Urinary Tract Infections

What are urinary tract infections?

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A urinary tract infection (UTI) is one of the most common infections a human can have. A UTI is an infection from microbes, or organisms that are too small to see without using a microscope. Bacteria causes most UTIs, but fungi and viruses can also cause UTIs.

The urinary tract consists of the kidneys, ureters, bladder, and urethra. UTIs occur most often in the lower tract, or the urethra and bladder. However, UTIs can also affect the upper tract, or ureters and kidneys. Upper tract UTIs are less common than lower tract UTIS, but usually end up being more severe.

Most UTIs are easily treatable, but they often require a doctor’s intervention. If a UTI progresses into the kidneys, there can be serious ramifications to the patient’s health. If you suspect you may have a urinary tract infection, make an appointment with your physician or with a urologist or nephrologist.

What causes UTIs?

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Any irritation to the urinary tract can cause a UTI. Additionally, anything that prevents the bladder from emptying can cause a UTI. Typically, a UTI develops from bacteria that has entered the urinary tract and begins to multiply.

The most common UTIs occur in the bladder and the urethra. They are most common in female bodies, though male bodies can also develop urinary tract infections.

  • Cystitis, or infection of the bladder, usually develops as a result of Escherichia coli (E. coli). This bacteria is usually found in the gastrointestinal tract. Sexual intercourse can cause cystitis, but people do not have to be sexually active to have this infection. Women have a small distance between the anus and urethra, which can allow bacteria to spread to the urethra and bladder.
  • Urethritis, or infection of the urethra, usually develops as a result of GI bacteria spreading from the anus to the urethra. Sexually transmitted infections, including chlamydia, herpes, gonorrhea, and mycoplasma, can also cause urethritis.

What are symptoms of UTIs?

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Not all UTIs present symptoms. If a UTI does present symptoms, it could include:

  • Cloudy urine
  • Strong-smelling urine
  • Burning sensations during urination
  • Intense, frequent urges to urinate
  • Small amounts of urine
  • Bright pink, red, or brown urine
  • Pelvic pain (in women)
  • Rectal pain (in men)

When a UTI reaches different parts of the urinary tract, it presents different symptoms. For example:

  • Urethra (urethritis): burning sensations during urination, discharge
  • Bladder (cystitis): discomfort in the lower abdomen, bloody urine, pelvic pressure, frequent urination, painful urination
  • Kidneys (acute pyelonephritis): nausea, vomiting, high fever, shaking, chills, back pain, side pain

Potential complications for UTIs include:

  • Risk of pregnant women delivering premature or low birth weight infants.
  • Recurrent UTIs, which includes experiencing two or more UTIs in a six-month window.
  • Sepsis, which can be fatal, particularly if the infection moves from the urinary tract to the kidneys.
  • Urethral narrowing, also known as stricture, for men.
  • Kidney damage from an untreated UTI.

Are there any risk factors or groups for UTIs?

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Women are more likely to develop UTIs than men. Many women develop more than one UTI throughout their life. UTI risk factors for women include:

  • Different types of birth control. Using a diaphragm and/or spermicidal agents might increase a woman’s chance of developing a UTI.
  • Placement of female genitalia. A woman’s urethra is much shorter than a man’s, so bacteria can reach a woman’s bladder fairly easily.
  • Menopause. Women experience a reduction in circulating estrogen after menopause that makes the urinary tract more prone to infection.
  • Level of sexual activity. Interacting with a new sexual partner can increase risk of developing a UTI.

Men who have enlarged prostates have a higher chance of developing a UTI. General risk factors for UTIs include:

  • Being older. Older adults are more likely to develop UTIs.
  • Using a catheter. If someone cannot urinate on their own, they will likely use a catheter, or tube, to do so. Unfortunately, using a catheter puts people at increased risk of developing a UTI.
  • Blockages in the urinary tract. An enlarged prostate or kidney stone can prevent urine from leaving the bladder and cause a UTI.
  • Undergoing a recent urinary procedure. Something as simple as an exam of the urinary tract, or as invasive as a urinary surgery, can increase the risk of developing a UTI.
  • Having urinary tract abnormalities. Sometimes babies are born with urinary tract abnormalities that prevent the baby from passing urine and potentially cause a UTI.
  • Having a suppressed immune system. Some immune diseases, like diabetes, can impact the immune system and increase the risk of developing a UTI.

How are UTIs diagnosed?

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A doctor will first perform a physical examination and review the patient’s symptoms. Then, the doctor will test the patient’s urine for microbes. The urine sample should be a “clean catch,” which means that the patient collects the sample midstream instead of at the beginning. This practice prevents the sample from collecting yeast or bacteria from the skin. If the patient has a UTI, the urine sample will have a high number of white blood cells.

A urine culture will reveal the presence of fungi or bacteria. This test can help the doctor determine the cause of the infection and figure out an effective treatment plan.

However, a doctor might have to conduct further testing if a patient is experiencing frequent UTIs. The doctor might order CT scan or MRI imaging of the urinary tract to determine if it has any abnormalities. A cystoscopy is another method of determining the cause of recurrent UTIs.

How are UTIs treated?

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UTI treatment depends on what kind of UTI is present.

  • Viral UTIs require antivirals.
  • Bacterial UTIs require antibiotics.
  • Fungal UTIs require antifungals.

A UTI treatment plan also hinges on the severity of the infection.

  • Simple infection. Basic bacterial UTIs will typically resolve using antibiotics like cephalexin, fosfomycin, trimethoprim, ceftriaxone, and nitrofurantoin. Simple UTI infections will usually go away within a few days with the proper treatment. Some people need to take antibiotics for a week or longer, depending on the severity of their infection.
  • Frequent infection. A doctor might prescribe a few different things for frequent UTIs. Treatment could include low-dose antibiotics for six months or longer, single-dose antibiotics after intercourse, or vaginal estrogen therapy.
  • Severe infection. A severe UTI might necessitate the use of intravenous antibiotics at the hospital.

What are lifestyle changes that could help with UTIs?

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UTIs are infections and require professional medical attention. There are no at-home treatments for UTIs, but there are at-home strategies for pain management.

  • Avoid drinks that have the potential to irritate the bladder. This includes alcohol, coffee, and soft drinks with caffeine or citrus juices.
  • Stay hydrated. Water dilutes the urine and flushes out harmful bacteria.
  • Apply a heating pad to the abdomen. Low-grade heat can reduce bladder discomfort or pressure.

Some studies suggest that drinking cranberry juice has infection-fighting potential, but the results are inconclusive.

A few ways to prevent UTIs include:

  • Not holding in urine for long stretches of time
  • Drinking 6-8 glasses of water per day
  • Talking with a doctor about managing any urinary difficulties
  • Using a topical or vaginal estrogen
  • Taking vaginal probiotics

Should you see a doctor for UTIs?

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Yes, you should see a doctor as soon as you begin to experience symptoms of a UTI. A prompt response to these symptoms means that you are reducing the chances of the infection spreading to other parts of the urinary tract. If you experience frequent UTIs, you should make an appointment with a doctor to figure out the cause.

What is the outlook for people living with UTIs?

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UTIs are fairly common and usually treatable. Untreated UTIs pose a huge health risk. It is important to catch a UTI at the symptoms’ onset to prevent the infection from spreading further along the urinary tract. The easiest UTI to treat occurs in the lower urinary tract, or the urethra and bladder. A UTI in the upper urinary tract, or ureter and kidneys, is more difficult to treat and can potentially spread in the blood, causing sepsis.