Urinary Tract Infection

What are urinary tract infections?

Urinary tract infections or UTIs are infections in any part of the urinary tract. They are a common health problem that affects millions of people each year. Women are especially prone to UTIs.

A UTI may affect any part of the urinary tract causing:

  • Urethritis. This is an infection of the urethra. This is the hollow tube that carries urine from the bladder to the outside of the body.
  • Cystitis. This is an infection in the bladder from germs that have moved up from the urethra.
  • Pyelonephritis. This infection of the kidneys is most often a result of an infection that has spread up the urinary tract, or from a blockage in the urinary tract. A blockage causes urine to back up into the ureters and kidneys.
  • Abscess. A collection of pus along the course of the urinary tract is called an abscess.

What causes urinary tract infections?

Normal urine is sterile and contains fluids, salts, and waste products. It does not contain bacteria, viruses, or fungi. A UTI happens when germs, most often bacteria from the digestive tract, get into the opening of the urethra and start to multiply.

Most UTIs are caused by E. coli bacteria, which normally live in the colon.

What are the symptoms of a urinary tract infection?

These are the most common symptoms of a UTI:

  • Frequent urination
  • Pain or burning when passing urine
  • Fever
  • Urine looks dark, cloudy, or reddish in color. (Blood may be present in the urine.)
  • Urine smells bad
  • Feeling pain even when not urinating
  • Tiredness
  • Pain in the back or side, below the ribs
  • Nausea and/or vomiting
  • Despite a strong urge to urinate, only a small amount of urine is passed
  • Women may feel an uncomfortable pressure above the pubic bone

The symptoms of a UTI may look like other conditions or medical problems. Always see a healthcare provider for a diagnosis.

How are urinary tract infections diagnosed?

Your healthcare provider will review your medical history and do a physical exam. Other tests may include:

  • Urinalysis. Lab testing of urine is done to check for various cells and chemicals, such as red and white blood cells, germs (like bacteria), or a lot of protein.
  • Urine culture. Lab is a test to grow potential bacteria found in the urine

If UTIs become a repeated problem, other tests may be used to see if the urinary tract is normal. These tests may include:

  • Cystoscopy. In this test, a thin, flexible tube and viewing device is put in through the urethra to examine the bladder and other parts of the urinary tract. Structural changes or blockages, such as tumors or stones can be found.
  • Kidney and bladder ultrasound. This imaging test uses high-frequency sound waves to make images of the bladder and the kidneys on a computer screen. The test is used to determine the size and shape of the bladder and the kidneys, and check for a mass, kidney stone(s), cysts, or other blockages or abnormalities.
  • CT scan. This is an imaging test that uses X-rays and a computer to make detailed images of the body. A CT scan shows details of the bones, muscles, fat, and organs.

How are urinary tract infections treated?

Your healthcare provider will figure out the best treatment based on:

  • How old you are
  • Your overall health and past health
  • How sick you are
  • How well you can handle specific medicines, procedures, or therapies
  • How long the condition is expected to last
  • Your opinion or preference

Treatment for UTIs may include:

  • Antibiotics
  • Other medicines to ease pain
  • Heat (such as heating pad) to ease pain

You may also need to make lifestyle changes  such as:

  • Drinking plenty of water to help wash bacteria out of the urinary tract
  • Avoiding coffee, alcohol, and spicy foods
  • Quitting smoking

Can urinary tract infections be prevented?

These steps may help reduce the chance of getting UTIs:

  • Drink plenty of water every day.
  • Drink cranberry juice. Large amounts of vitamin C limit the growth of some bacteria by acidifying the urine. Vitamin C supplements have the same effect.
  • Urinate when you feel the need. Do not wait.
  • Females, wipe from front to back to keep bacteria around the anus from going in the vagina or urethra.
  • Take showers instead of tub baths.
  • Clean the genital area before and after sex, and urinate shortly after sex.
  • Women should not use feminine hygiene sprays or scented douches.
  • Cotton underwear and loose fitting clothes help keep the area around the urethra dry. Tight clothes and nylon underwear trap moisture. This can help bacteria grow.
  • Repeated bouts of urinary tract infections can be treated with small doses of regular antibiotics.

Please talk with your healthcare provider with any questions or concerns you may have about UTIs.

Key points about urinary tract infections

  • Urinary tract infections (UTIs) are a common health problem that affects millions of people each year. These infections can affect any part of the urinary tract.
  • Most UTIs are caused by E. coli bacteria, which normally live in the colon.
  • The most common symptoms of UTIs include changes in urination such as frequency, pain, or burning; urine looks dark, cloudy, or red and smells bad; back or side pain; nausea/vomiting; and fever.
  • Antibiotics are used to treat UTIs. Other treatments may include pain relievers, and drinking plenty of water to help wash bacteria out of the urinary tract.
  • Other things that can be done may help reduce the likelihood of developing UTIs.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Urinary Tract Infections in Women

Urinary Tract Infections in Women

Cross section side view of female pelvis showing kidney connected to bladder by ureter. Urethra is tube from bladder to outside. Behind bladder is uterus connected to outside by vagina. Rectum is behind uterus connected to outside by anus.

