failed or there is another problem affecting the
urinary tract (not just the infection).
UTIs in women
UTIs are most common in
young to middle-aged women. They occur more often in women than in men
because:
The rectum is closer to the urine outlet (urethra) in women than in men. This allows
bacteria present in stool to enter the urinary tract more
easily.
The urethra is shorter in women than in men, which allows
bacteria to reach the bladder more easily.
In women, sexual
intercourse can push bacteria into the urethra.
The fluid produced
by a man's
prostate gland helps kill bacteria in his urinary
tract.
Some women have an ongoing problem with UTIs. If a woman has more
than two bladder infections in 6 months or more than three infections in a
year, she is said to have recurrent UTIs. Recurrent UTIs usually get better
with extended antibiotic treatment. But infection may recur as soon as the
woman stops taking antibiotics. For this reason, doctors usually recommend preventive antibiotics.
UTIs in men
Most urinary tract infections in men are caused by bacteria.
UTIs in older men are more often related to
prostate problems. This can make them more difficult
to treat. Having an
enlarged prostate, which is common in older men, can
limit the body's ability to pass urine. Repeated UTIs may indicate
prostatitis,
epididymitis, or another urinary tract problem.
Urinary tract infections (UTIs) are most common in young to middle-aged sexually
active
women. Things that increase a woman's risk of getting
UTIs include:
Sexual activity, which pushes bacteria into
the urethra. Sexual activity with the use of a diaphragm and spermicide raises
the risk.
Pregnancy.
Previous
UTIs.
Lack of
estrogen, which allows bacteria that can cause UTIs to
grow more easily in the
vagina or
urethra. Women who have gone through
menopause are at increased risk for UTIs.
Risk factors in men
Things that increase a man's
risk of UTIs include:
Unprotected sex with a woman
who has a vaginal infection.
HIV infection.
Risk factors in both women and men
Certain risk
factors apply to both women and men. These include:
Having a
catheter in place. Bacteria can enter the catheter and start an infection. Most at risk are
older adults who are in hospitals or who live in long-term care facilities.
Kidney stones and other obstructions in the urinary
tract. These may block the flow of urine, raising the risk of bacterial
infection.
Diabetes. People with diabetes are at
greater risk for UTIs because their immune systems are weakened. Also,
long-term high blood sugar can damage the kidneys' filtering system (diabetic nephropathy).
Structural problems
of the urinary tract. These may be present at birth or develop later in
life.
When To Call a Doctor
Call your doctor immediately if painful urination or other symptoms of a
urinary tract infection (UTI) occur with:
Nausea and vomiting.
Fever and
chills.
Pain in the flank, which is felt just below the rib cage and above the waist on one or both sides of the back,
or
lower belly pain.
Call your doctor immediately if you are pregnant and have symptoms of a UTI (listed above).
Call a doctor if you:
Have had UTI symptoms previously and have those
symptoms again.
Have minor symptoms of a UTI that do not clear up
in 1 to 2 days, such as pain or burning when you urinate, foul-smelling urine,
or the urge to urinate frequently while passing only small amounts of
urine.
Notice blood or pus in your urine.
Have symptoms
of a UTI and you have diabetes.
Have been taking antibiotics for a UTI but your symptoms do not
improve or they come back (recur) after improving temporarily.
Watchful waiting
Watchful waiting is a wait-and-see approach. If
you get better on your own, you won't need treatment. If you get worse, you and
your doctor will decide what to do next.
In adults, home
treatment for minor urinary tract infections (UTIs) often resolves the problem.
Home treatment includes drinking plenty of water and urinating often, emptying
the bladder each time.
Try home treatment for 1 to 2 days if your
symptoms are minor.
If your symptoms last longer than 1 to 2 days
or are severe, seek medical help.
Your doctor may order a
urine culture to confirm the diagnosis of a suspected
UTI. But if your doctor thinks you have a UTI, he or she may have you start taking antibiotics right away without waiting for the results of your test.
Tests used less frequently
If the infection does
not respond to treatment with antibiotics or recurs rapidly, if the infection
may be
complicated by other factors , or, in some cases, if
the kidneys are infected, your doctor may order other tests to:
Look for the cause of recurrent or chronic
infections.
Check for other kidney problems.
Diagnose
structural problems of the urinary tract that might make you more likely to get
UTIs.
Find out whether the infection is caused by unusual
bacteria.
If you get UTIs often, your doctor may write you a
standing prescription for antibiotics that you can fill without a doctor's
appointment. Then when you first have symptoms of a UTI, you can start taking
medicine right away. You may want to use a
home test for UTI to make sure you have an infection
before you start antibiotics.
Treatment Overview
Antibiotics can treat most
urinary tract infections (UTIs) successfully. The
goals of treatment for UTIs are to relieve symptoms, eliminate the infection
and prevent recurrence, and prevent unlikely but serious complications such as
kidney damage and
sepsis . In pregnant women, treatment protects the
woman and the fetus.
Initial treatment
Treatment for
bladder infections is usually a
combination of
antibiotics and home treatment. Home treatment
includes drinking a lot of water and fluids and urinating frequently, emptying
your bladder each time. More testing is not needed if your symptoms
improve.
Oral antibiotics usually can treat kidney infections
(pyelonephritis). But you may need a brief hospital
stay and a short course of
intravenous (IV) antibiotics if you are too ill or
nauseated to take medicine by mouth (oral medicine). Kidney infections tend to
make people more severely ill than bladder infections.
You may
need more tests before and after treatment if you:
If you have a severe kidney infection, or if a bladder or
kidney infection is
complicated by other factors , you may need hospital
care.
