A urinary tract infection (UTI) is an infection involving the kidneys, ureters,

bladder, or urethra. These are the structures that urine passes through before
being eliminated from the body.

 The kidneys are a pair of small organs that lie on either side of the spine at
about waist level. They have several important functions in the body,
including removing waste and excess water from the blood and eliminating
them as urine. These functions make them important in the regulation
of blood pressure. Kidneys are also very sensitive to changes in blood
sugarlevels and blood pressure and electrolyte balance.
Both diabetes and hypertension can cause damage to these organs.
 Two ureters, narrow tubes about 10 inches long, drain urine from each
kidney into the bladder.
 The bladder is a small saclike organ that collects and stores urine. When
the urine reaches a certain level in the bladder, we experience the
sensation that we have to void, then the muscle lining the bladder can be
voluntarily contracted to expel the urine.
 The urethra is a small tube connecting the bladder with the outside of the
body. A muscle called the urinary sphincter, located at the junction of the
bladder and the urethra, must relax at the same time the bladder contracts
to expel urine.

Any part of this system can become infected. As a rule, the farther up in the
urinary tract the infection is located, the more serious it is.

 The upper urinary tract is composed of the kidneys and ureters. Infection in
the upper urinary tract generally affects the kidneys (pyelonephritis), which
can cause fever, chills, nausea, vomiting, and other severe symptoms.
  The lower urinary tract consists of the bladder and the urethra. Infection in
the lower urinary tract can affect the urethra (urethritis) or the bladder
(cystitis).

In the United States, urinary tract infections account for more than 10 million

visits to medical offices and hospitals each year.

 Urinary tract infections are much more common in adults than in children,

but about 1%-2% of children do get urinary tract infections. Urinary tract
infections in children are more likely to be serious than those in adults
(especially in younger children).
 Urinary tract infection is the most common urinary tract problem in children
besides bedwetting.
 Urinary tract infection is second only to respiratory infection as the most
common type of infection.
 These infections are much more common in girls and women than in boys
and men younger than 50 years of age. The reason for this is not well
understood, but anatomic differences between the genders (a shorter
urethra in women) might be partially responsible.
 About 40% of women and 12% of men have a urinary tract infection at
some time in their life.

 Bladder Infections: UTI Causes, Symptoms, Treatments

Urinary Tract Infection (UTI) Symptoms and Signs

Symptoms of a urinary tract infection (UTI) are similar in men, women, and children.
  Early symptoms and signs are usually easy to recognize and primarily
involve pain, discomfort, or burning when trying to urinate.
 Accompanying this can be the sense that one needs to urinate urgently
(known as urinary urgency) or the need for frequent urination (called
urinary frequency). Even when there is a strong urge to urinate, you may
pass only a small amount of urine.
 The urine itself may appear bloody or cloudy. Men may feel pain in the
rectum, while women may experience pain around the pubic bone.

What are causes and risk factors for a urinary tract

infection?

The urine is normally sterile. An infection occurs when bacteria get into the urine
and begin to grow. The bacterial infection usually starts at the opening of the
urethra where the urine leaves the body and moves upward into the urinary tract.

 The culprit in at least 90% of uncomplicated infections is a type of bacteria

called Escherichia coli, better known as E. coli. These bacteria normally
live in the bowel (colon) and around the anus.
 These bacteria can move from the area around the anus to the opening of
the urethra. The two most common causes of this are improper wiping and
sexual intercourse.
 Usually, the act of emptying the bladder (urinating) flushes the bacteria out
of the urethra. If there are too many bacteria, urinating may not stop their
spread.
 The bacteria can travel up the urethra to the bladder, where they can grow
and cause an infection.
 The infection can spread further as the bacteria move up from the bladder
via the ureters.
 If they reach the kidney, they can cause a kidney infection (pyelonephritis),
which can become a very serious condition if not treated promptly.
The following people are at increased risk of urinary tract infection:

