Urinary Tract Infections (UTIs)

A wooden toy person sits on a white toilet Giorgio Trovato/Unsplash

You desperately have to pee, but once you’ve rushed to the bathroom, only a few drops come out. Or the urine stream is normal, but it burns painfully. These are symptoms of cystitis or a urinary tract infection (UTI). This is so common that most people experience it at least once at some point in our lives. “UTI” and “cystitis” are often used interchangeably, but it’s worth knowing the difference. Cystitis is an inflammation or infection of the bladder, which is usually, but not always, caused by an infection, and is by far the most common type of UTI. UTIs are infections caused by bacteria, such as E. coli, that get into the urethra and bladder (and occasionally the kidneys) from the gastrointestinal system. In either case, cystitis and UTIs are treatable and may be preventable.

So what causes UTIs?

Pregnant people are especially susceptible. Early in pregnancy progesterone (as a smooth muscle relaxant) causes the ureters (the tubes carrying urine from the kidneys to the bladder) to dilate, which increases the likelihood of UTIs. Later in pregnancy, pressure from the growing fetus keeps some urine in the bladder and ureters, allowing bacteria to grow.

Postmenopausal women are also susceptible because of the effect of hormonal changes on the bladder and urethra.

High chronic stress levels, trauma to the urethra from childbirth, and catheterization can predispose you to getting them. A sudden increase in sexual activity can also be a trigger (hence the term “honeymoon cystitis”). Occasionally, UTIs are caused by a congenital anatomical abnormality or, mostly in older people or women who have had many children without receiving appropriate pelvic physical therapy, a prolapsed (fallen) urethra or bladder. Very rarely, viruses such as chlamydia and trichomoniasis can also cause UTIs.

Cystitis (inflammation or infection of the bladder) is by far the most common UTI in women. While the symptoms can be frightening, cystitis in itself is not usually serious. If you suddenly have to urinate every few minutes and it burns like crazy even though almost nothing comes out, you probably have cystitis. There may also be blood and/or pus in the urine. You may have pain just above your pubic bone, and sometimes there is a peculiar, heavy odor when you first urinate in the morning.

For tips on preventing UTIs, see Prevention and Home Treatments for Urinary Tract Infections (UTIs).

It’s also possible to get mild temporary symptoms (such as peeing frequently) without actually having an infection. This can be caused by a number of things, including simply drinking too much coffee or tea (both are diuretics), premenstrual difficulties, food allergies, vaginitis, anxiety, or irritation to the area. Irritation can be caused by bubble baths, soaps, spermicide, laundry detergent, or douches. As long as you are in good health and not pregnant, you can usually treat mild symptoms yourself for 24 hours before consulting a practitioner.

Cystitis often disappears without treatment. If symptoms persist beyond 24 hours, recur frequently, or are accompanied by chills, fever, vomiting, and/or pain in the kidneys (near the middle of the back), see a health care provider right away. These symptoms suggest that the infection has spread to your kidneys, resulting in pyelonephritis, a serious problem that requires prompt medical treatment.

Also see your provider if you have blood or pus in the urine, pain on urination during pregnancy, diabetes or other chronic illness, or a history of kidney infection or diseases or abnormalities of the urinary tract. Untreated chronic infections can lead to serious complications, such as high blood pressure or premature births (if occurring during pregnancy).

Diagnosis

When cystitis does not respond to self-help treatments within twenty-four hours, or it recurs frequently, get a urine test. Make sure your provider asks for a clean voided specimen and does a pelvic exam to rule out other infections. Your urine should be examined for evidence of blood and pus, then cultured.

Sometimes, even when you have symptoms, the culture may come back negative (not showing any infection). False-negative cultures may be due to mishandling or too-dilute urine; you may also get a false-negative report if your cystitis is caused by something other than bacterial infection. White blood cells in the urine plus a negative culture (acute urethral syndrome) may indicate a chlamydia infection. Some women have bacteria in the urine without symptoms; especially in pregnant women, this should be treated with antibiotics to prevent kidney infection and other complications.

Medical Treatments for Urinary Tract Infections

For symptoms that are severe or indicate a kidney infection, medications are usually started immediately. For milder infections, many health care providers prefer to wait for culture results before prescribing a drug.

Most UTIs respond rapidly to a variety of antibiotics. Drugs commonly used include ampicillin, nitrofurantoin, tetracycline, ciprofloxacin, a sulfamethoxazole and trimethoprim combination (Bactrim/Septra), and sulfonamides (Gantrisin). (Women who have a deficiency of glucose-6-phosphate dehydrogenase should not take sulfonamides.) You may get a single large dose or several doses spread out over three to ten days.

Taking antibiotics can cause diarrhea or yeast infections. If cystitis symptoms persist longer than two days after you start taking drugs, contact your healthcare provider again. The organisms may be resistant to the antibiotics you are using.

Acetaminophen may relieve pain from UTIs. Some practitioners recommend a drug called Pyridium, an anesthetic that relieves pain but does not treat the infection itself. (Pyridium dyes the urine a bright orange, which will permanently stain clothing. It also can cause nausea, dizziness, and possibly allergic reactions.)

If menopause-related hormonal changes are a factor in recurring UTIs, long-term, low-dose estrogen can often prevent future infections.

Surgical treatment for UTIs should be limited to specific situations in which a woman’s anatomy is clearly causative. Pelvic floor exercises (Kegels) can sometimes forestall the need for this operation and help prevent future infections.

Unfortunately, even with drugs and/or surgery, many women continue to have recurrent urinary tract infections.