Urinary tract infections (UTI)

What is a urinary tract infection (UTI)?

A UTI is any infection that affects the bladder (a sac that collects and stores urine), kidneys (filter and remove waste from the blood), urethra (a tube connecting the bladder to outside of the body) or ureters (tubes that connect the kidneys to the bladder. The most common type of UTI is a bladder infection (cystitis).

A UTI can make passing urine (peeing) extremely uncomfortable because it can cause stinging or burning. UTIs are more common in women because women have a shorter urethra and therefore germs can enter more easily.

How common are UTIs

Urinary tract infections are very common and occur in up to 50% of women. Around 33% of women develop a UTI by the age of 24 years. UTIs also affect men but much less frequently and are very uncommon in men under the age of 50 years.

What are the symptoms of a UTI?

  • Burning or stinging pain passing urine
  • Passing urine more frequently
  • Blood in the urine
  • Pain or discomfort in the tummy (abdomen)
  • Strong, smelly or cloudy urine
  • Feeling generally unwell
  • Confusion or agitation (especially in older people)
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​Important symptoms to look out for that suggest a kidney infection

  • Severe pain in the stomach (abdomen) or back
  • Back pain especially on either side underneath the ribs
  • Fevers or temperatures

How common are UTIs?

UTIs are one of the most common problems seen by a GP or ACP. Approximately one third of women will develop a UTI by the age of 24 years. Women who have suffered with a UTI in the past have a 20-30% chance of having another UTI (recurrent UTI).

Women are much more likely to develop a UTI compared to men because:

  • Women have a shorter urethra
  • The opening of the urethra is closer to the back passage (anus) so there is a higher risk of bacteria (germs) entering

What causes UTIs?

A UTI is usually caused when bacteria from around the back passage (anus) enter the urethra and end up in the bladder causing an infection. Some of the risks factors for developing a UTI are:

  • Being female
  • Sexual intercourse
  • Being pregnant
  • Having had a UTI in the past
  • Having a long-term illness that can lower the immune system such as diabetes or cancer
  • Taking medication that can lower the immune system such as chemotherapy or immunosuppressants (e.g. prednisolone, cyclosporine, mesalazine)
  • Physical problems with the urethra, bladder, ureter or kidneys
  • Dryness of the vagina
  • Having a catheter (a tube that passes into the bladder that helps to drain urine)

How are UTIs treated?

Most UTIs are treated with antibiotics. Antibiotics fight the infection that causes a UTI. In most cases women usually need a three day course of antibiotics. Men sometimes need a longer course of antibiotics to treat a UTI.

There’s a small chance that the antibiotic prescribed by a GP or ACP may not work against a UTI. This is because the bacteria (germs) might be resistant to that antibiotic. If the bacteria have become resistant to the antibiotic then a different antibiotic might be considered. It is important to provide a urine (pee) sample to a GP or ACP so that it can be sent to a laboratory to see which antibiotics will work against the germ.

Common antibiotics used to treat UTIs are:

  • Nitrofurantoin
  • Trimethoprim
  • Cefalexin
  • Co-amoxiclav (Augmentin)
  • Pivmecillinam
  • Fosfomycin
  • Amoxicillin
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How can I prevent UTIs?

For some people, UTIs can be difficult to prevent. This might be because of reasons that are beyond control such as abnormalities in the urinary tract (urethra, bladder, ureters or kidneys) or having a long-term condition that lowers the immune system and stops it from fighting infections easily.

However there are a number of ways to reduce your chances of catching a UTI:

Drink plenty of fluid. Fluids help flush all the channels in the urinary system and therefore prevent germs from sticking around. Therefore, drinking frequently is the best way to help prevent the build up of germs. Some people have found that cranberry juice can reduce the chances of getting a UTI although the evidence for this isn’t very strong.

​Wipe from front to back. Women should wipe from front to back when cleaning the back passage (anus). This will reduce the chance of germs entering the urinary tract.

​Avoid baths. Showers reduce the chances of contaminated water entering the urinary tract.

​Pass urine immediately after sex. This will help wash away any germs that could have been introduced into the urethra during sex.

​Change nappies frequently. Changing a baby’s nappy frequently will reduce the risk of germs entering the urinary tract.

​Pass urine often. Holding urine or resisting the urge to go can lead to germs sitting in the bladder, which might increase the chance of developing an infection.

​Wear loose-fitting clothing and underwear. Loose clothing improves air movement around the urethra and helps prevent the build up of moisture for germs to grow (germs like moist environments).

​Use non-spermicidal lube. Using non-spermicidal lube (lube that does not destroy sperm) during sex helps keep the ‘good bacteria’ in the vagina and reduce the risk of infection.