 People with conditions that block (obstruct) the urinary tract, such
as kidney stones
 People with medical conditions that cause incomplete bladder emptying
(for example, spinal cord injury)
 Postmenopausal women: Decreased circulating estrogen makes the
urinary tract more vulnerable to a UTI.
 People with suppressed immune systems: Examples of situations in which
the immune system is suppressed are HIV/AIDS and diabetes. People who
take immunosuppressant medications such
as chemotherapy for cancer also are at increased risk.
 Women who are sexually active: Sexual intercourse can introduce larger
numbers of bacteria into the bladder. Urinating after intercourse seems to
decrease the likelihood of developing a urinary tract infection.
 Women who use a diaphragm for birth control
 Men with an enlarged prostate: Prostatitis or obstruction of the urethra by
an enlarged prostate can lead to incomplete bladder emptying, thus
increasing the risk of infection. This is most common in older men.
 Breastfeeding has been found to decrease the risk for urinary tract
infections in children.

The following special groups may be at increased risk of urinary tract infection:

 Very young infants: Bacteria gain entry to the urinary tract via the
bloodstream from other sites in the body.
  Young children: Young children have trouble wiping themselves and
washing their hands well after a bowel movement. Poor hygiene has been
linked to an increased frequency of urinary tract infections.
 Children of all ages: Urinary tract infection in children can be (but is not
always) a sign of an abnormality in the urinary tract, usually a partial
blockage. An example is a condition in which urine moves backward from
the bladder up the ureters (vesicoureteral reflux).
 Hospitalized patients or nursing-home residents: Many of these individuals
are catheterized for long periods and are thus vulnerable to infection of the
urinary tract. Catheterization means that a thin tube (catheter) is placed in
the urethra to drain urine from the bladder. This is done for people who
have problems urinating or cannot reach a toilet to urinate on their own.
 Patients using catheters: If a patient is required to empty their bladder
using a catheter, they are at increased risk for infection.

Are urinary tract infections contagious?

No. Urinary tract infections (UTIs) are not contagious.

What are urinary tract infection symptoms and signs?

Lower urinary tract infection (infections of the bladder or urethra)

 Bladder (cystitis, or bladder infection): The lining of the urethra and bladder
becomes inflamed and irritated.
 Dysuria: pain or burning during urination
 Frequency: more frequent urination (or waking up at night to urinate,
sometimes referred to as nocturia); often with only a small amount of urine
 Urinary urgency: the sensation of having to urinate urgently
  Cloudy, bad-smelling, or bloody urine
 Lower abdominal pain or pelvic pressure or pain
 Mild fever (less than 101 F), chills, and "just not feeling well" (malaise)
 Urethra (urethritis): Burning with urination

Upper urinary tract infection (pyelonephritis, or kidney infection)

Symptoms develop rapidly and may or may not include the symptoms for a lower
urinary tract infection.

 Fairly high fever (higher than 101 F)

 Shaking chills
 Nausea
 Vomiting
 Flank pain: pain in the back or side, usually on only one side at about waist
level

In newborns, infants, children, and elderly people, the classic symptoms of a

urinary tract infection may not be present. Other symptoms may indicate a
urinary tract infection.

 Newborns: fever or hypothermia (low temperature), poor feeding, jaundice

 Infants: vomiting, diarrhea, fever, poor feeding, not thriving
 Children: irritability, eating poorly, unexplained fever that doesn't go away,
loss of bowel control, loose bowels, change in urination pattern
 Elderly people: fever or hypothermia, poor appetite, lethargy, change in
mental status
Pregnant women are at increased risk for an UTI. Typically, pregnant women do
not have unusual or unique symptoms. If a woman is pregnant, her urine should
be checked during prenatal visits because an unrecognized infection can
cause pregnancy health complications.

Although most people have symptoms with a urinary tract infection, some do not.

The symptoms of urinary tract infection can resemble those of sexually

transmitted diseases.

When should people seek medical care for a UTI?

