In this article:
- Urinary tract infection (UTI) is an infection caused by an overgrowth of harmful bacteria.
- Women are more vulnerable to UTIs than men because they have a shorter urethra, which makes it easier for bacteria to reach the bladder.
- If not properly treated, the infection can advance to the kidneys.
- An infection in the urethra is called urethritis, a bladder infection is called cystitis, and a kidney infection is called pyelonephritis.
- UTIs can be managed by practicing proper personal hygiene and taking doctor-prescribed medications.
Urinary tract infections (UTIs) are caused by the rapid growth of bacteria in different parts of the urinary system, namely, the kidneys, ureters, urethra, and bladder.
UTIs are major contributors to the global burden of disease and health expenditure and affect people of all ages. The overwhelming incidence of UTI can be gauged from the fact that it affects nearly 150 million people around the world every year.
Although both genders can contract UTI, women have a far higher likelihood of developing this condition than men. Women have a shorter urethra, which facilitates the easy travel of bacteria up to the bladder.
An overwhelming 40% of women have grappled with this condition at one point or another, and approximately 20% experience recurrence. Recurrent UTI is mostly due to the antibiotic resistance developed by the causative organisms through biofilm formation. (1)
Immediate medical treatment is necessary so that the infection does not cause damage to the kidneys. In addition to conventional treatment, a number of home remedies can help relieve UTI-related discomfort and can fast-track recovery.
Types of Urinary Tract Infections
The urinary tract comprises of the bladder and urethra in the lower part of the system and the kidneys and ureters in the upper part.
Depending upon which section of the tract harbors the bacteria, UTIs can be divided into two broad categories. Infections that are limited to the bladder and urethra are referred to as lower UTIs, whereas those that affect the kidneys and ureters are described as upper UTIs.
Lower UTIs are far more prevalent than upper UTIs and pose a lesser health risk. It is when the bacteria enter the upper urinary tract that the condition can take a serious turn, sometimes even leading to kidney damage.
The three types of UTIs are:
The urethra is a narrow tube that carries urine from the bladder to be excreted outside the body. The inflammation of this duct due to an infection is referred to as urethritis.
Although most cases of urethritis result from sexually contracted infections, sometimes the swelling can be a by-product of physical trauma or injury to the urethra.
Infection-causing bacteria can travel up the urethra into the bladder and give rise to a common type of UTI known as cystitis.
These bacteria multiply within the bladder and attach themselves to its internal lining. Due to this bacterial activity, the bladder becomes irritated, and inflammation occurs. However, the damage is quite superficial and usually resolves after a short duration.
Women are more affected by this kind of bladder infection since they have shorter urethras than men.
An infection that spreads further upstream through the ureters into the kidneys is known as pyelonephritis. This kind of UTI usually results from a blockage in the urinary tract, which may cause a backflow of urine into the kidneys.
Because your kidneys are involved, this kind of infection can disrupt your renal function, damage your kidneys, and lead to other serious health complications. However, prompt treatment can help contain the damage and safeguard you from any potential risks.
Causes of Urinary Tract Infections
The most common culprit behind 90% of UTI cases is enteric bacteria, a strain of bacteria that populate the human intestinal tract but rarely cause any health concern.
It is when these otherwise harmless bacteria enter the urinary tract that infections may occur. The urinary tract provides an ideal breeding ground for these bacteria, resulting in full-blown infections.
If the infection is left untreated, the disease-causing bacteria can then make their way up into the urinary tract. The infection can progress from the urethra to the bladder and then eventually to the kidneys through the ureters.
However, most UTIs occur in the urethra and bladder only. Often, these infections are resolved before it can spread to the kidneys.
