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Over half of all women and about 12 percent of men will experience at least one UTI in their lifetime.
By: Susan C. Olmstead
Urinary tract infections (UTIs) occur when bacteria enter the urinary tract, causing pain and burning with urination. If left untreated, UTIs may lead to worsening symptoms and further complications.
UTIs are very common in women and not uncommon in men. Approximately 50 percent to 60 percent of all women will experience at least one UTI in their lifetime, while about 12 percent of men will. Globally, the incidence of UTIs has increased from about 252 million reported cases in 1990 to about 404 million in 2019.
According to the Urology Care Foundation, UTIs are the second most common type of infection in the body and are the reason for over 8 million doctor visits each year.
While most UTIs are not serious and can be easily treated, they can be dangerous if the infection travels to the kidneys and enters the bloodstream, leading to sepsis.
“A UTI is often thought of as being a minor issue, but it can be life-threatening. It’s not anything to take lightly. Even if the symptoms are minor, you need to get it taken care of,” Dr. Jennifer J. Bryan said on an American Medical Association site.
What Are the Types of UTIs?
The urinary tract comprises the urethra, bladder, ureters, and kidneys. A UTI may affect the urethra (causing urethritis), the bladder (causing cystitis), or the kidneys (leading to pyelonephritis).
Most UTIs are considered “lower UTIs” because they affect the lower urinary tract (the bladder and urethra). A UTI that has progressed through the ureters (which are the tubes leading to the kidneys) into the kidneys is called an “upper UTI” and requires aggressive treatment.
What Are the Symptoms and Early Signs of a UTI?
Symptoms and signs of a UTI may include the following:
A burning sensation when urinating.
An urgent need to urinate.
Bloody or cloudy urine.
Frequent urination.
Pressure or pain in the lower abdomen.
Bad-smelling urine.
The location of the infection may result in varying symptoms, such as the following:
Kidneys: back or side pain, fever, chills, nausea, vomiting.
Bladder: pelvic pressure, lower abdomen discomfort, frequent and/or painful urination, blood in urine.
Urethra: burning sensation during urination, discharge.
UTIs in young children and older people may be more challenging to diagnose because these populations may not exhibit typical symptoms or may have trouble communicating their symptoms.
What Causes UTIs?
UTIs occur when bacteria enter the urinary tract through the urethra. These bacteria, typically Escherichia coli (E. coli), may come from the vagina, anus, a urinary catheter, or a genital infection. Women are much more likely to develop UTIs than men due to their anatomy since the urethra is so close to the anus, and the urethral opening is close to the bladder.
Sexual activity may also introduce bacteria into the urinary tract. Sexually transmitted infections (STIs), such as herpes, gonorrhea, and chlamydia, can also cause UTIs in the urethra, also known as urethritis.
Who Is More Likely to Develop UTIs?
The following factors put a person more at risk of developing UTIs:
Age: Older adults are more prone to UTIs, which account for more than one-third of all nursing home-associated infections. After menopause, women may be more susceptible to recurrent UTIs due to changes in the vulvovaginal area, a phenomenon known as genitourinary syndrome of menopause (GSM).
Sex: Being female is itself a risk factor for developing a UTI due to female anatomy, including a shorter urethra. Women are 30 times more likely than men to develop them.
Sexual activity.
A previous UTI.
Changes in “good” vaginal bacteria due to factors such as menopause or the use of spermicides.
Structural problems in the urinary tract, such as enlarged prostate.
Poor hygiene when using the toilet, especially among children.
Vesicoureteral reflux: This condition sends urine backward up the tract toward the bladder. It is more commonly seen in UTIs in children.
High blood sugar.
Kidney stones.
Suppressed immune system.
Sexually transmitted infections.
Catheters: UTIs are the most common type of health care-associated infection reported to the National Healthcare Safety Network (NHSN). Hospitalized patients who require urinary catheters are especially at risk for UTIs. This phenomenon is known as catheter-associated urinary tract infection (CAUTI). When UTIs occur in a hospital setting, about 75 percent result from catheterization.
Some people are inherently more at risk of developing complicated UTIs, which are infections that carry a higher risk of treatment failure. In the United States, over 626,000 people are admitted to the hospital each year for complicated UTIs, accounting for about 1.8 percent of all admissions. The following populations are more at risk of complicated UTIs:
Those with recurrent UTIs: Recurrent UTIs are defined as at least two infections within six months or three within a year. Recurring UTIs are more likely to occur in sexually active young women and those with anatomical abnormalities in the urinary tract.