Any adult or child who develops any of the symptoms of a urinary tract infection
needs to be evaluated by a medical professional, preferably within 24 hours.
Most medical offices can test urine for infection by using a quick urine "dipstick"
test.

 Someone who has symptoms of a lower urinary tract infection should call a
health care professional for an appointment, preferably on the same day
that symptoms are recognized.
 Someone who has symptoms of an upper urinary tract infection involving
the kidneys should call a health care professional immediately. Depending
on the situation, he or she will recommend either a visit to the office or to a
hospital emergency department.
If someone has symptoms of a lower urinary tract infection and any of the
following applies, he or she may be at risk for complications of the urinary tract
infection.

 Vomiting and inability to keep down clear fluids or medication

 Not better after taking antibiotics for two days
 Pregnant
 Having diabetes or another disease that affects the immune system
 Taking medication that suppresses the immune system such
as cancer chemotherapy

Infants, children, and elderly people with any of the signs and symptoms of
UTI should see their health-care professional as soon as possible or go to an
emergency department for evaluation.

 Fever, lethargy, and poor appetite may indicate a urinary tract infection in
these groups, but they may also be signs of something more serious.
 Urinary tract infections have the potential to make these vulnerable people
very ill when the bacteria spread into the bloodstream.

How do health care professionals diagnose a urinary

tract infection?
Diagnosis of a urinary tract infection is based on information someone gives
about his or her symptoms, medical and surgical history, medications, habits,
and lifestyle. A physical examination and lab tests complete the evaluation.

A health care professional may simply perform a urine dipstick test in the office.
Only a few minutes are needed to obtain results. Your health-care provider may
also send a urine sample to the lab for culture testing (see below). These results
take a few days to come back. This tells the doctor the exact bacteria causing the
infection and to which antibiotics these bacteria have resistance or sensitivity.
The culture is usually sent for special populations, including men, because they
are less likely to get UTIs. It is not necessary to send a culture for everyone
because the majority of UTIs are caused by the same bacteria.

 The single most important lab test is urinalysis. A urine culture will be
tested for signs of infection, such as the presence of white blood cells and
bacteria.
 In certain circumstances, urine also may be "cultured." This means that a
small amount of the urine is brushed on a sterile nutrient substance in
a plastic plate. The plate is allowed to sit for a few days and then examined
to see what kind of bacteria are growing on it. These bacteria are treated
with different antibiotics to see which works best against them. This helps
determine the best treatment for the specific infection.
 Blood tests usually are not required unless a complicated condition, such
as pyelonephritis or kidney failure, is suspected.

For a culture specimen, the patient will be asked to give a clean-catch,

midstream urine specimen. This avoids contamination of the urine with bacteria
from the skin. Patients will be instructed in how to do this.

 Midstream means urinating a little into the toilet before collecting a

specimen. The idea is to avoid collecting the urine that comes out first, as
this urine is often contaminated.
 Clean-catch refers to a midstream sample that was collected after cleaning
the area of the urethral opening.
  Adult women and older girls: Cleanse the area around the urethral opening
gently (but completely) using a sterile wipe or soap and water. Catch the
urine midstream. For some women, catheterization (inserting a tube into
the bladder) may be the only way to obtain a sterile, uncontaminated
specimen.
 Men and boys: A sterile specimen can usually be obtained with a
midstream catch. Uncircumcised males should retract the foreskin and
cleanse the area before urinating.
 Newborns: Urine may be obtained with a catheter or a procedure in which
a needle is introduced through the lower abdominal wall to draw (aspirate)
urine from the bladder.
 Infants and children: Either catheterization or the needle aspiration method
is used.

If someone cannot produce a urine specimen or is unable to follow instructions

for a clean-catch specimen, a health-care professional may obtain a urine
specimen by catheterization.

 This means placing a thin tube (catheter) in the urethra to drain urine from
the bladder.
 The catheter usually is removed after the bladder is emptied.
 The catheter may remain in place if someone is very ill or if it is necessary
to collect all urine or measure urine output.