Symptoms of Urinary Tract Infections
Common symptoms of UTI include:
- Frequent urge to urinate but only passing a small quantity of urine
- Burning sensation when urinating
- Change in urine color
- Cloudy urine
- Intensely foul-smelling urine
- Pus or blood in the urine
- Painful urination
- Pain radiating from the bladder, lower abdomen, groin, or pelvis
- Back pain
- Malaise, general discomfort, or being unwell
- Diminished energy levels characterized by lack of interest in activities and constant fatigue
- Vaginal irritation
- Pain while having penetrative sex
Diagnosis of Urinary Tract Infections
Your doctor is likely to prescribe a urinalysis to check for the presence of blood cells, proteins, bacteria, and other biochemical compounds that indicate UTI. A urine culture may also be ordered to identify the causative bacteria and the appropriate antibiotic to be given.
Individuals with recurrent UTIs may be checked for kidney stones or swelling in the kidneys. For this, the doctor may order an x-ray of the urinary tract (cystogram).
A cystoscopic exam may also be done, in which a small tube is inserted into the urethra to check the inside of the bladder and urethra for any problems that might be causing the symptoms.
Standard Treatment for Urinary Tract Infections
UTIs are usually treated with antibiotics and biofilm disruptors.
Your doctor will prescribe antibiotics in accordance with the results of the lab tests. Make sure you take the complete course of antibiotics. Drink ample amounts of water to facilitate the removal of the bacteria through the urine.
Some doctors also prescribe phenazopyridine (Pyridium) to reduce bladder pain during urination. However, keep in mind that this medication can only relieve the pain; it is still necessary to take antibiotics to fight the infection.
Mild UTIs are prescribed a 3-7 day antibiotic course, whereas recurrent or severe UTIs require a treatment duration of 10-14 days.
Individuals who contract UTIs about 3-4 times a year need to see a doctor. They may be prescribed low-dose antibiotics to be taken for 6 months at least or after sexual intercourse to prevent recurrences.
Note: Individuals with recurrent UTIs must not self-medicate by using leftover antibiotics.
The UTI-causing bacteria and their extracellular secretions can adhere to the epithelial lining of the urinary tract. This cluster of bacteria and their by-products is called a biofilm.
Biofilms can hamper the action of most antibiotics, making treatment difficult. They contribute to the development of antibiotic resistance and recurrence of the infection in some individuals.
Thus, it is necessary to completely demolish the bacterial presence from your system to prevent any recurrence. One way of doing so is by using biofilm disruptors.
Biofilm disruptors are composed of enzymes that shatter the biofilm matrix of the bacteria. These enzymes work by dissolving the sugar and fibrin lining of the pathogenic biofilm and destroying it completely.
Tips to Ward Off a Urinary Tract Infection
1. Self-Care Tips
- When nature calls, answer: Always urinate on the first impulse. Do not hold your urine for long.
- Practice toilet hygiene: Ensure proper hygiene habits. Wipe yourself properly front to back whenever you visit the restroom.
- Practice post-sex hygiene: Make sure to urinate every time you have sex to flush out the bacteria.
- Observe menstrual hygiene: Change your sanitary pads or tampons frequently when on a period. Wearing blood-stained pads or tampons for long can breed bacteria that can travel up to your urethra.
- Keep yourself hydrated: Drink plenty of water to encourage regular bowel movements and avoid constipation. When you are constipated, bacteria can remain in the rectum, which may cause UTI.
- Stay physically active: Regular exercise, along with a healthy, wholesome diet, provides the perfect boost to your immune system.
- Modify your diet: Add fiber-rich and immunity-boosting foods to your diet, which can embolden your body’s natural defenses against the infection-causing bacteria.
As long as the infection persists, it is best to avoid foods that can further irritate your bladder and make recovery more difficult. Follow a diet that is low on spicy, sugary, carbonated, and acidic foods.
- Avoid using irritant products: Several products such as spermicides, douches, deodorant sprays, scented toilet rolls, dusting powders, and other feminine hygiene products can irritate the urethra and cause an infection in some women. Doctors recommend the avoidance of these products to keep UTI at bay.
- Apply a warm compress: Set the temperature of your heating pad to comfortably warm, and place it on your abdomen to relieve bladder pressure or discomfort.
