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A urinary tract infection (UTI) is caused when bacteria enter the urethra and spread throughout the urinary system. The urinary tract actually includes the kidneys, the ureters, the bladder and the urethra, although infections of specific organs are given individual names. Infections will usually start in the urethra and the bladder and then move on to the ureters and kidneys, so it's important to get UTIs treated promptly before they become more serious.
Urinary tract infections are more common in women, and while the exact reason isn't known, it's most likely due to the relative shortness of the female urethra and the urethra's closeness to the vaginal and anal openings, allowing cross-contamination.
Anyone who has to use a catheter for an extended period of time is also at risk for a urinary tract infection. Even though catheters are sterilized, they provide an easy means for bacteria to enter the urinary tract.
Obstructions in the urinary tract, such as kidney stones, conditions that don't allow the bladder to completely empty, and some congenital defects all have the potential to cause UTIs by introducing bacteria to the system. Any disease that weakens the immune system can cause urinary tract infections by making bacteria more difficult to fight. In males, being uncircumcised is also a potential breeding ground for bacteria.
The symptoms of a urinary tract infection vary from person to person. The urge to urinate frequently is common, although they may actually produce little urine at any given time. There may also be a burning pain while urinating and a milky, cloudy or reddish tint to the urine. There may be pressure in the pelvic area. People with a UTI may also have more generic symptoms, such as feeling tired and worn out or having a fever. A fever, along with nausea, vomiting and a pain in the back or under the ribs, may mean that the infection has become more severe and spread to the kidneys.
A doctor will test for a urinary tract infection through urinalysis, and an infection can typically be treated with antibiotics. If you suspect that you may have a UTI, you should visit your doctor immediately.
Symptoms of lower urinary tract infections usually begin suddenly and may include one or more of the following signs:
The urge to urinate frequently, which may recur immediately after the bladder is emptied.
A painful burning sensation when urinating. (If this is the only symptom, then the infection is most likely urethritis, an infection limited to the urethra.)
Discomfort or pressure in the lower abdomen. The abdomen can feel bloated.
Pain in the pelvic area or back.
The urine often has a strong smell, looks cloudy, or contains blood. This is a sign of pyuria, or a high white blood cell count in the urine, and is a very reliable indicator of urinary tract infections.
Occasionally, fever develops.
Symptoms of kidney infections tend to affect the whole body and be more severe than those of cystitis (inflammation of the bladder and ureters). They may include:
Symptoms of lower UTIs that persist longer than a week. (Sometimes lower UTI symptoms may be the only signs of kidney infection. People at highest risk for such "silent" upper urinary tract infections include patients with diabetes, impaired immune systems, or a history of relapsing or recurring UTIs.)
An increased need to urinate at night.
Chills and persistent fever (typically lasting more than 2 days).
Pain in the flank (pain that runs along the back at about waist level).
Vomiting and nausea.
UTIs in infants and preschool children tend to be more serious than those that occur in young women, in part because they are more likely to involve the kidneys. (Older children are more likely to have lower urinary tract infections and standard symptoms.) Infants and young children should always be checked for UTIs if the following symptoms are present:
A persistent high fever of otherwise unknown cause, particularly if it is accompanied by signs of feeding problems and debility, such as listlessness and fatigue.
Painful, frequent, and foul smelling urine. (Parents are generally unable to identify a UTI just by the smell of their child's urine. Medical tests are needed.)
Cloudy urine. (If the urine is clear, the child most likely has some other ailment, although it is not absolute proof that the child is UTI-free.)
A recurrence of bedwetting or poor urine control during the day in the child who had previously achieved control.
Abdominal and low back pain may be present.
Vomiting and abdominal pain (usually in infants).
The classic lower UTI symptoms of pain, frequency, or urgency and upper tract symptoms of flank pain, chills, and tenderness may be absent or altered in older patients with UTIs.
Symptoms of UTIs that may occur in seniors but not in younger adults may include mental changes or confusion, nausea or vomiting, abdominal pain, or cough and shortness of breath. Concomitant illness may further confuse the picture and make diagnosis difficult.
Treatment for a UTI should be designed for each patient individually and is usually based on how sick the patient is, what pathogen(s) are causing the infection, and the susceptibility of the pathogen(s) to treatments. Patients who are very ill usually require IV antibiotics and admission to a hospital; they usually have a kidney infection (pyelonephritis) that may be spreading to the bloodstream. Other people may have a milder infection (cystitis) and may get well quickly with oral antibiotics. Still others may have a UTI caused by pathogens that cause STDs and may require more than a single oral antibiotic. The caregivers often begin treatment before the pathogenic agent and its antibiotic susceptibilities are known, so in some individuals, the antibiotic treatment may need to be changed. In addition, pediatric patients and pregnant patients should not use certain antibiotics that are commonly used in adults. For example, ciprofloxacin (Cipro) and other related quinolones should not be used in children or pregnant patients due to side effects. However, penicillins and cephalosporins are usually considered safe for both groups if the individuals are not allergic to the antibiotics. Patients with STD-related UTIs usually require two antibiotics to eliminate STD pathogens. The less frequent or rare fungal and parasitic pathogens require specific antifungal or antiparasitic medications; these more complicated UTIs should often be treated in consultation with an infectious-disease expert.
All antibiotics prescribed should be taken even if the person's symptoms disappear early. Reoccurrence of the UTI and even antibiotic resistance of the pathogen may happen in individuals who are not adequately treated.
Over-the-counter medicines offer relief from the pain and discomfort of UTIs but they don't cure UTIs. Over-the-counter products that contain the medicine phenazopyridine, which works in the bladder to relieve pain. This medication turns urine an orange-red color, so patients should not be worried when this occurs. This medication can also turn other body fluids orange, including tears, and can stain contact lenses.