Urinary Tract Infection

The urinary system is the body’s drainage system for removing wastes and extra water. It includes two kidneys, two ureters, a bladder, and a urethra. Urinary tract infections (UTIs) are the second most common type of infection in the body.

YOU MAY HAVE A UTI IF YOU NOTICE:

• Pain or burning when you urinate
• Fever, tiredness, or shakiness
• An urge to urinate often
• Pressure in your lower belly
• Urine that smells bad or looks cloudy or reddish
• Pain in your back or side below the ribs

People of any age or sex can get UTIs. But about four times as many women get UTIs as men. You’re also at higher risk if you have diabetes, need a tube to drain your bladder, or have a spinal cord injury.

If you think you have a UTI it is important to see your doctor. Your doctor can tell if you have a UTI with a urine test. Treatment is with antibiotics.

Prevention

Drinking lots of fluid can help flush bacteria from your system. Water is best. Most people should try for six to eight, 8-ounce glasses a day. Talk with your health care provider if you can’t drink this amount due to other health problems, such as urinary incontinence, urinary frequency, or kidney failure.

BATHROOM HABITS

Urinate often and when you first feel the urge. Bacteria can grow when urine stays in the bladder too long. Urinate shortly after sex to flush away bacteria that might have entered your urethra during sex. Drinking a glass of water will also help flush bacteria away.

After using the toilet, always wipe from front to back. This step is most important after a bowel movement to keep from getting bacteria into the urethra.

CLOTHING

Wear cotton underwear and loose-fitting clothes so air can keep the area around the urethra dry. Avoid nylon underwear and tight-fitting jeans, which can trap moisture and help bacteria grow.

BIRTH CONTROL

For women, using a diaphragm or spermicide for birth control can lead to UTIs by increasing bacteria growth. If you have trouble with UTIs, try switching to a new form of birth control. Unlubricated condoms or spermicidal condoms increase irritation, which may help bacteria grow. Consider switching to lubricated condoms without spermicide or using a nonspermicidal lubricant.

Risk Factors

People of any age or sex can get UTIs. But about four times as many women get UTIs as men. Women have a shorter urethra, which makes it easier for bacteria to reach the bladder. Also, the opening of a woman’s urethra is near the vagina and anus, where bacteria live. Women who use a diaphragm are also more likely to get UTIs than women who use other forms of birth control.

OTHERS AT HIGHER RISK FOR UTIS ARE PEOPLE:

• with diabetes or problems with the body’s natural defense system
• who need a tube to drain their bladder
• with urinary tract abnormalities that block the flow of urine
• with spinal cord injuries or other nerve damage

Causes

Most UTIs are caused by bacteria that live in the bowel. The bacterium Escherichia coli (E. coli) causes most UTIs.

The urinary tract has several systems to prevent infection. The points where the ureters attach to the bladder act like one-way valves to prevent urine from backing up toward the kidneys, and urination washes microbes out of the body. In men, the prostate gland produces secretions that slow bacterial growth. In both sexes, immune defenses also prevent infection. But despite these safeguards, infections still occur.

Symptoms

YOU SHOULD SEE YOUR HEALTH CARE PROVIDER IF YOU HAVE ANY OF THESE SIGNS OR SYMPTOMS:

• a burning feeling when you urinate
• frequent or intense urges to urinate, even when you have little urine to pass
• pain in your back or side below the ribs
• cloudy, dark, bloody, or foul-smelling urine
• fever or chills

Diagnosis

Health care providers diagnose UTIs by asking about your symptoms and then testing a sample of your urine. Your urine will be checked with a microscope for bacteria and white blood cells, which the body produces to fight infection. Because bacteria can be found in the urine of healthy people, a UTI is diagnosed based both on symptoms and a lab test.

If you have repeat infections or are in the hospital, your urine may be cultured. The culture is performed by placing part of the urine sample in a tube or dish with a substance that encourages any bacteria present to grow. Once the bacteria have multiplied, which usually takes 1 to 3 days, they can be identified. Your health care provider may also order a sensitivity test, which tests the bacteria for sensitivity to different antibiotics to see which medicine is best for treating the infection.

If you have repeat infections, your health care provider may also order one or more tests to see if your urinary tract is normal.

Kidney and bladder ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. The images can show abnormalities in the kidneys and bladder. However, this test cannot reveal all important urinary abnormalities or measure how well the kidneys work.

Voiding cystourethrogram. This test is an x-ray image of the bladder and urethra taken while the bladder is full and during urination, also called voiding. As you lie on the x-ray table, a health care provider inserts the tip of a thin, flexible tube called a catheter through your urethra into your bladder. The catheter is then removed and x-ray images are taken during urination. This test can show abnormalities of the inside of your urethra and bladder. The test can also determine whether the flow of urine is normal when your bladder empties.

Computerized tomography (CT) scan. CT scans use a combination of x rays and computer technology to create three-dimensional (3-D) images. CT scans can provide clearer, more detailed images to help the health care provider understand the problem.

Magnetic resonance imaging (MRI). MRI machines use radio waves and magnets to produce detailed pictures of your body’s internal organs and soft tissues without using x rays. Like CT scans, MRIs can provide clearer, more detailed images.

Radionuclide scan. A radionuclide scan is an imaging technique that relies on the detection of small amounts of radiation after injection of radioactive chemicals. Radioactive chemicals injected into your blood can provide information about your kidney function. Radioactive chemicals can also be put into the fluids used to fill your bladder and urethra for x ray, MRI, and CT imaging.

Urodynamics. Urodynamic testing is any procedure that looks at how well your bladder, sphincters, and urethra are storing and releasing urine. Most urodynamic tests focus on your bladder’s ability to hold urine and empty steadily and completely. Urodynamic tests can also show whether your bladder is having abnormal contractions that cause leakage.

Cystoscopy. Cystoscopy is a procedure that uses a tubelike instrument to look inside the urethra and bladder. Cystoscopy may be used to look for swelling, redness, and other signs of infection.

Treatment

UTIs are treated with antibiotics that can kill the bacteria causing the infection. The antibiotic prescribed will depend on the type of bacteria causing your UTI.

You may need to take antibiotics for a few days or for 7 days or longer. The length of treatment depends on a few factors:

• how severe the infection is
• whether you were given the right antibiotic at first
• whether the bacteria resists the antibiotic
• whether you have repeat infections
• whether you have a urinary tract abnormality that blocks the flow of urine
• whether you are male or female; men may need longer treatment because bacteria can hide deep inside prostate tissue

Follow your health care provider’s instructions carefully and completely when taking antibiotics.

Drinking lots of fluids and urinating frequently will speed healing. If needed, you may take various medicines to relieve the pain of a UTI. A heating pad on the back or abdomen may also help.

Recovery

Most UTIs can be cured. Bladder infection symptoms most often go away within 24 to 48 hours after treatment begins. If you have a kidney infection, it may take 1 week or longer for symptoms to go away.