- Take vitamin C: Vitamin C may increase the acidic content of your urine and help control the growth of bacteria. Consume foods that are naturally loaded with vitamin C, or ask your doctor about taking a supplement.
- Pre-surgical care: Antibiotics are usually administered before urinary tract surgery to minimize the risk of infection and complications. Ask your doctor about it.
2. Stay Hydrated
Increasing your fluid intake is the most fundamental step in the treatment of UTIs. No intervention can replace your fluid intake when it comes to addressing UTIs.
You must drink a minimum of 8-10 glasses of water daily. Higher fluid intake will result in more urine production, making it easier for the body to expel the infection-causing bacteria from your system. Thus, drink more to recover faster. (10)
You can also meet your daily fluid needs by eating succulent fruits and vegetables or drinking their juices. These alternate sources are often packed with a number of vitamins and minerals, which can further strengthen your body’s fight against the infection.
Note: Limit your intake of caffeinated and alcoholic beverages for as long as the infection persists. These beverages are counterproductive and can even dehydrate your body.
3. Drink Cranberry Juice
Cranberries are almost entirely made up of water (about 90%) and are high in flavonoids. These nutrient-rich berries are renowned for their antioxidant properties, but they also exhibit a mild degree of antibacterial activity, which can be optimized for combating UTIs.
Cranberry juice contains concentrated amounts of proanthocyanidins (PACs), a class of polyphenolic compounds that may prevent the infection-causing bacteria from adhering to the urethral opening.
A study reported that the consumption of varying amounts of cranberry (450 ml to 720 ml) resulted in a low urinary pH. (4)
Cranberries were also found to play a significant role in inhibiting the associated symptoms of UTI by arresting the inflammation caused by a microbial attack in the urinary system. (4)
A 2018 review found that cranberry products may be safe, cost-effective, and non-antibiotic agents for UTI prevention, especially in those who use a urinary catheter for prolonged periods or have undergone radiotherapy for prostate cancer. (2)
However, some inconsistencies have to be taken into account. For starters, the recommended dose of PAC that engendered the desired effect was unclear. Second, the subject pool in the reviewed studies was quite heterogeneous, which presents some disadvantages. (2)
Moreover, the findings of a 2017 meta-analysis, which included seven randomized controlled trials conducted on a total of 1,498 participants, revealed that cranberry might help lower the risk of UTI recurrence in otherwise healthy women. (3)
However, since most of the studies included in this activity had a relatively small sample size, these results need to be confirmed by more high-quality and large-scale research. (3)
Yet another 2014 randomized controlled trial demonstrated the promising potential of cranberry capsules in reducing the incidence of clinically defined UTIs in high-risk subjects. However, no such benefits were reported in people with a low UTI risk. (5)
Note: Cranberry juice is not recommended for people with a history of kidney stones. Consume unsweetened cranberry juice if you wish to optimize its medicinal value. If the taste is unpalatable for you, mix it with a small amount of apple juice.
While considerable evidence supports the use of cranberry products as a therapeutic agent against UTI, it is recommended that you consult your doctor for the appropriate dosage and mode of consumption.
4. Take Probiotics
Probiotics are beneficial bacteria that help to keep harmful bacteria in check. When the good and bad bacteria within the body are in a healthy equilibrium, the risk of infection and disease is inadvertently reduced, and vice versa.
You can help your body fight off the UTI-causing bacteria by giving it a dose of probiotics. When there is an overgrowth of harmful bacteria in the urinary tract, you need good bacteria in larger forces to counter their activity and curb the infection.
A number of dietary sources can supply your body with probiotics and restore the balance between favorable and unfavorable bacteria.
Fermented foods like greek yogurt, suerkraut, cheese, kimchi, kefir are loaded with probiotics, but you can also take it in supplement form if you fail to get your required dose through dietary sources alone.
As is the case with any other supplement, you must consult your doctor about the proper dosage before starting.
