Urinary tract infections (UTIs) are a common condition affecting up to 50% of women at least once¹ in their lifetime. According to the Office on Women’s Health², women are 30 times more likely to get UTIs than men, with as many as 4 in 10 experiencing a repeat infection within 6 months. About 1 in 10 men³ will experience a UTI at least once. This article serves as a guide to urinary tract infections, encompassing their symptoms, causes, diagnostic tests, treatment options and more.
What is a Urinary Tract Infection?
A urinary tract infection is an infection of the urinary system. It occurs when there is significant bacteria within the urinary system, including the kidneys, ureters, bladder and urethra. UTIs can impact any part of the urinary system, although they usually begin with the bladder or urethra⁴. Prompt treatment is essential to stop the infection from spreading to the ureters and kidneys.
Different Parts of the Urinary Tract
The urinary tract is a network of organs responsible for removing waste from the body. It consists of the kidneys, ureters (upper urinary tract) and bladder and urethra (lower urinary tract). Each part has a distinct function: filtering the blood, eliminating waste and removing excess fluid. Infection in each location, known as different types of UTIs, may present with specific symptoms. The three main types of urinary tract infections are:
Lower Urinary Tract Infections:
- Cystitis (Bladder Infection): Cystitis is the most common type of UTI that occurs in the bladder. Individuals may experience signs such as frequent or painful urination, cloudy or discoloured urine, and lower abdominal pain.
Upper Urinary Tract Infections:
- Pyelonephritis (Kidney Infection): Pyelonephritis typically progresses from a bladder infection and is considered more serious than cystitis. It can affect one or both kidneys. Symptoms include fever, chills, nausea and pain in the back or sides.
- Urethritis (Urethra Infection, mainly in males, sometimes related to sexually transmitted infections): Urethritis refers to the inflammation of the urethra. This type of infection can cause discharge and a burning sensation during urination. There are three types of urethritis: gonococcal urethritis (caused by gonorrhoea), nongonococcal urethritis (not caused by gonorrhoea), and non-specific urethritis (of unknown cause).
General Symptoms of a Urinary Tract Infection
Although UTI symptoms may vary depending on the location of the infection, they generally include:
- Urge incontinence (an urgent and uncontrollable need to pee, often resulting in leakage), or “urgency”
- Frequent urination, or “frequency”
- Burning sensation during urination, or “dysuria”
- Cloudy or reddish-coloured urine
- Foul-smelling urine
- Pressure or pain in the pelvic region
- Malaise (a general feeling of discomfort and weakness)
- Fever and chills
- Sometimes, headache, backaches, loin pain, vomiting
Causes of Urinary Tract Infections
Normal urine is sterile and does not contain any bacteria⁵. Urinary tract infections happen when pathogens enter the urinary tract and multiply, leading to an infection.
E. coli, a type of bacteria that lives in the gut, accounts for over 90% of bladder infections⁶. E. coli can spread to the bladder when it reaches the urethra due to inadequate hygiene when wiping, after sexual activities, or due to bacterial overgrowth.
Other bacteria, such as Klebsiella pneumoniae, Enterococcus faecalis and Staphylococcus aureus, can also cause UTI, although these cases are less common. Fungi and viruses are also less common causes of UTIs.
Risk Factors
Adult women comprise the largest demographic group affected by urinary tract infections. This is due to the female anatomy, which includes a shorter urethra compared to men, providing less distance for bacteria to travel before migrating to the bladder. Other factors contributing to a higher incidence of developing a urinary tract infection include:
- Sexual Activity: Sexual intercourse can introduce bacteria to the urinary tract, posing a higher risk for individuals who are sexually active or have new sexual partners.
- Pregnant Women: Pregnant women undergo changes during gestation that make them more prone to UTIs, including hormonal, physiological and immune system changes.
- Menopause: A drop in oestrogen levels can alter the vaginal flora, particularly the lactobacilli, thereby increasing your vulnerability to UTIs.
