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Urinary Tract Infection

How common are UTIs?

UTIs are a very common type of infection in women. In the UK, it is estimated that one woman in three will have a UTI before the age of 24, and that half of all women will have at least one UTI during their lifetime. The outlook for most cases of UTI is excellent. The infections are usually mild and will usually resolve within four to five days. Antibiotics can be used to help speed up the recovery time. However, some women find that they experience repeated UTIs, and that they require long-term treatment with antibiotics to prevent the infection returning.

The urinary tract

The urinary tract is made up of:

  • The kidneys, which extract waste materials from the blood and convert them into urine.
  • The ureters, which are tubes that run from the kidney to the bladder.
  • The bladder, which is a balloon-shaped organ that is used to store urine.
  • The urethra, which is the tube that passes from the bladder through the penis (in men) or vulva (in women), through which urine passes. In women, the urethra is located between the opening of the vagina and the clitoris.

Types of UTI

A UTI develops when part of the urinary tract becomes infected, usually by bacteria. Bacteria can enter the urinary system through the urethra or, more rarely, through the bloodstream. There is usually no obvious reason why the urinary tract gets infected, although some women find that they develop a UTI after having sexual intercourse.

There are two types of UTI:

  • Lower UTI is an infection of the lower part of the urinary tract, which includes the bladder and the urethra. An infection of the bladder is called cystitis, and an infection of the urethra is known as urethritis.
  • Upper UTI is an infection of the upper part of the urinary tract, which includes the kidneys and the ureters. Upper UTIs are potentially more serious than lower UTIs because there is a risk of kidney damage.
The symptoms of a lower UTI include:

  • cloudy urine
  • a need to urinate more frequently, either during the day, or night, or both
  • pain or discomfort when passing urine
  • an urgent need to urinate (holding in your urine becomes more difficult)
  • unusually unpleasant smelling urine
  • blood in your urine (haematuria)
  • abdominal pain
  • a feeling of tenderness around your pelvis
  • back pain
  • a general sense of feeling unwell
Upper urinary tract infection
The symptoms of an upper UTI include:
  • a high temperature (fever) of 38ºC (100.4ºF) or above
  • uncontrollable shivering
  • nausea
  • vomiting
  • diarrhoea

You may also experience pain in your side, back or groin. The pain can range from moderate to severe, and it is often worse when you are urinating.

In addition, you may experience the symptoms of a lower UTI because the infection can spread from your kidneys to your lower urinary tract.

When to seek medical advice

An upper UTI has a higher risk of complications, so it is always recommended that you visit your GP if you suspect that you have an upper UTI. You should also visit your GP if you think that you have a lower UTI and your symptoms do not improve after five days, or they suddenly get worse.

Most urinary tract infections (UTIs) are caused by bacteria that live in the digestive system.It is thought that the bacteria can be spread via the anus (the opening through which stools are passed out of the body) to the urethra.This can happen if, when wiping your anus after going to toilet, the toilet paper comes into contact with your genitals. The bacteria can then multiply and move through your urinary tract causing the following possible infections:

Risk factors

Women are more likely to develop a UTI than men. This is because a woman’s urethra is located closer to the anus than a man’s, which makes it easier for bacteria from the anus to reach the urethra. The female urethra is also much shorter than the male urethra (which runs through the penis), making it easier for bacteria to reach the bladder.

You are also more likely to develop a UTI if:
  • You have a condition that obstructs or blocks your urinary tract, such as kidney stones.
  • You have a condition that prevents you from fully emptying your bladder. If urine stays for too long in the bladder it provides an environment that allows bacteria to thrive and multiply.
  • You have a weakened immune system, for example, because you have diabetes, or are undergoing chemotherapy (medication to treat cancer).
  • You are female and sexually active. Sexual intercourse can irritate the urethra, allowing bacteria to travel more easily through it and into your bladder.
  • You use a diaphragm. Diaphragms (a barrier form of contraception that sits inside the vagina) can place pressure on the bladder, preventing it from emptying properly.
  • Your sexual partner uses condoms coated with spermicide. The chemicals in spermicide gel can irritate the vagina making it more vulnerable to infection.