Review studies found that probiotics may regulate urinary microbiota (UM), reducing the risk of urogenital infections. However, further large-scale studies are needed to provide definitive insights into the therapeutic role of probiotics in UTI treatment. (6)(7)(9)
Yet another 2019 randomized controlled trial that included 181 children with a history of febrile UTI suggested that probiotic therapy may help reduce the risk of UTI recurrence in children without causing any adverse side effects. (8)
Probiotic consumption may be a safe and effective way to replenish the good bacteria in your urinary system, reducing the risk of UTI and its recurrence. That said, there is still a lot of blind spots as far as dosage and mode of consumption are concerned, which can only be addressed through further research on the topic.
Also, before initiating any major dietary intervention such as consuming probiotics, you must consult your doctor about the risks and appropriate dosage.
5. Take D-Mannose Supplements
D-mannose is a natural sugar found in fruits and vegetables that may combat UTI-causing bacteria. D mannose supplements can help cleanse the urethra by eliminating bacteria in a way similar to most antibiotics.
A randomized placebo-controlled nonblinded clinical trial that included 308 female subjects found D-mannose powder to be as effective as conventional antibiotics (nitrofurantoin) for preventing recurrent UTI. However, these findings need to be confirmed by more rigorous and large-scale studies. (11)
Another pilot study performed between April 2014 and July 2015 at the Department of Gynecological Obstetrics and Urologic Sciences of the Sapienza University of Rome highlighted the potential efficacy of D-mannose supplementation for the management and prevention of acute cystitis. (12)
However, as promising as the results of this study are, they need to be corroborated by more extensive research to be advocated for large-scale therapy. (12)
Risk Factors for Urinary Tract Infections
While almost anyone can be down with a UTI, some people are more likely than others to contract this infection. These groups include:
- People who have diabetes
- Infants with a congenital abnormality in the urinary tract
- Women, especially those on birth control or who are sexually active
- People who are overweight
- Men who have trouble with urination or bladder emptying
- People who are using urinary catheters
- People who have a history of spinal cord injuries
Recurrence of UTI
The following factors can make you more prone to a UTI recurrence:
Functional Problems: If you have any kind of structural deformity in the urinary tract, you are more likely to suffer from recurrent episodes of UTI.
Vesicoureteral reflux, for instance, is a common form of urinary tract dysfunction that is characterized by a backward flow of urine from the bladder into one or both of the ureters and sometimes even to the kidneys.
When urine passes from the ureters into the bladder, a set of valves keeps it from moving backward. A problem arises when either or both of these valves have defects.
Some people are born with such malfunctioning valves. Others may develop this condition due to excessive pressure inside the bladder.
Female Anatomy: Women have shorter urethras than men. The short length makes it easier for the infection-carrying bacteria to find their way into the urinary tract.
Sexual Intercourse: Sexually active women are more prone to recurrent UTIs. During sexual intercourse, bacteria in the vaginal area are pushed up into the urethra and travel to the bladder. Urine in the bladder offers the perfect environment for them to multiply and cause an infection.
Improper Toilet Hygiene: People who are in the habit of wiping their nether region from back to front after defecating are more at risk of reinfection. The bacteria around the anus are brought to the urethral opening, which is an entry point into the urinary tract.
Contraceptives: People who use contraceptives such as spermicides and diaphragms often suffer from repetitive bouts of UTI.
Complications of Urinary Tract Infections
Untreated and recurrent UTIs can lead to the following problems:
- Pyelonephritis: It is a severe form of UTI that affects the kidneys and is associated with several serious complications, including kidney damage. If left untreated, this type of kidney infection can severely jeopardize your renal as well as overall health.
- Struvite stones: Struvite is a mineral that is secreted by certain strains of bacteria that are responsible for UTI. When these bacteria break down urea into ammonia, they release struvite as a by-product, which crystallizes to form struvite stones.
People who frequently suffer from UTIs are more likely to develop these stones due to the increased bacterial presence. Due to the higher incidence of UTIs in women, they are more susceptible to developing struvite stones than men.
