In this article
A urinary tract infection (UTI) affects about 150 million people worldwide every year and is one of the most common infections in humans. According to the National Institute for Health and Care Excellence (NICE), urinary tract infection (UTI) is the most common hospital-acquired infection in the UK, accounting for 23% of all hospital-acquired infections.
In 2019, the Guardian reported that more than 12,000 patients, the majority women, attended hospital with persistent UTIs or cystitis, up from around 4,500 in 2001. Overall admissions for UTIs generally (as opposed to persistent infections) also more than doubled, from 73,000 in 2001 to 172,000 in 2019 and the figures ramp up steadily year on year.
Figures obtained independently by the patient campaign group CUTIC also showed a 54% increase in A & E admissions for UTIs between 2012 and 2016 and a 34% rise in diagnoses of urosepsis, a life-threatening complication.
Suspected UTIs are responsible for 3% of all GP consultations in England, which could be as many as 10.2 million GP consultations each year in the UK.
What is a Urinary Tract Infection?
Urinary tract infections, known as UTIs, are infections that can affect different parts of your urinary tract, including your bladder (‘cystitis’), urethra – the tubes that carry urine (‘urethritis’) – or kidneys (‘pyelonephritis’).
Who can get a Urinary Tract Infection?
Anyone can get a UTI at any age, but despite anyone being susceptible to developing a UTI, they are more prevalent among women. A woman’s urethra is shorter than a man’s, and because of the shorter distance in women, bacteria can more easily enter and reach the bladder. The urethra is responsible for carrying urine from the bladder. It is estimated that around half of all women in the UK have had a UTI. According to NICE, around 1 in 10 girls and 1 in 30 boys will have had a UTI by the age of 16 years.
Older people are also more susceptible to UTIs due to a weaker flow of urine, meaning the bladder doesn’t empty fully. In men, an enlarged prostate can also make it difficult to empty the bladder completely. This can lead to bacteria building up in the urine and bladder.
What are the types of Urinary Tract Infections?
A lower urinary tract infection refers to the inflammation and infection of the bladder and the urethra.
The kidneys control the amount of water in the blood and filter out waste products to form urine. Each kidney has a tube called a ureter, which joins the kidney to the bladder.
The urine leaves the kidneys through the ureters and enters the bladder. The bladder ‘signals’ the urge to urinate and urine leaves the body through a tube called the urethra.
The urinary system is designed to minimise the risk of serious infection in the kidneys. It does this by preventing the urine from flowing back up into the kidneys from the bladder. Most urinary infections are confined to the bladder and, while causing symptoms, are not serious or life threatening.
Women are more prone to lower UTIs than men. Cystitis is the most common lower urinary tract infection. Cystitis refers to inflammation of the bladder and urethritis refers to inflammation of the urethra.
Cystitis is an infection of the bladder that almost always follows bacterial infection in the urine. It is the most common type of urinary tract infection (UTI), particularly in women. Cystitis occurs when bacteria travel up the urethra, infect the urine and inflame the bladder lining. It isn’t dangerous or contagious, and the infection can’t be passed on to a partner during sex. However, if left untreated, the infection can backtrack deeper into the urinary system from the bladder and reach the kidneys.
Women in their late teens and older are most susceptible to cystitis, especially if they are sexually active. The female urethra is only 4 cm long, which gives bacteria easy access to the bladder.
Men tend to get cystitis later in life. Where trouble with urine flow is a symptom, this may indicate that the underlying cause is a problem with their prostate gland.
Cystitis is common in older people, particularly if they are unwell. Bladder catheters and some urinary tract operations may also increase the risk of cystitis.
Cystitis in a child always needs to be investigated, because it may indicate a more serious condition such as urinary reflux, also known as vesicoureteral reflux. This is a bladder-valve problem, which allows urine to flow back towards the kidneys.
Urethritis and prostatitis are also considered lower UTIs. Urethritis refers to inflammation often caused by an infection of the urethra, and prostatitis refers to inflammation often caused by an infection of the prostate. Urethritis and prostatitis are related and commonly occur together, and often it is difficult to distinguish urethritis from prostatitis as symptoms are very similar; however, typically, prostatitis causes more severe symptoms and suggests a more severe infection.
Upper urinary tract infections are not as common as lower UTIs. An upper urinary tract infection mainly refers to the kidneys and the tubes that lead from the kidney into the urinary bladder. These tubes are called the ureters. A urinary infection of the kidney is referred to as pyelonephritis. A kidney infection may begin in the tube that carries urine from the body (urethra) or in the bladder. The infection can travel to one or both kidneys. A kidney infection needs prompt medical treatment. If not treated properly, an infection can cause lasting damage to the kidneys.