If you are a woman and you have the typical symptoms of a lower UTI, further testing is not usually required to confirm the diagnosis. This is because a lower UTI causes a distinctive pattern of symptoms, so a reasonably confident diagnosis can be made simply by asking you about your symptoms.

When testing is required

There are a number of circumstances where testing is usually recommended. These are:
  • In cases of a suspected upper UTI. These infections have a higher risk of complications, so a careful assessment of the state of the urinary tract needs to be made.
  • In cases where a person has blood in their urine. Although unlikely, this could be a symptom of bladder cancer so it is important to rule out or confirm the diagnosis.
  • In cases where a person has a risk factor that makes them more vulnerable to developing serious complications, such as having a weakened immune system.

Initial testing involves taking a urine sample and testing it for the presence of bacteria. This can confirm the diagnosis and it is useful for deciding what the most effective antibiotic is to use for your treatment.

Further testing

Further testing for a UTI is only required if your symptoms fail to improve, or you experience repeated UTIs that could be caused by abnormalities in your urinary tract, such as a bladder stone.

Further testing may also be required to rule out a diagnosis of bladder cancer in cases where you have noticed blood in your urine.

Intravenous urogram (IVU)

One test that is used to assess the state of the urinary tract is called an intravenous urogram (IVU).

Before the IVU takes place, you will be injected with a special dye that shows up on an X-ray. The radiologist (a specialist in using medical imaging technology, such as X-rays) will study how the dye moves through your urinary system in order to see whether there are any problems.

You may experience a metallic taste in your mouth and flushed, itchy skin when the dye is injected. However, this is normal and these symptoms should pass after a few minutes.

Cystoscopy

Another test that is sometimes used is known as a cystoscopy. A cystoscopy is a procedure that uses a special instrument, called a cystoscope, to examine the inside of your bladder. A cystoscope is a thin, flexible telescope that is passed into your body so that the doctor can look inside your bladder.

A cystoscopy usually takes between five and ten minutes to perform. The urologist will study the lining of your bladder and urethra in order to identify any abnormal areas.  

Treating recurring UTIs

If you have repeated and recurring UTIs, further treatment may be required to prevent permanent damage to your urinary tract. If it is thought that the recurring UTIs are due to your urethra becoming irritated after sexual intercourse, you may be given antibiotic tablets. You should take a tablet after each time that you have sex, ideally in the first two hours after intercourse.

If you are using a diaphragm or spermicide-coated condom as your main method of contraception, you may want to consider using another method that does not increase your risk of developing UTIs, such as the contraceptive pill. If the recurring UTIs are not thought to be linked to sexual intercourse, you may be given a low-dose antibiotic to take daily.

Preventing Urinary tract Infection

While not all cases of urinary tract infection (UTI) can be prevented, there are some steps you can take to reduce your risk of developing an infection. These are explained below.

Cranberry juice and capsules - Drinking cranberry juice may help to prevent UTIs. If you have had recurring UTIs, higher strength cranberry capsules are recommended. These are available from most pharmacists. However, you should not consume cranberry juice or cranberry capsules if you are taking warfarin (a medicine that is used to prevent blood clots).

Treat constipation promptly - Constipation (where it is difficult to pass stools) can increase your chances of developing a UTI. Recommended treatments for constipation include:
  • increasing the amount of fibre in your diet
  • using a mild laxative on a short-term basis
  • drinking plenty of fluids

Other useful advice

The following advice may be useful in helping you to keep your bladder and urethra free from bacteria:

  • go to the toilet as soon as you feel the need to urinate, rather than holding it in
  • wipe from front to back after going to the toilet
  • practise good hygiene by washing your genitals every day, and before having sex
  • empty your bladder after having sex

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