Treatment if the condition gets worse or recurs
If
your
urinary tract infection (UTI) does not improve after
treatment with
antibiotics, you will need further evaluation and
additional antibiotic treatment.
If the infection spreads and
affects your kidney function or causes widespread infection (sepsis ), you will need hospital care. These
complications are not common. And they rarely occur in people who are otherwise
healthy.
A new
infection, rather than a relapse of the same infection, usually is the cause of
a UTI that keeps coming back (recurs).
Women with recurrent bladder infections may be treated with
preventive antibiotic therapy.
Recurrent
UTIs in men are usually a sign of prostate infection (prostatitis).
Chronic prostatitis can be hard to treat. For more information, see the topic
Prostatitis . Follow-up checkups are usually needed for men who have UTIs and are always needed if the infection recurs.
Prevention
You can take steps to prevent new or
relapsing
urinary tract infections (UTIs).
Prevention tips for men and women
Drinking more water and other liquids may help.
When you urinate, take time to empty your bladder as much as possible.
Prevention tips for women
Urinate immediately after sexual intercourse.
This is the best protection women have against UTIs, because it helps prevent
bacteria from moving into the urethra.
Avoid using condoms
coated with spermicide or a diaphragm for birth control if your doctor believes
they are causing you to get UTIs.
Change sanitary napkins
often.
Wipe from front to back
after using the toilet to avoid spreading bacteria from your anus to your
urinary tract.
Some women have found cranberry juice to be helpful, although the evidence from studies isn't strong.
If you get UTIs often, ask your doctor about taking
antibiotics right after sexual intercourse to prevent recurrent
UTIs.
Post-menopausal women may want to ask their doctors about
using vaginal estrogen to prevent recurrent UTIs.
Prevention tip for men
Keep the tip of your penis clean, especially if
you are uncircumcised. The foreskin can trap bacteria, which can then get into
the urinary tract and cause infection.
Home Treatment
Some people who have had a UTI in the past may be able to avoid getting another infection by taking action at the first sign of any pain or burning with urination. Here are some tips:
Drink lots of water, especially during the
first 24 hours after your symptoms appear. This will help make the urine less
concentrated and wash out the infection-causing bacteria. This may alter some
of your body's normal defense mechanisms. But most doctors recommend drinking a
lot of fluids when you have a UTI.
Urinate frequently and completely, to empty your bladder each
time.
But these steps won't cure a UTI, so don't delay getting medical treatment and starting on an antibiotic if you have an infection.
To relieve pain, take a hot bath or lay a heating pad over
your genital area. Never go to sleep with a heating pad in place.
Self-treatment of recurrent UTIs
If you are a
woman who has frequent uncomplicated UTIs, your doctor may write a standing
prescription for
antibiotics to take if you notice symptoms of a UTI.
If you and your doctor agree to follow this approach and you start to have symptoms
that you are certain are caused by a UTI, follow your doctor's instructions for
taking the medicine and for watching your symptoms. Be sure to tell your doctor
if your symptoms do not improve or if you start having UTIs more often than in
the past.
Medications
Oral antibiotics can treat most bladder
infections and uncomplicated kidney infections successfully. In many cases, if
the symptoms and
urinalysis suggest a
urinary tract infection (UTI), you will start taking
antibiotics without waiting for the results of a
urine culture .
The number of days your
doctor will have you take antibiotics depends on your infection and the type of
antibiotic medicine.
Antibiotics for recurrent infections
Doctors
sometimes advise that women with repeat infections use
preventive antibiotic therapy. This may include taking
a small dose of antibiotics daily or on alternate days, taking antibiotics
after sexual intercourse (since sex often triggers UTIs in women with recurrent
infections), or taking antibiotics only when you develop symptoms. Talk with
your doctor about which treatment strategy is right for you.
Medication choices
Medicines used to treat UTIs include:
Antibiotics to cure the infection. Antibiotics used
for UTIs include sulfonamides with trimethoprim (such as Bactrim).
Phenazopyridine (such as Uristat) to
treat the pain and burning of a UTI. Uristat is an example of phenazopyridine
you can buy without a prescription.
Antibiotics , including sulfonamides
with trimethoprim (such as Bactrim).
Methenamine (such as
Hiprex).
Vaginal estrogen (such as Estrace, Estring, or Vagifem) for women who have been through
menopause.
Be safe with medicines. Read and follow all instructions on the label. Be sure to tell your doctor if you are or think you may
be pregnant. Some of these medicines are not safe to use if you are
pregnant .
What to think about
These medicines are often
prescribed in a less costly
generic form rather than under a brand name. A
pharmacist might also decide to give you a generic instead of a brand name
medicine unless the prescription says "no generic."
Take all of
the antibiotics your doctor has prescribed. Most people begin to feel better
soon after they begin the medicine. But if you stop taking the medicine as soon
as you feel better, the infection may return. And not taking the full course of
antibiotics encourages the development of bacteria that are
resistant to antibiotics. This not only makes
antibiotics less effective but also makes bacterial infections harder to
treat.
Other Places To Get Help
Organizations
National Kidney and Urologic Diseases Information Clearinghouse (U.S.)
Lee BSB, et al. (2012). Methenamine hippurate for preventing urinary tract infections. Cochrane Database of Systematic Reviews (10).
Neumann I, Moore P (2014). Pyelonephritis (acute) in non-pregnant women. BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/0807/overview.html. Accessed January 8, 2015.
Perrotta C, et al. (2008). Oestrogens for preventing recurrent urinary tract infection in postmenopausal women. Cochrane Database of Systematic Reviews (2).
Credits
ByHealthwise Staff Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine Adam Husney, MD - Family Medicine Elizabeth T. Russo, MD - Internal Medicine Specialist Medical ReviewerAvery L. Seifert, MD - Urology
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