Urinary Tract Infection | UTI

What is a UTI?

A urinary tract infection (UTI) is a bacterial infection of the urinary tract. The most common type of urinary tract infection is a bacterial bladder infection or cystitis. UTIs are much more common in women than men however UTIs in males tend to be more complicated and difficult to treat. 

Up to 50% of women will experience a UTI in their lifetime while only about 5% of men will. A UTI can range from mild irritation in the lower urinary tract and bladder, often resolving on its own with the body’s immune system or with antibiotics, to life-threatening if it’s severe and spreads to the kidneys.

UTI Symptoms

The symptoms of a UTI can vary from person to person. UTIs can share many symptoms with other infections and health conditions. It is important you seek medical advice and provide a detailed history when being diagnosed.

UTI symptoms in men and UTI symptoms in women tend to share most of the common UTI symptoms although women may experience more pelvic pain than men.

Urinary tract infection symptoms can differ based on where the infection is in the urinary tract. Lower urinary tract infections such as bladder infections (cystitis) can have the following symptoms:

• Increased urgency to urinate
• Increased frequency of urination
• Pain, discomfort, or burning when urinating (dysuria)
• Pain in the flow abdomen
• Sense of bladder fullness (even when empty)
• Cloudy urine
• Strong smelling urine
• Blood in the urine

An upper urinary tract infection (pyelonephritis) affecting the kidneys is a serious medical problem that requires you to see a health professional as soon as possible.

Signs of an upper urinary tract infection are:

• Lower back pain or pain in the sides
• Fever
• Chills
• Nausea
• Vomiting

 If you have any of these symptoms, present to your doctor straight away or if they are unavailable go to a hospital.

What causes a UTI?

A UTI is most often caused by bacteria entering the urinary system through the urethra and multiplying. The urinary tract is usually a bacteria-free environment and when bacteria enters the body begins an immune system response to try to remove the bacteria, causing inflammation and UTI symptoms.

The bacteria can come from a number of places and be of a variety of different types. The most frequent type of bacteria that causes bacterial cystitis is Escherichia coli (E.coli). This comes from a healthy digestive tract and is excreted with faeces. It makes up between 75-95% of UTI cases.

Another major bacteria that cause UTIs is Staphylococcus saphrophyticus which is also a part of the normal human bacteria. It makes up 5-10% of cases.

Diagnosis

Diagnosis starts with answering a number of questions relating to the symptoms you are experiencing. This allows a doctor to rule out other potential infections and complications.

It is important that you provide as much information as possible to the diagnosing health professional before you get UTI treatment. Many conditions have similar symptoms but require significantly different treatment to a UTI. 

For example, sexually transmitted infections such as chlamydia can very easily be misdiagnosed as a UTI as they may both cause pain on urination and increased urinary frequency but, chlamydia can cause discharge where a UTI usually will not. This is why it is important to be comprehensive when describing symptoms.

If diagnostic questions are not clear enough to make a diagnosis alone, a urine test can be taken. The urine sample is examined in a lab for bacteria which will identify if it is a bacterial infection as well as if the bacteria are resistant to any antibiotics.

If you experience recurrent UTIs, your doctor may consider investigating further with an ultrasound, CT, MRI scan, or small camera to see the urinary tract and bladder. These are uncommon and only used if absolutely necessary.

UTI treatment

Most lower UTIs are bacterial and can be treated with oral antibiotics. If you have symptoms of an upper urinary tract infection, it is important you seek urgent treatment as they often require intravenous antibiotics and close monitoring. 

If you still have symptoms after 48 hours of treatment, it is important that you refer back to your doctor so they can investigate further.

Please note we are unable to name specific medicines due to Australian law.

Antibiotics for UTI

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There are 3 common types of antibiotics that are used to treat uncomplicated lower UTIs. Each is used depending on whether the medicine is suitable for you and if there is any resistance to antibiotics in the bacteria infecting the urinary tract.

These antibiotics work by either preventing bacterial growth in the bladder, allowing the body to clear the infection or actively killing them. As with all antibiotics, it is important that you complete the full course prescribed by your doctor, even if you begin to feel better earlier. This prevents UTI bacteria from becoming resistant to antibiotics and prevents them from returning if not fully cleared.

Like all medicines, these treatments can have side effects but not everyone will experience them. The most common side effects for these UTI treatments are gastric upset, stomach upset, diarrhoea and headaches.

Symptomatic relief

Over the counter UTI medication can be effective in relieving the uncomfortable symptoms of UTIs. Over the counter analgesics and non-steroidal anti-inflammatories (NSAIDs) can be used to assist in dealing with lower abdominal pain. NSAIDs, in particular, are useful as UTI pain is the result of inflammation. It is important that you only use these medicines if they are appropriate for you. NSAIDs may not be appropriate for people with certain medical conditions or on certain medicines. Consult your doctor or pharmacist if you are unsure.

Urinary Alkalinisers are used for relief from the burning sensation and pain when urinating. It is proposed these work by reducing the acidity of the urine. The scientific evidence on these medicines is mixed and their effectiveness has not been established. They can also interact with certain antibiotics for UTIs, so use them with caution and only under advice from a professional.

Alternative UTI treatments

There are some further natural and alternative medicines for UTI treatment over the counter. Cranberry juice has long been speculated to help treat a UTI but the evidence is mixed. Some studies indicate it can help stop bacteria from attaching to bladder walls however they are still unsure whether it is effective in preventing recurrent UTIs.

Vitamin C is another speculated natural treatment for UTIs. At the moment there is no clinical evidence that vitamin C is effective and it is not recommended at this stage.

Probiotic benefits for preventing UTIs have been investigated and the evidence suggests although they can produce other positive outcomes for general health, it did not find they reduced the risk of recurrent UTIs.

Self-care and preventing urinary tract infections

There are a number of risk factors that increase the risk of UTIs. There are a  number of self-care techniques that can be used with a UTI to help with symptoms and without a UTI to help prevent them. These techniques include:

• Drinking plenty of fluid, preferably water
• When wiping after urination, women should wipe from front to back
• Avoid harsh soaps and hygiene products, use mild ones and wash them off thoroughly
• Wear cotton underwear
• Avoid wearing tight-fitting pants
• Do not ignore the urge to urinate, allow yourself to go to the bathroom
• Urinate after sexual intercourse
• Avoid constipation or treat it quickly
• Wash your genitals daily but do not use harsh soaps

Implementing these techniques should help to reduce your chances of getting an infection or reduce the amount of irritation you experience when you have an infection.

UTI FAQs

How do you get a UTI?

Infection occurs due to bacteria entering the urinary tract through the urethra (where you urinate from) where it begins to multiply. Typically the urinary tract is sterile (contains no bacteria), so when bacteria enters, it results in an immune response and inflammation as the body tries to remove the bacteria.

How long does a UTI last?

Most UTIs will go away within 24 to 48 hours of treatment. It is always recommended to finish your full prescribed course of antibiotics regardless of if you begin to feel better.

Untreated UTIs can sometimes resolve on their own in under a week however, sometimes they will worsen and can spread to your kidneys causing back or side pain. If this happens seek medical attention immediately.

How to get rid of a UTI

Mild UTIs can sometimes resolve on their own, however, if the symptoms of a UTI are not improving within 48 hours it is recommended to seek antibiotic treatment from a doctor.

Will a UTI go away without antibiotics?

Mild UTIs can resolve without antibiotics however, it can be risky to not treat a confirmed UTI as it may worsen or spread to the kidneys. Consult a doctor about diagnosis and treatment if you suspect a UTI and follow their advice.

Written by Clinical Pharmacist Tyson Wilkman