UTIs in men

UTIs are less common in men than in women but can be more serious.

The urethra is longer in men than in women, which means that bacteria have to travel further to set up an infection in the bladder. For this reason, it is less common to have bladder infections (cystitis) in men. If you are a man and have any of the symptoms of cystitis listed above, you should discuss this with a GP or ACP.

You can also get infections of the urethra (urethritis) which are most commonly caused by sexually transmitted infections (STIs) like chlamydia or gonorrhoea. These infections can cause burning when you pee and can also cause itching, unusual discharge or rashes/lesions (blisters or sores). If you think you might have an STI it is important to get tested and treated.

Prostatitis (an infection of the prostate) can cause similar symptoms as a UTI, as well as fever (high temperature), chills, muscle aches, pain in the pelvis, pain in the penis or difficulty passing urine. If you have any of these symptoms please contact a GP or ACP for advice. This is because prostatitis can lead to complications such as abscesses (collections of pus and bacteria in the prostate), long-term infections or infection that spreads throughout your body.

If you have a heart condition or have had heart valve replacement surgery it is especially important to see a GP or ACP if you think you might have prostatitis. 

UTIs in children

UTIs are common in children but it is important that they are treated to prevent complications later on. Kidney infection is the most serious form of a UTI in children as it can lead to damage to the kidney if not treated quickly. All children with symptoms of a UTI should be discussed with a GP or ACP.

In babies and young children symptoms of a UTI may be quite vague. You may notice that your child’s urine smells unpleasant or they have diarrhoea (runny poo) or vomiting. You may also notice that they are not feeding normally, are more irritable than usual or have a high temperature (fever). Fever might be the only symptom of a UTI in babies and young children.

Older children may complain of pain when they pee, they might wet themselves or need to pee more frequently or more urgently than normal. They also may have a fever or complain of stomach pain.

There are some factors that might increase your child’s risk of a UTI:

  • Being female and less than 4 years old or male and less than 1 year old
  • Being a boy who is not circumcised
    • Although it is important to note that MOST boys who are NOT circumcised DO NOT get UTIs
  • Having a catheter in their bladder for a long time due to being in hospital or being unwell
  • Being born with parts of the urinary tract system that did not form normally
  • If a child has had one UTI, there is slightly higher chance of getting another one

UTIs in pregnancy

If you are pregnant, you are more likely to develop a UTI. The changes made in your body when you are pregnant, make you more likely to develop kidney infections. The hormonal changes in pregnancy relax the ureters (tubes that connect the kidneys to the bladder) and allow bacteria to travel up to the kidneys more easily than in a woman who is not pregnant.

Bacteria can also be present in your urine but you may not experience any symptoms. This is referred to as asymptomatic bacteriuria and happens in 2-7% of pregnant women. It should be treated in pregnancy to prevent complications that can be caused by bacteria in your urine.

If you receive treatment for your UTI, your baby most likely will not be affected. However, there is a small chance that an infection can cause problems such as preterm birth (baby being born early), or your baby weighing less than normal. For this reason, it is important to see a GP or ACP to receive the correct treatment.

Because pregnant women don’t always have symptoms of bacteria in the urine, it is recommended that you do a screening urine sample at least once early in your pregnancy to check for this. Your midwife or GP can help you arrange this.

The symptoms of urgency to pass urine or frequency are common as part of normal pregnancy. However, if you have burning or stinging when you pass urine, fevers or chills, or pain in your back, please contact a GP or ACP.

UTIs or asymptomatic bacteriuria should be treated with antibiotics. Your GP or ACP will ensure that the antibiotics are safe to take during pregnancy. Different antibiotics are safe at different stages of pregnancy so it is important to check with a GP or ACP before taking any medications.

It is usually recommended that a repeat urine test is done a week after completing antibiotics to make sure the infection has gone.

If you are getting frequent UTIs in your pregnancy, your GP or ACP may recommend that you take antibiotics to prevent further infections in the remainder of your pregnancy.

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What else do I need to know?

If you think you have a UTI and you have an underlying health condition that may affects your body’s ability to fight infection such as diabetes or cancer or if you have ever had surgery on your kidneys, ureters, bladder, prostate or urethra please contact a GP or ACP for advice.

If you notice that you are getting frequent UTIs you should discuss this with a GP or ACP to find out if you need any further tests. 

It may be helpful to avoid sex until your symptoms have improved. It is not possible for you to pass on a UTI to your partner, but the infection may cause sex to be painful or uncomfortable.

Do not take medications like ibuprofen or aspirin (or other non-steroidal anti-inflammatory medications, known as NSAIDs) if you have an infection in your kidney. If you normally take these for another condition, please speak a GP or ACP.