Urinary Tract Infection (UTI; Cystitis)

“UTI” stands for Urinary Tract Infection, which technically means anywhere from the meatus (outside opening to the urethra) to the kidney (see Diagram — Anatomy of the Urinary System).  However, whenever we use the term, we’re referring to a bladder infection.  If it’s a kidney infection we say Pyelonephritis, urethral infection is Urethritis, prostate infection is Prostatitis.

UTIs are very common among women, since their urethra is so much shorter than in men.  So germs have a longer distance to get up into a man’s bladder, by which time he usually urinates them out (though older men & baby boys also get UTIs).  About 25% of women will get a UTI at least once in their lives.  The most common bacteria to cause UTIs is E. coli, which comprises 90% of our normal stool (poop).

However uncomfortable a UTI may be, it’s not dangerous if germs remain only in the bladder.  It’s easily cured with antibiotics.  It often goes away on its own.  However, the danger in waiting is that after a week, there’s a much greater possibility that the germ has moved up to the kidney.  Kidney infections are lots more serious (see Pyelonephritis).

Symptoms of UTI include pain with urinating, urinating small amounts frequently (frequency), usually with a sense of really having to go (urgency), and sometimes blood in the urine (hematuria).  The blood may look alarming, but if it’s due to a UTI, it means nothing and goes away.  Hematuria without infection is different, and could be a sign of cancer.  Sometimes the only symptom of a UTI is abdominal pain in the bladder area.

Not every urinary symptom is an infection.ย  If the pain is mainly felt on the outside skin, it may be due to vaginal diseases.ย  Urinating large amounts frequently could be diabetes.ย  Urgency & frequency could be caused by various pelvic (gynecologic) conditions, the most serious of which would be ectopic pregnancy.ย  Women with chronic urinary problems may have Interstitial Cystitis (men too, but itโ€™s much less common)

We diagnose UTI by a urinalysis, looking for white blood cells (WBCs) in the urine.  This can often be done very rapidly with a simple dipstick, that also shows blood, sugar, protein, maybe bacteria, & other things.  If the urinalysis is negative, there’s no UTI. 

However, if there are WBCs, the dipstick can’t tell if they came from the urine or were washed in from the vagina.  It’s necessary for the lab to look under the microscope to get an idea, which takes a day.  So it’s very important that patients collect a clean catch urine for the exam.  This is especially important for women who have even the least bit of vaginal discharge.

We can also order a urine culture and sensitivity to see what germ is growing, and what drugs work best.  But this takes at least 2 days, and for a simple UTI, usually isn’t worth the money or time.  It’s more necessary for kidney infections, or if the UTI isn’t getting better on treatment, or for people who have very frequent UTIs (just to be sure).

Some unlucky women get UTIs over & over.  This is because of a genetic predisposition for bacteria to live in the outside area around the urethra.  Sex makes it easier for the germ to enter; this is not an STD, but simply due to rubbing & friction that occurs during sex.  The only disease to watch for in a woman with frequent UTIs would be chronic kidney stones, which may be due to a specific bacteria (Proteus), which we think of if the urinalysis shows an alkaline urine (opposite of normal acid urine).

Frequent UTIs in women have nothing to do with how much fluids they drink, how they wipe themselves, or anything else.  Urinating immediately after sex may help with prevention, but it has to be immediately, which may not be pleasant if it ruins the joy of sex.  What I usually do is give 3 days of antibiotics for patients to have at home, and begin taking at the very beginning of symptoms (which they know very well).  I give them a large quantity, so they don’t have to pay for repeated refills or make constant appointments.

Men with UTIs are a little different, because the condition is uncommon.  They need a culture every time.  Frequent UTIs in a man would warrant investigation for diseases of the bladder and or prostate.

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