Urinary Tract Infections
Urinary tract infections (UTIs) are very common. They can be painful and uncomfortable, but they usually pass within a few days or can be easily treated with a course of antibiotics.
UTIs are more common in women than in men. It’s estimated that half of all women in the UK will have a UTI at least once in their life, and 1 in 2,000 healthy men will develop one each year.
A urinary tract infection (UTI) causes the lining of the bladder and urethra become inflammed and sore. The usual symptoms are one or more of the following:
- a feeling of discomfort when you pass urine, usually a stinging or burning pain in the urethra
- a constant feeling that you want to pass urine; although you may be bursting to go, there is hardly any urine in the bladder
- a dragging ache in your lower abdomen
- dark or “strong” urine which may contain visible blood from the inflammation
If your kidneys become infected you may develop a fever or back pain. If you have these symptoms and you have had symptoms of a lower urinary tract infection as above, then you should seek medical advice, as these infections need to be treated promptly with antibiotics.
Cystsitis or infections of the lower urinary tract occur in women of all ages, and only need to be investigated if they are recurrent, or there are other worrying symptoms. Some women are genetically or anatomically predisposed to getting infections. Women who have gone through menopause have a change in the lining of the vagina and lose the protective effects of oestrogen that decrease the likelihood of infections. Postmenopausal women with UTIs may benefit from hormone replacement. Sexual intercourse may predispose some women to urinary tract infections.
Disorders such as diabetes also put people at higher risk for UTIs because of the body’s decrease in immune function and thus a reduced ability to fight off infections such as UTIs
You are more likely to get a UTI if you have recently had a urological operation, if you have a catheter in place, or if your urinary tract has a structural abnormality. Patients who do not empty their bladder completely may develop infections, and while this is one of the commonest causes of infections in men whose prostate enlarges and blocks off the flow of urine out of the bladder as they get older, infections in men always need thorough investigation.
If you think that you might have a urinary infection, then you should contact your doctor. A urine analysis is performed, and if there are signs of an infection a urine culture is usually obtained. Many patients are treated with antibiotics before the results of this are known.
If you are having fevers and symptoms of a UTI, recurrent infections (in women), a single infection in a man, or persistent symptoms despite therapy, then further tests are required. These might include a further urine culture, an ultrasound or CT scan, a flexible cystoscopy and a flow rate and residual scan.
As soon as you feel the first twinges, start drinking a lot of water or another bland liquid such as milk or weak tea. Avoid strong coffee, tea or alcohol. For the first 3 hours, drink at least half a pint every 20 minutes to flush out the infection before it gets a grip
- Take one tablespoonful of bicarbonate of soda dissolved in water as soon as possible and repeat this every 3-4 hours. This reduces the acidity of the urine and helps to relieve the stinging
- Keep warm and place a hot water bottle over your tummy or between your thighs to ease the abdominal discomfort
- Take a mild painkiller such as aspirin or paracetamol
- Do not self-medicate with antibiotics left over from previous infections or from other people
- If you have been prescribed “self-start antibiotics” by your doctor or urologist, start taking the tablets, after you have provided a urine sample for your doctor to send to the laboratory
First an underlying cause of urinary tract infection needs to be excluded. Once this has been done a number of approaches can be tried to reduce recurrence:
- Drink plenty (3-4 pints) of bland liquid each day to help keep the bladder clear of germs
- Always pass urine after intercourse
- Use plain water for washing; always wipe from “front to back”
- Avoid bubble baths, talcum powder, all personal (vaginal) deodorants & feminine wipes
- Always try and make sure that you have emptied your bladder, by squeezing out the last few drops if possible
- Cranberry juice or cranberry tablets taken regularly may help reduce the chance of recurrent infections
If your symptoms are related to sexual intercourse, you should wash carefully with plain water before having intercourse. Use a special lubricant (KY Jelly) during intercourse – this is available from most chemists without prescription. It is helpful to empty out your bladder immediately after intercourse to flush out any germs which may have entered the urethra. Some women, however, continue to suffer problems despite these measures experiencing recurrent cystitis after sexual activity. In this situation, it is best to take a single antibiotic tablet (Norfloxacin, Trimethoprim or Cephalexin) immediately after intercourse and to take regular cranberry juice or tablets.
In some patients with recurrent infections self-starter antibiotics might be used. This is where patients start to take antibiotics themselves when they feel the symptoms of an infection coming on, without the need to see their doctor each time. Some patients respond well to D-Mannose or Hiprex (Methenamine) treatment. In other patients a low dose of prophylactic antibiotic may be taken each day. Your doctor will be able to discuss with you which approach is best.
The British Association of Urological Surgeons (BAUS) have information on their website to help patients manage urinary tract infections. Click image to open document.