If struvite stones are not properly and promptly treated, they can continue growing in size and become large enough to block the kidney, ureter, or bladder.
UTI During Pregnancy
There is an increased prevalence of UTIs among pregnant women, largely due to the anatomical changes that they go through. The fetus grows inside the uterus, which sits atop the bladder. Thus, the weight of the burgeoning uterus during pregnancy is borne directly by the bladder.
The increased pressure can sometimes obstruct the flow of urine from the bladder into the urethra and can pave the way for an infection. The longer the infection is allowed to fester, the more likely that the bacteria will spread to the kidneys.
Once the kidneys become infected, the risk of preterm labor increases, moreover, childbearing women who are diagnosed with kidney infection are more likely to deliver low-birth-weight babies.
Even a mild case of UTI can escalate into a serious condition if not addressed in a proper and timely manner. The infection should be an even bigger concern during pregnancy when another life may be affected.
To avoid any kind of adverse pregnancy outcomes, it is essential that the UTI must be treated as soon as possible. Early treatment is key to ensure that the infection will not affect the baby.
Speak to your ob-gyn about the most appropriate treatment strategy for your condition. The doctor will prescribe antibiotics that are safe to use during pregnancy.
Urinary Tract Infections vs. Kidney Stones
Certain symptoms that are typically associated with UTIs can also be experienced during the early stages of kidney stone formation, but both conditions are fundamentally different.
UTIs are caused by the entry of certain bacteria, such as E.coli, into the urinary system. These pathogens multiply and move up the urinary tract, from the urethra to the bladder and eventually to the kidneys, if the infection is left untreated.
Kidney stones develop when the body does not produce enough urine to excrete the excess mineral salts from the body. These minerals accumulate within the kidney and crystallize over time to form kidney stones.
Although the root cause of kidney stones is different from that of UTIs, the former can be a risk factor for the latter.
If a kidney stone gets lodged into the urinary tract, the blockage can create an ideal environment for the UTI-causing bacteria to flourish. For this reason, people with kidney stones have an increased likelihood of developing UTIs.
Also, since the preliminary symptoms of kidney stones can easily be mistaken for those of a UTI, the patient may fail to get proper and timely treatment for the stones.
UTI in Infants and Children
Infants and young children are especially prone to UTIs, which often go undetected due to the absence of noticeable symptoms. UTIs are pretty common and easy to treat, but they do not resolve on their own.
The delay in treatment can make the condition worse for the child, which necessitates that parents remain vigilant about the slightest sign of an infection.
Fever is one of the first and most reliable signs of an infection. The body raises its core temperature to destroy the invading bacteria, which translates into a fever.
Thus, even if your child runs a high temperature but does not show other symptoms, you must still exercise the necessary precautions and visit the doctor. In fact, there is a 1 in 20 chance that a fever-stricken child without other noticeable symptoms is suffering from a UTI.
Other common warning signs to look out for include:
- Nausea and vomiting
- Painful urination
- Pain in the lower abdomen
- Increased urination
The incidence of UTIs is much higher among girls as they have shorter urethras than boys. Uncircumcised boys have a slightly higher risk of developing UTIs than those who have been circumcised.
Myth 1: Tight clothing can cause UTIs.
Some people believe that wearing tight clothes can lead to UTIs, but there is no truth to this claim. The fit of your clothing is not an issue, so long as your clothes are dry.
The infection-causing bacteria thrive in warm, humid conditions, and that is why you should change out of damp clothes as soon as possible to avoid contracting an infection. This is a major concern for women who lose some degree of bladder control during pregnancy and encounter frequent urine leaks as a result.
Certain fabrics tend to be more absorbent than others and have the ability to wick moisture away from your body. Cotton fares the best on both these counts and is, therefore, the most preferred fabric choice for underpants.
Myth 2: Men do not get UTIs.
While it is true that UTI is predominantly a female problem, it can affect men as well. Men with an enlarged prostate or kidney stones often experience difficulty in emptying their bladder, which can result in the accumulation of bacteria in the urinary tract.