What are the symptoms of Urinary Tract Infections?
The different types of UTIs have varying severity of symptoms. Symptoms can vary from very mild to severe, depending on whether the infection is confined to the bladder (cystitis) or has affected the kidney(s) as well (pyelonephritis).
Symptoms of bladder infection (cystitis) include:
- Smelly or cloudy urine.
- Passing urine frequently or feeling the need to pass urine more often.
- Passing urine more often than usual at night.
- Feeling that the bladder has not been emptied.
- Urgency – a pressing need to pass urine.
- Pain and/or a burning feeling on passing urine, some describe it as a sharp stinging feeling.
- Pain in the lower abdomen (tummy).
- Suprapubic discomfort/tenderness.
- Pain in the urethra.
- Bloodstained urine.
- A mild temperature.
- In severe cases, fever, feeling generally unwell, muscle aches, and shivering.
Children may wet themselves or wet the bed and try to avoid passing urine because of the burning sensation.
Suspect lower urinary tract infection in children aged under 3 months with signs and symptoms, including:
- Poor feeding or failure to thrive.
- Abdominal pain.
- Offensive urine.
- The presence of blood in urine (haematuria).
Some elderly people may experience confusion and agitation.
The elderly with underlying cognitive impairment may show signs of:
- Reduced ability to carry out activities of daily living.
UTIs can cause severe confusion which develops quickly over a couple of days, especially in older people. These symptoms can mirror dementia-like symptoms, but don’t jump to conclusions.
Many of the symptoms are the same for both men and women. However, it is possible for women to develop pelvic pains while suffering from a UTI, while men can suffer from rectal pain symptoms. Although symptoms can feel uncomfortable and painful, mild UTIs such as mild cases of cystitis usually clear up within a few days and rarely cause long-term damage.
Infections of the kidneys and/or the ureter are more serious and symptoms include:
- A high temperature, or feeling hot and shivery.
- Shaking (rigors) and chills.
- Frequent, painful urination.
- Reduced fluid intake.
- Feeling sick or being sick.
- Pain in the lower back or sides of the abdomen, the kidney area.
Suspect pyelonephritis in all children with unexplained fever of 38°C or more, or loin pain/tenderness.
In very rare cases this type of infection can cause permanent kidney scars, which in turn can lead to kidney disease.
A kidney infection can sometimes lead to a dangerous condition called sepsis which can be life threatening.
Symptoms of sepsis include:
- Rapid breathing and heart rate.
What causes Urinary Tract Infections?
Urinary tract infections (UTIs) are usually caused by bacteria from faeces in the gut, for example, E. coli, colonising the skin around the opening of the urethra and then entering the urinary tract. Other types of bacteria may be responsible, and the type of organism can sometimes give a pointer to the underlying problem.
This is more likely to happen in women, because women have a shorter urethra that is closer to the anus, making it easier for the bacteria to enter and travel through the urinary tract.
Germs such as Mycoplasma and Chlamydia can cause urethritis in both men and women. These germs can be passed on during sexual intercourse so both partners need medical treatment to avoid re-infection.
Lots of things can increase the risk of getting a UTI, including:
- Being pregnant – During pregnancy, the drainage system from the kidney to the bladder widens so urine does not drain as quickly.
- Having sex.
- Using products containing spermicide.
- Having a condition that blocks the urinary tract such as kidney stones.
- Having a condition that prevents the bladder from draining.
- Having a urinary catheter.
- Having a weak immune system.
- Having a family history of UTIs.
- Not drinking enough water and other fluids.
- Not keeping the genitals clean and having poor hygiene.
- Having a condition that makes it difficult to fully empty the bladder, such as an enlarged prostate gland in men and constipation in children.
- Having vesicoureteral reflux when the bladder contracts, allowing some urine back into the ureters rather than being sent down the urethra.
- In men, an enlarged prostate gland can make it difficult to empty the bladder fully, which can put men more at risk of developing a UTI.
- In older women, the tissues of the urethra and bladder become thinner and drier with age as well as after menopause or a hysterectomy.
- People with diabetes are at increased risk of having UTIs as their urine may have a high glucose (sugar) content, which makes it easier for bacteria to multiply.
- Chronic conditions, some medications, and problems with incontinence put older people at an increased risk.
Some people believe certain trigger foods can increase the discomfort caused by cystitis. Alcohol, coffee, acidic fruits, spicy foods and sweeteners in particular are believed to cause further bladder irritation.
How are UTIs diagnosed?
Anyone with the symptoms of a UTI should contact their GP. GPs can usually diagnose a UTI by asking about the symptoms, examining the person, and arranging for a sample of urine to be tested. They will usually ask you to provide a “mid-stream” urine specimen. To do this, you must catch a small amount of urine halfway through emptying your bladder. Do not collect the first or last part of the urine flow because this may cause a false result.