Depending on their symptoms, sexually active women could require a pelvic

examination because pelvic infections can have similar symptoms as a urinary
tract infection. Males will require a genital examination, and depending on the
symptoms, most likely a prostate examination. A prostate infection (prostatitis)
requires a longer course of antibiotics than a urinary tract infection.

Men will most likely require a rectal examination so that the prostate can be
checked. A prostate infection (prostatitis) requires a longer course of antibiotics
than a urinary tract infection.

Rarely, an imaging test may be indicated to detect any underlying problem in the
urinary tract that could cause an infection. This is usually only necessary in
repeat infections or special circumstances (unusual bacteria, suspected anatomic
abnormalities).

 An ultrasound examination can evaluate kidney and bladder problems.

 A fluoroscopic study can show any physical problems that predispose
children to urinary tract infections.
 Intravenous pyelogram (IVP) is a special series of X-rays that uses a
contrast dye to highlight abnormalities in the urinary tract.
 Cystoscopy involves insertion of a thin, flexible tube with a tiny camera on
the end through the urethra into the bladder. This allows detection of
abnormalities inside the bladder that might contribute to infections.
 A CT scan gives a very detailed three-dimensional picture of the urinary
tract.

Imaging tests are most often needed for the following groups:

 Children with repeat urinary tract infections, especially boys

 Up to 50% of infants and 30% of older children with a urinary tract infection
have an anatomic abnormality. The child's pediatrician should investigate
this possibility.
  Adults with frequent or recurrent urinary tract infections
 People who have blood in the urine

What kinds of doctors treat urinary tract infections?

Most urinary tract infections can be treated by your primary-care doctor (including
family medicine and internal-medicine specialists, as well as gynecologists) or
your child's pediatrician. They are usually the best provider to treat you as they
are most familiar with your medical history, medications you are taking, and other
factors that might affect your treatment. If you seek treatment in an urgent-care
facility, a specialist in emergency medicine may be involved in your care.

If there are frequent reoccurrences of UTIs or if complicating circumstances are

present, your primary-care doctor might refer you to a urologist, a physician who
specializes in diagnosis and treatment of conditions related to the urinary system.

Are there home remedies for a urinary tract infection?

  

 There are a variety of self-care measures (home remedies) and other

treatments available for urinary tract infections.

 Use a hot-water bottle to ease pain.

 Drink plenty of water.
 Avoid coffee, alcohol, and spicy foods, all of which irritate the bladder.
 There are some indications that cranberry juice can help fight a urinary
tract infection.
Because the symptoms of a urinary tract infection mimic those of other
conditions, someone should see a health-care professional if a urinary tract
infection is suspected. A urine test is needed to confirm an infection. Self-care is
not recommended.

What is the treatment for a urinary tract infection?

The usual treatment for both simple and complicated urinary tract infections is
antibiotics. The type of antibiotic and duration of treatment depend on the
circumstances. Examples of common antibiotics used in treatment include, but
are not limited
to, amoxicillin, sulfamethoxazole/trimethoprim (Bactrim), ciprofloxacin, nitrofurant
oin (Macrobid), and many others. Your health-care provider will chose the
appropriate medication for your condition and the specific causative organisms.

Lower urinary tract infection (cystitis, or bladder infection)

 In an otherwise healthy person, a three-day course of antibiotics is usually

enough. Some providers prefer a seven-day course of antibiotics.
Occasionally, a single dose of an antibiotic is used. A health-care
professional will determine which of these options is best.
 In adult males, if the prostate is also infected (prostatitis), four weeks or
more of antibiotic treatment may be required.
 Adult females with potential for or early involvement of the kidneys, urinary
tract abnormalities, or diabetes are usually given a five- to seven-day
course of antibiotics.
 Children with uncomplicated cystitis are usually given a 10-day course of
antibiotics.
  To alleviate burning pain during urination, phenazopyridine (Pyridium) or a
similar drug, can be used in addition to antibiotics for one to two days.