However, the incidence of UTI in males is still lower than that in females.
Myth 3: The recurrence of urinary infection suggests that the antibiotic did not work.
A UTI that makes a comeback after being resolved with an antibiotic course is often misinterpreted by many as a failure of treatment. However, UTI recurrence is pretty common but has little to do with the effectiveness of your medication.
In most cases, your doctor will order a urine culture to arrive at a conclusive explanation for the recurrence and will make adjustments to your treatment accordingly.
When to See a Doctor
If you suspect a UTI, immediately seek medical help to prevent the condition from worsening. Proper and timely treatment is needed to avoid complications.
Medical attention becomes even more imperative if you experience any of the following symptoms:
- Blood in the urine
- Incessant pain and burning sensation during urination
- Fever and chills
What you may ask your doctor:
- Is my condition treatable without medication?
- How long will it take to eliminate the infection completely?
- What hygiene measure should I undertake?
- Do these medications have any side effects?
- What dietary changes do you suggest?
What your doctor may ask you:
- What symptoms are you experiencing?
- For how long have you been experiencing the symptoms?
- Do you suffer from recurrent UTIs?
- Are you sexually active?
Expert Answers (Q&A)
Answered by Dr. Dana C. Rice, MD (Urologist)
Urinary tract infection is a catchall phrase that is used loosely in many different ways. Ureaplasma infections are sexually transmitted infections (STI) that can lead to urinary symptoms.
However, not all bacterial infections in the bladder are sexually transmitted. In fact, most bacterial cystitis infections (bladder infections) are not sexually transmitted.
There are also upper urinary tract infections (kidney infections) that are not sexually transmitted and are often called UTIs, instead of pyelonephritis. In addition, many “UTIs” are not infections at all but rather urethral irritation or pain.
The female’s anatomical structure makes them more prone to bacterial infections. The urethra in females is much shorter than that in males. Hence, bacteria can reach the bladder more easily in females.
In addition, the urethra is in close proximity to the vaginal area, which naturally is colonized with bacteria. Hormone status also can impact susceptibility to UTIs.
All of these are possible causes of the increased infection risk over men.
Symptoms of a UTI can pass without treatment. If a true bacterial infection is documented, it is possible that it may flush out on its own. It is also possible to be colonized with bacteria, meaning there will always be bacteria in the urine, but it does not cause symptoms for the patient.
When a patient is colonized with bacteria, their symptoms may actually get more bothersome if they are treated with antibiotics. Also, overtreating with antibiotics for negative urine cultures can lead to antibiotic-resistant organisms.
True culture-positive UTIs should be treated if the patient is symptomatic and experiences pain, blood in the urine, fever, etc. Treating infections early can prevent bladder lining irritation and inflammation, ascending infections (pyelonephritis), and sepsis.
Bladder analgesics such as phenazopyridine (Pyridium, AZO, etc.) would provide most patients relief from the dysuria and urinary frequency. It is not an antibiotic, however, so it will not treat a bacterial infection.
D-Mannose is a supplement that has been shown to prevent UTIs and is also widely available. Patients with E. coli infections can take D-mannose and AZO to avoid antibiotic treatment for UTIs.
Knowing your body and learning your trigger points are of utmost importance. Patients who track their symptoms and can pinpoint causes for UTIs can generally develop prevention strategies that work well consistently.
Hormones, sexual acts, hydration status, time of and position when voiding, and bowel movements play roles in UTI prevention. Drinking plenty of water, lubrication during sexual intercourse, and timed voiding are the most effective preventive tips across all age groups.
About Dr. Dana C. Rice, MD: Dr. Rice is a board-certified urologist in Washington, DC. After completing her medical studies, she did her postgraduate residency at George Washington University.
She co-authored a chapter on a book about urinary tract infections and developed her very own UTI Tracker app to help educate patients and physicians alike. Dr. Rice resides in Mclean, VA, and maintains a very busy surgical practice.