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Urinary Tract Infection

Overview

When you feel a burning sensation while peeing, the first thing you may wonder is: “Do I have a urinary tract infection?” It’s a telltale symptom of a well-known condition that doesn’t have long-lasting effects when caught and treated early.  

Urinary tract infections (UTIs) affect people across the lifespan, from infancy through old age. They affect women and girls more often than men and boys, although they’re more prevalent in male babies than female babies. And for men, the likelihood of having a urinary tract infection rises after age 65, when they may have enlarged prostates.  

It’s important to note that once you have a UTI, it’s more likely to recur in the future. About 20 or 30% of people who have one urinary tract infection have another.  

The good news is that it’s a condition that responds well to treatment and can often be cured within several days.  

“A change in urinary symptoms should not be ignored—if you experience pain with urination, pelvic pressure, or certainly blood in the urine seek medical attention,” says Yale Medicine urologist Joseph Brito III, MD.

What is a urinary tract infection?

A urinary tract infection occurs when bacteria causes inflammation and/or discomfort within the urinary tract.  

Bacteria can enter the urinary tract under certain conditions, but often is flushed out before causing an infection. But for someone with a urinary tract infection, bacteria remains in the urethra, and may travel to the bladder. Sometimes, bacteria travels from the bladder to the kidneys, where a more serious infection can occur.

What causes urinary tract infections?

Most urinary tract infections are caused by E. coli, but some are caused by Staphylococcussaprophyticus or other types of bacteria. When urinary tract infections are triggered by bacteria entering from the bloodstream, which is rare, they’re usually caused by Salmonella or Staphylococcus aureus.  

The anatomy of the urinary tract of women makes them more likely to have a urinary tract infection than men. In particular, women have a shorter urethra than men, which means bacteria has less distance to travel to reach the bladder where it can cause an infection. Also, a woman’s urethra is located much closer to the anus than a man’s urethra. Sex play, intercourse, and wiping from back to front after bowel movements may make the transfer of bacteria from the anus to the urethra more likely among women.  

When a man has an enlarged prostate, and has trouble emptying his bladder, bacteria is more likely to build up in the urine, which remains for longer periods within the bladder, leading to a urinary tract infection.

What are the risk factors for urinary tract infection?

Certain conditions raise the likelihood that bacteria will have the opportunity to collect within the urinary tract and remain there long enough to cause infection, including:

  • Pregnancy
  • Obesity
  • A personal or family history of urinary tract infections
  • Using spermicide and/or a diaphragm as birth control
  • Having frequent sexual encounters
  • Urinary incontinence
  • Sexually transmitted infections
  • Enlarged prostate
  • Having an uncircumcised penis (for boys up to 1 year of age)
  • Kidney transplant
  • Catheter usage
  • Certain chronic health conditions, like diabetes or kidney disease
  • A weakened immune system

What are the symptoms of urinary tract infections?

People who have urinary tract infections in the urethra or bladder often have symptoms such as:

  • Pain or burning when peeing
  • Having the urge to pee often
  • Awakening with the urge to pee two or more times per night
  • The presence of blood in the urine
  • Urine that looks cloudy
  • Urine that has an unpleasant smell
  • Pelvic pain or pressure
  • Inability to fully empty the bladder
  • Wetting the bed at night or having accidents during the daytime

People whose urinary tract infections affect the kidneys or ureters may experience the above-mentioned symptoms, and they may also have:

  • Fever
  • Chills
  • Pain in the side, abdomen, or lower back
  • Nausea and/or vomiting

How is a urinary tract infection diagnosed?

To arrive at a diagnosis, your doctor will ask about symptoms, including whether you have pain or burning while peeing. If you’ve had urinary tract infections in the past, the doctor will want to know.  

You’ll also be asked to provide a urine sample, so the bacterial content can be analyzed. Sometimes, doctors may diagnose an infection in those who have recurrent urinary tract infections after hearing about symptoms, without doing a urine test.  

If you have had multiple urinary tract infections, you may need an ultrasound or CT scan to determine if there’s a structural abnormality within the urethra, bladder, ureters or kidneys or if you have kidney stones.  

Doctors test pregnant women for urinary tract infections at routine prenatal visits. Those who are found to have bacteria in the urinary tract are treated, even if they don’t have symptoms. (Untreated infections during pregnancy may lead to low birthweight babies or early delivery.)

How is a urinary tract infection treated?

The usual treatment for a urinary tract infection is a course of oral antibiotics, which helps to eradicate bacteria in the urinary tract. Some are single-dose treatments, while others are taken for several days.  

If the infection makes its way to the kidneys, intravenous antibiotics may be prescribed. Doctors try to treat infections quickly, because complications may lead to kidney damage in some people.  

Symptoms tend to improve within the first day of taking antibiotics, but people must take the full course of medication as prescribed.

Other medications, which may be recommended in addition to antibiotics, include:

  • Over-the-counter painkillers, to alleviate pain or fever
  • Phenazopyridine, which helps to relieve pain and burning within the urinary tract

The following lifestyle changes may help to reduce the risk of recurrence:

  • Drink more fluids, which helps to flush out bacteria from the urinary tract
  • Pee after having sex
  • Avoid spermicide usage
  • Consider a form of birth control other than a diaphragm
  • Don’t use vaginal douches
  • Lose weight (for those with obesity)
  • Wipe front to back after using the bathroom (among females)
  • For people who are incontinent, use pads to keep the perineum (the area of skin between the anus and vagina or scrotum) dry

Sometimes, doctors prescribe the following treatments to people with recurrent infections:

  • Vaginal estrogen, for menopausal women
  • Preventive antibiotics

What is the outlook for people with urinary tract infections?

Although urinary tract infections may be uncomfortable, they can be cured with antibiotics. People who have recurrent infections should be assessed by their doctors to find a possible cause for repeat infections.

What makes Yale Medicine unique in its treatment of urinary tract infections?

“UTI management usually starts with the primary care provider, but patients with recurrent or resurgent infections should be referred to a urologist to determine the underlying source,” says Dr. Brito. “Though most UTI symptoms will respond to a course of antibiotics, similar symptoms may signal something more serious. Don’t ignore what your body is trying to tell you.”