- Select Birth Control: Certain types of birth control methods, like diaphragms and spermicidal agents, can disrupt the healthy bacteria⁷ that normally help to prevent infection.
- Urinary Tract Abnormalities: Structural issues or obstructions in the urinary tract can provide a site for bacteria to grow. Kidney stones are one such condition affecting 1 in 10 individuals⁸.
- Previous UTIs: Having experienced previous urinary tract infections automatically increases the likelihood of recurrence.
- Other Factors: Diabetes, specific genetic factors, and urinary catheter use also predispose individuals to UTIs.
Diagnosis and Treatment of Urinary Tract Infections
It is important to consult a healthcare professional if you suspect a urinary tract infection. Diagnosis can be obtained through a combination of your symptoms, reviewing your medical history, conducting a physical examination, and performing diagnostic tests such as urinalysis or urine culture. Both require patients to provide a sample of their urine in a cup, which is then tested for specific constituents in urine (urinalysis) and strains of bacteria (urine culture). In cases where fever is present, blood tests may be ordered to assess the severity of the infection. Sometimes, a CT urogram may be ordered to rule out obstruction, stones or abscess.
Most urinary tract infections can be treated with antibiotics. Your doctor will prescribe the antibiotic that is most effective for your particular case either empirically or based on antibiogram of culture results. Complete the full course of antibiotics as directed, as not doing so may increase your chances of UTI recurrence. Individuals who are dealing with UTIs associated with other complications may need hospitalisation and additional treatments to better manage their conditions.
How to Prevent Urinary Tract Infections
There are several ways to reduce your chances of getting a urinary tract infection. Most of these preventive measures involve lifestyle changes that promote better hygiene and urinary tract health.
- Stay Hydrated: Drinking plenty of water helps to naturally flush out bacteria from your urinary tract.
- Pee More Often: Empty your bladder regularly. Additionally, urinating after intercourse can eliminate bacteria that might enter the urethra during sexual activity.
- Practise Good Hygiene: Wash your hands before and after using the toilet and engaging in sexual activity. Change your pads and tampons regularly to prevent bacterial growth.
- Wipe Front-to-Back: This helps to avoid spreading bacteria from the anus to the vagina. Never wipe twice with the same toilet paper.
- Shower More: And maintain good perineal hygiene.
- Use Gentle Feminine Products: Fragrances can irritate the urethra. Besides opting for non-scented products, avoid overusing douches and sprays.
Contact our specialists at ID Specialists for more information.
References
- Urinary Tract Infection (UTI) | National University Hospital (NUH). https://www.nuh.com.sg/health-resources/diseases-and-conditions/urinary-tract-infection-uti. Accessed July 15, 2024.
- Urinary tract infections | Womenshealth.gov. https://www.womenshealth.gov/a-z-topics/urinary-tract-infections. Accessed July 15, 2024.
- Bebell L. Antibiotic-resistant urinary tract infections are on the rise. Harvard Health Publishing (HHP). Published October 14, 2019. https://www.health.harvard.edu/blog/antibiotic-resistant-urinary-tract-infections-are-on-the-rise-2019101417982. Accessed July 15, 2024.
- Urinary Tract Infection (UTI) – Symptoms & Causes | Gleneagles Hospital. https://www.gleneagles.com.sg/conditions-diseases/urinary-tract-infection/symptoms-causes. Accessed July 15, 2024.
- Urinary Tract Infections. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/urinary-tract-infections. Accessed July 15, 2024.
- Urinary Tract Infections. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9135-urinary-tract-infections. Accessed July 15, 2024.
- Fernandes A, Yadav P, Nalawade O, Joshi S, Jobby R. Chapter 20 – Properties, classification and applications of lantibiotics from Gram-positive bacteria. ScienceDirect. Published 2023. https://www.sciencedirect.com/science/article/abs/pii/B9780323991414000163. Accessed July 15, 2024.
- Kidney Stones. National Kidney Foundation. https://www.kidney.org/atoz/content/kidneystones. Accessed July 15, 2024.