Upper urinary tract infection (pyelonephritis)

 Young, otherwise healthy patients with symptoms of pyelonephritis can be

treated as outpatients. They may receive IV fluids and antibiotics or an
injection of antibiotics in the emergency department, followed by 10-14
days of oral antibiotics. They should follow up with their health-care
professional in one to two days to monitor improvement.
 If someone is very ill, dehydrated, or unable to keep anything in his or her
stomach because of vomiting, an IV will be inserted into the arm. He or she
will be admitted to the hospital and given fluids and antibiotics through the
IV until he/she is well enough to switch to an oral antibiotic.
 A complicated, acute infection may require treatment for several weeks.

A person may be hospitalized if he or she has symptoms of pyelonephritis and

any of the following:

 Appear very ill

 Are pregnant
 Have not gotten better with outpatient antibiotic treatment
 Have underlying diseases that compromise the immune system
(diabetes is one example) or are taking immunosuppressive medication
 Are unable to keep anything in the stomach because of nausea or vomiting
 Had previous kidney disease, especially pyelonephritis, within the last 30
days
 Have a device such as a urinary catheter in place
  Have kidney stones

Urethritis in men and women can be caused by the same bacteria as sexually
transmitted diseases(STDs). Therefore, people with symptoms of STDs (vaginal
or penile discharge, for example) should be treated with appropriate antibiotics.
Your doctor will have to evaluate you for STDs as well as UTIs if you experience
any pain in the genital area.

How long does a UTI last after treatment with

antibiotics?
  Symptoms of lower urinary tract infections usually resolve within 24 hours
of starting the medication. The full amount of prescribed antibiotics should be
taken even if the symptoms are fully gone.

Upper urinary tract symptoms (pyelonephritis) will usually take longer to respond
to treatment. The patient will usually improve within 24 hours, but it will often take
longer until all symptoms resolve.

What follow-up is needed for a urinary tract infection?

Follow a health-care professional's treatment recommendations. Finish all
medications even if feeling better before the medication is gone. A health-care
professional will want the patient to have a follow-up appointment to repeat
the urinalysis and make sure he or she is getting better.

 Children and adults with kidney involvement should be seen again in one
to two days.
 People recovering from uncomplicated lower urinary tract infections might
be told that they only have to return if symptoms don't go away or if they
return.
Occasionally, the infection does not go away with the first treatment. If someone
is being treated for an infection and has any of the following, call a health-care
professional promptly:

 Fever or pain with urination is not gone after two days of antibiotic
treatment.
 Someone cannot keep the medication down or it has severe side effects.
 Someone is unable to keep foods, fluids, or medication down because
of nausea or vomiting.
 Someone develops signs of kidney involvement (such as flank pain,
shaking chills, high fever).
 Someone's symptoms are worse rather than better after two days of
antibiotics.

Is it possible to prevent a urinary tract infection?

Women and girls should wipe from front to back (not back to front) after bowel
movements. This helps prevent bacteria from the anus entering the urethra.

Empty the bladder regularly and completely, especially after sexual intercourse.

Drink plenty of fluids, especially water.

Cranberry juice, especially, has been shown to help prevent urinary tract

infections.

Women should empty the bladder soon after sexual intercourse.

What is the prognosis of a urinary tract infection?

For people with uncomplicated cystitis or pyelonephritis, antibiotic treatment
usually brings complete resolution of the infection.

If not treated promptly, urinary tract infections can cause permanent scarring of
the urinary tract.

Recurrent urinary tract infections can become a problem and will require close
monitoring by your health care provider.

Pyelonephritis, if not treated promptly, can spread to the bloodstream and cause
a very severe infection.

 Short-term and long-term kidney damage can be a result of pyelonephritis.

 Death from pyelonephritis is rare in otherwise healthy people.
 Factors associated with poor outcome are old age or general debility,
kidney stones, recent hospitalization, diabetes, sickle cell disease, cancer,
or chronic kidney disease