Treatment usually begins soon after a urine sample has been taken; however, in a few circumstances, further tests may be needed in hospital to check for abnormalities.
Further tests may also be needed if you have frequent urinary infections or if you also have high blood pressure, other abnormalities in the urine or are pregnant.
Can UTIs be treated naturally?
The key to urinary tract infection is to prevent it from becoming a kidney infection, which can go into the bloodstream and lead to sepsis. This is why it is important to contact the GP or NHS 111 at the first signs of symptoms, so that they can prescribe the correct treatment for the condition.
The GP may, however, suggest natural remedies such as drinking plenty of fluids that will help flush out the bacteria more often, and/or over-the-counter treatments to help with the symptoms. Patients should always follow their GP’s advice.
How are Urinary Tract Infections treated?
UTIs are normally treated with a short course of antibiotics such as amoxicillin or nitrofurantoin.
The type of antibiotic prescribed and dose will depend on various factors, including:
- Your previous history.
- Other medications (drugs) you may be taking.
- The likely type of bacteria.
- The result of urine microscopy, culture and sensitivity.
- Previous bacterial sensitivities.
- The severity of the infection.
- How unwell you are.
Bladder infection (cystitis) usually responds rapidly to a short course of antibiotics, but kidney infection (pyelonephritis) generally requires a longer course of treatment. Symptoms will normally pass within three to five days of starting treatment. You must complete the whole course of antibiotics that you have been prescribed, even if you are feeling better. More severe cases or kidney infections may require a 14-day course of antibiotics.
In severe infections, where you are unwell with severe dehydration, sickness or inability to keep down any fluids you take by mouth, hospital treatment with antibiotics by injection may be necessary.
However, the bacteria E. coli that causes 85% of UTIs are becoming resistant to antibiotics. This means that infections are becoming more difficult to treat so researchers are investigating ways to develop alternative treatments.
The GP may also recommend over-the-counter painkillers such as paracetamol that can help with any pain.
What to do if Urinary Tract Infections Keep coming back
There are many reasons why some people may have recurring urinary infections. If you keep getting UTIs, you must talk to your GP. After talking with you, your GP will either recommend treatments for recurring urinary infections or send you to a specialist called a urologist. A urologist focuses on diseases and problems of the entire urinary system, so may be able to better pinpoint what is causing your infections and how to treat and prevent them.
Recurrent cystitis, pyelonephritis and all urinary infections in men or children should be investigated. Ultrasound scanning is the main method of investigation, looking particularly at bladder emptying.
The British Association of Urological Surgeons have cited some novel treatments being trialled in urology departments for intractable cystitis.
- Vaccine treatments.
- Urinary antiseptics taken by mouth.
- Chemical treatments put directly into your bladder through a small catheter.
How to prevent Urinary Tract Infections
It is not always possible to prevent UTIs, but there are things you can do to manage and control the risk, such as:
- Wiping from front to back when going to the toilet.
- Maintaining hygiene by washing daily using unperfumed soap.
- Trying to empty your bladder fully when peeing.
- Wearing cotton underwear.
- Drinking plenty of fluids, aim for six to eight glasses of water a day.
- Emptying your bladder after sex.
- Change children’s nappies frequently.
- Increase your vitamin C intake.
- Taking probiotics.
- If you have taken birth control for a long time or are peri- or post-menopausal, talk to your doctor about vaginal oestrogen.
You should avoid:
- Holding on when you feel the urge to urinate.
- Using perfumed soaps or talcum powder.
- Wearing tight trousers/jeans or synthetic underwear.
- Using a contraceptive diaphragm or condoms with spermicidal lubricant on them – You may wish to use another method of contraception instead.
Cranberry juice has historically been linked to preventing cystitis, although there is very little scientific evidence to support any significant benefits. Most recently, research carried out by the Cochrane Collaboration concluded that cranberries were no more effective in preventing cystitis than drinking water.
Speak to your GP if these measures don’t work. They may suggest taking a long-term course of antibiotics or they may give you a prescription for antibiotics that you can use as soon as you experience symptoms of a UTI.
It is important to get treatment for a UTI if you have symptoms that last for more than two days due to the possibility that the infection can spread and cause complications. It is always best to consult your GP and treat UTIs with antibiotics.
You should definitely see a doctor if:
- Minor cystitis symptoms do not clear up in 2 days.
- You are diabetic or have an impaired immune system.
- You are pregnant.
- The patient is a child under 16 years.
- You are over 65.
- Antibiotics to treat cystitis don’t appear to be working.
- Symptoms reappear shortly after finishing a course of antibiotics.