Immunocompromised patients.
Males.
Pregnant women.
People with a presence of obstructing ureteral stones.
Those with long-term urinary catheter use.
People with treatment-resistant recurring UTIs.
How Are UTIs Diagnosed?
If your doctor suspects you have a UTI, a urinalysis will first be ordered. During this urine test, you urinate into a cup, which is sent to the lab to test for nitrites, leukocyte esterase, and white blood cells. If there is frequent recurrence or resistance to treatment, additional tests such as the following may be required:
Urine culture: This test requires a urine sample that will be tested for different types of bacteria. Results take one to three days to allow bacteria to grow in culture plates, and, ultimately, their sensitivity to different antibiotics is tested.
Kidney ultrasound: For children especially, other tests, including a kidney ultrasound, may be required.
Voiding cystourethrogram (VCUG): A VCUG may also be needed for children. A VCUG is a type of X-ray that examines the urinary tract. A catheter is inserted into the urethra, and the bladder is filled with dye. X-rays are then taken as the bladder fills and drains. This test helps diagnose vesicoureteral reflux and other problems with structure.
Computed tomography (CT) scan: This imaging test is more precise than a regular X-ray. It may be used to find structural issues.
Magnetic resonance imaging (MRI): This may be required for recurrent UTIs to detect structural abnormalities in the urinary tract.
Cystoscopy: This test requires a thin instrument with a lens inserted into the urethra so the doctor can view the bladder. It may be necessary for recurrent UTIs or infections that are unresponsive to treatment.
What Are the Complications of UTIs?
If a UTI goes untreated and worsens, the following complications may occur:
Kidney infection: A kidney infection may result if the bacteria causing a lower UTI travel up the upper urinary tract and into the kidneys. Symptoms of a kidney infection may include nausea, vomiting, fever, chills, and back or side pain.
Sepsis: If a kidney infection is not treated, it can lead to sepsis, a life-threatening condition.
Kidney damage: Severe untreated UTIs may cause permanent kidney damage with loss of efficient filtering function.
Narrowed urethra: This may occur in men with repeated urethral infections. It is more common in men than women. One reason is that the male urethra is much more likely to be infected by sexually transmitted diseases during intercourse. An enlarged or infected prostate can further complicate this narrowing.
Premature infant delivery: Women who get UTIs when they’re pregnant may deliver a baby early or with a low birth weight.
What Are the Treatments for UTIs?
UTIs are typically treated with antibiotics. The antibiotics most commonly used for simple UTIs include the following:
- Doxycycline.
- Ciprofloxacin/levofloxacin
- Trimethoprim and sulfamethoxazole.
- Fosfomycin.
- Nitrofurantoin.
- Cephalexin.
- Ceftriaxone.
Typically, these antibiotics are prescribed for about a week. Patients should always complete the entire round of antibiotics prescribed, even if they feel better, to prevent symptom recurrence and the growth of antibiotic-resistant bacteria. In the case of recurrent UTIs, low-dose antibiotics may be necessary over a more extended period.
How Does Mindset Affect UTIs?
Although a positive mindset alone cannot prevent UTIs, it has been shown that lower urinary tract symptoms are associated with anxiety and depression.
“The exact nature of the association between bladder symptoms and psychosocial measures remains unknown and is likely due to a complex interplay between heritability, psychosocial factors, and environmental stress,” according to researchers at the University of Southern California. Addressing symptoms alone may not be sufficient for some patients whose urinary tract difficulties may be tied to anxiety, depression, or stress, they wrote.
Promptly treating UTIs with medication and pursuing long-term solutions to recurrent UTIs help mitigate distress in patients with this condition. Those patients whose symptoms seem to be connected to stress may want to seek counseling or look into other ways to improve their mental health to help cope with or manage UTIs.
What Are the Natural Approaches to UTIs?
Some studies have shown that drinking cranberry juice may decrease occurrences of UTIs in women. Cranberries contain A-type proanthocyanidins (PACS), anthocyanins, benzoic acid, D-mannose, and ursolic acid. PACS have been shown to prevent the bacterium E. coli from adhering to uroepithelial cells in the urinary tract.