Urinary tract infections (UTIs) are most often caused by bacteria. These bacteria enter the urinary tract. The bacteria may come from outside the body. Or they may travel from the skin outside the rectum or vagina into the urethra. Female anatomy makes it easy for bacteria from the bowel to enter a woman’s urinary tract, which is the most common source of UTI. This means women develop UTIs more often than men. Pain in or around the urinary tract is a common UTI symptom. But the only way to know for sure if you have a UTI for the healthcare provider to test your urine. The two tests that may be done are the urinalysis and urine culture.

Types of UTIs

  • Cystitis. A bladder infection (cystitis) is the most common UTI in women. You may have urgent or frequent urination. You may also have pain, burning when you urinate, and bloody urine.

  • Urethritis. This is an inflamed urethra, which is the tube that carries urine from the bladder to outside the body. You may have lower stomach or back pain. You may also have urgent or frequent urination.

  • Pyelonephritis. This is a kidney infection. If not treated, it can be serious and damage your kidneys. In severe cases, you may need to stay in the hospital. You may have a fever and lower back pain.

Medicines to treat a UTI

Most UTIs are treated with antibiotics. These kill the bacteria. The length of time you need to take them depends on the type of infection. It may be as short as 3 days. If you have repeated UTIs, you may need a low-dose antibiotic for several months. Take antibiotics exactly as directed. Don’t stop taking them until all of the medicine is gone. If you stop taking the antibiotic too soon, the infection may not go away. You may also develop a resistance to the antibiotic. This can make it much harder to treat.

Lifestyle changes to treat and prevent UTIs

The lifestyle changes below will help get rid of your UTI. They may also help prevent future UTIs.

  • Drink plenty of fluids. This includes water, juice, or other caffeine-free drinks. Fluids help flush bacteria out of your body.

  • Empty your bladder. Always empty your bladder when you feel the urge to urinate. And always urinate before going to sleep. Urine that stays in your bladder can lead to infection. Try to urinate before and after sex as well.

  • Practice good personal hygiene. Wipe yourself from front to back after using the toilet. This helps keep bacteria from getting into the urethra.

  • Use condoms during sex. These help prevent UTIs caused by sexually transmitted bacteria. Also don't use spermicides during sex. These can increase the risk for UTIs. Choose other forms of birth control instead. For women who tend to get UTIs after sex, a low-dose of a preventive antibiotic may be used. Be sure to discuss this option with your healthcare provider.

  • Follow up with your healthcare provider as directed. He or she may test to make sure the infection has cleared. If needed, more treatment may be started.

Urinary Tract Infections in Men

Urinary Tract Infections in Men

Side view cross section of male pelvis showing penis, testicle, urethra going through penis from bladder, rectum behind bladder, and kidney attached to bladder by ureter.

Urinary tract infections (UTIs) are most often caused by bacteria that invade the urinary tract. The bacteria may come from outside the body. Or they may travel from the skin outside of the rectum into the urethra. Pain in or around the urinary tract is a common symptom for most UTIs. But the only way to know for sure if you have a UTI is to have a urinalysis and urine culture. 

Types of UTIs

  • Cystitis. This is a bladder infection. It is often linked to a blockage from an enlarged prostate. You may have an urgent or frequent need to urinate, and bloody urine. Treatment includes antibiotics and medicine to relax or shrink the prostate. Sometimes you will need surgery.

  • Urethritis. This is an infection of the urethra. You may have a discharge from the urethra or burning when you urinate. You may also have pain in the urethra or penis. It is treated with antibiotics.

  • Prostatitis. This is an inflammation or infection of the prostate. You may have an urgent or frequent need to urinate, fever, or burning when you urinate. Or you may have a tender prostate, or a vague feeling of pressure. Prostatitis is treated with a range of medicines, depending on the cause.

  • Pyelonephritis. This is a kidney infection. If not treated, it can be serious and damage your kidneys. In severe cases you may need to stay in the hospital. You may have a fever and lower back pain.

Medicines to treat a UTI

Most UTIs are treated with antibiotics. These kill the bacteria. The length of time you need to take them depends on the type of infection. Take antibiotics exactly as directed until all of the medicine is gone. If you don't, the infection may not go away and may become harder to treat. For certain types of UTIs, you may be given other medicine to help treat your symptoms.

Lifestyle changes to treat and prevent UTIs

The lifestyle changes below will help get rid of your current infection. They may also help prevent future UTIs.

  • Drink plenty of fluids such as water, juice, or other caffeine-free drinks. This helps flush bacteria out of your system.

  • Empty your bladder when you feel the urge to urinate and before going to sleep. Urine that stays in your bladder promotes infection.

  • Use condoms during sex. These help prevent UTIs caused by sexually transmitted bacteria.

  • Keep follow-up appointments with your healthcare provider. He or she can may do tests to make sure the infection has cleared. If needed, more treatment can be started.

Other treatments to prevent UTIs

Most UTIs respond to medicine. But sometimes you will need a procedure or surgery. This can treat an enlarged prostate, or remove a kidney stone or other blockage. Surgery may also treat problems caused by scarring or long-term infections.

Catheter-Associated Urinary Tract Infections

Catheter-Associated Urinary Tract Infections

Cross section of bladder showing catheter in place.

A catheter-associated urinary tract infection (CAUTI) is an infection of the urinary system. CAUTI is caused by bacteria that enter the urinary tract when a urinary catheter is used. This is a tube that’s placed into the bladder to drain urine.

The urinary system

This system includes the kidneys, ureters, bladder, and urethra. The kidneys filter blood and make urine. The ureters carry urine from the kidneys to the bladder. The bladder stores urine. The urethra carries urine from the bladder to the outside of the body.

What is a urinary catheter?

A urinary catheter is a thin, flexible tube. It is placed in the bladder to drain urine. Urine flows through the tube into a collecting bag outside of the body. There are different types of urinary catheters. The most common type is an indwelling catheter. This is also known as a urethral catheter. This is because it’s placed into the bladder through the urethra. This catheter is also called a Foley catheter.

Why is a urinary catheter needed?

A urinary catheter is needed for any of the following:

  • You can’t get up to use the toilet because your mobility is limited. This may be due to surgery, an injury, or illness.

  • You have a blockage in your urinary system.

  • Your healthcare provider needs to measure the amount of urine you pass.

  • The function of your kidneys and bladder is being tested.

  • You’re not able to control your bladder (incontinence).

In most cases, the urinary catheter is temporary. You'll need it only until the problem that requires it is resolved. 

How does a CAUTI develop?

Bacteria can enter the urinary tract as the catheter is put into the urethra. Bacteria can also get into the urinary tract while the catheter is in place. The common bacteria that cause a CAUTI are ones that live in the intestine. These bacteria don’t normally cause problems in the intestine. But when they get into the urinary tract, a CAUTI can result.

Why is a CAUTI of concern?

Left untreated, a CAUTI can lead to health problems. These problems may include bladder infection, prostate infection, and kidney infection. A CAUTI can prolong your hospital stay. If the infection is not treated in time, serious health complications may occur.

What are the symptoms of a CAUTI?

  • A burning feeling, pressure, or pain in your lower abdomen

  • Fever or chills

  • Urine in the collecting bag is cloudy or bloody (pink or red)

  • Burning feeling in the urethra or genital area

  • Aching in the back (kidney area)

  • Nausea and vomiting

  • Person is confused, or is not alert, or has a change in behavior (mainly affects older patients)

  • Note that sometimes a person won’t have any symptoms but may still have a CAUTI.

Tell a healthcare provider right away if you or your loved one has any of these symptoms.

How is CAUTI diagnosed?

If you have symptoms of CAUTI your healthcare provider will order tests. These include a urine test, blood tests, and other tests as needed.

How is CAUTI treated? 

Treatment may involve any of the following:

  • Antibiotics. Your healthcare provider will likely prescribe antibiotics if you have symptoms. Be aware that if you don’t have symptoms, you may not be given antibiotics. This is to prevent an increase in bacteria that resist (can’t be killed by) certain antibiotics.

  • Removing the catheter. The catheter will be removed when your healthcare provider decides it’s no longer needed. This usually helps stop the infection.

  • Changing the catheter. If you still need a catheter, the old one will be removed. A new one will be put in. This may help stop the infection.

How do hospital and long-term facility staff prevent CAUTI?

To keep patients from getting a CAUTI, the staff follow certain procedures:

  • Prescribe a catheter only when it’s needed. It is removed as soon as it’s no longer needed.

  • Use sterile (clean) technique when placing the catheter into the urinary tract. This means before putting the catheter in, the caregiver washes his or her hands with soap and water. He or she then puts on sterile gloves. A sterile catheter kit that has cleansers is used to cleanse the patient’s genital area.

  • Before performing catheter care, caregivers also wash their hands or use an alcohol-based hand cleanser.

  • Hang the bag lower than your bladder. This prevents urine from flowing back into your bladder.

  • Ensure that the bag is emptied regularly.

What you can do as a patient to prevent CAUTI

You can help prevent yourself from getting a CAUTI by doing the following:

  • Every day ask your healthcare provider how long you need to have the catheter. The longer you have a catheter, the higher your chance of getting a CAUTI.

  • If a caregiver doesn’t clean his or her hands and put on gloves before touching your catheter, ask them to do so.

  • If you’ve been taught how to care for your catheter, be sure to wash your hands before and after each session.

  • Make sure your bag is lower than your bladder. If it’s not, tell your caregiver.

  • Don’t disconnect the catheter and drain tube. Doing so allows germs to get into the catheter.

  • Cleansing of the genital and perineal areas is very important to help decrease bacteria in areas surrounding the catheter. Ask your doctor what you should use and how often to clean these areas.

If you are discharged with an indwelling catheter

  • Before you leave the hospital, make sure you understand the instructions on how to care for your catheter at home.

  • Ask your healthcare provider how long you need the catheter. Also ask if you need to make a follow-up appointment to have the catheter removed.

  • Always use sterile (clean) technique when caring for your catheter. Wash your hands before and after doing any catheter care.

  • Call your healthcare provider right away if you develop symptoms of a CAUTI (see above).