By Susan C. Olmstead
Urinary tract infections (UTIs) occur when bacteria enter the urinary tract, causing pain and burning with urination. If left untreated, UTIs may lead to worsening symptoms and further complications.
UTIs are very common in women and not uncommon in men. Approximately 50 percent to 60 percent of all women will experience at least one UTI in their lifetime, while about 12 percent of men will. Globally, the incidence of UTIs has increased from about 252 million reported cases in 1990 to about 404 million in 2019.
According to the Urology Care Foundation, UTIs are the second most common type of infection in the body and are the reason for over 8 million doctor visits each year.
While most UTIs are not serious and can be easily treated, they can be dangerous if the infection travels to the kidneys and enters the bloodstream, leading to sepsis.
“A UTI is often thought of as being a minor issue, but it can be life-threatening. It’s not anything to take lightly. Even if the symptoms are minor, you need to get it taken care of,” Dr. Jennifer J. Bryan said on an American Medical Association site.
What Are the Types of UTIs?
The urinary tract comprises the urethra, bladder, ureters, and kidneys. A UTI may affect the urethra (causing urethritis), the bladder (causing cystitis), or the kidneys (leading to pyelonephritis).
Most UTIs are considered “lower UTIs” because they affect the lower urinary tract (the bladder and urethra). A UTI that has progressed through the ureters (which are the tubes leading to the kidneys) into the kidneys is called an “upper UTI” and requires aggressive treatment.
What Are the Symptoms and Early Signs of a UTI?
Symptoms and signs of a UTI may include the following:
- A burning sensation when urinating.
- An urgent need to urinate.
- Bloody or cloudy urine.
- Frequent urination.
- Pressure or pain in the lower abdomen.
- Bad-smelling urine.
The location of the infection may result in varying symptoms, such as the following:
- Kidneys: back or side pain, fever, chills, nausea, vomiting.
- Bladder: pelvic pressure, lower abdomen discomfort, frequent and/or painful urination, blood in urine.
- Urethra: burning sensation during urination, discharge.
UTIs in young children and older people may be more challenging to diagnose because these populations may not exhibit typical symptoms or may have trouble communicating their symptoms.
What Causes UTIs?
UTIs occur when bacteria enter the urinary tract through the urethra. These bacteria, typically Escherichia coli (E. coli), may come from the vagina, anus, a urinary catheter, or a genital infection. Women are much more likely to develop UTIs than men due to their anatomy since the urethra is so close to the anus, and the urethral opening is close to the bladder.
Sexual activity may also introduce bacteria into the urinary tract. Sexually transmitted infections (STIs), such as herpes, gonorrhea, and chlamydia, can also cause UTIs in the urethra, also known as urethritis.
Who Is More Likely to Develop UTIs?
The following factors put a person more at risk of developing UTIs:
- Age: Older adults are more prone to UTIs, which account for more than one-third of all nursing home-associated infections. After menopause, women may be more susceptible to recurrent UTIs due to changes in the vulvovaginal area, a phenomenon known as genitourinary syndrome of menopause (GSM).
- Sex: Being female is itself a risk factor for developing a UTI due to female anatomy, including a shorter urethra. Women are 30 times more likely than men to develop them.
- Sexual activity.
- A previous UTI.
- Changes in “good” vaginal bacteria due to factors such as menopause or the use of spermicides.
- Structural problems in the urinary tract, such as enlarged prostate.
- Poor hygiene when using the toilet, especially among children.
- Vesicoureteral reflux: This condition sends urine backward up the tract toward the bladder. It is more commonly seen in UTIs in children.
- High blood sugar.
- Kidney stones.
- Suppressed immune system.
- Sexually transmitted infections.
- Catheters: UTIs are the most common type of health care-associated infection reported to the National Healthcare Safety Network (NHSN). Hospitalized patients who require urinary catheters are especially at risk for UTIs. This phenomenon is known as catheter-associated urinary tract infection (CAUTI). When UTIs occur in a hospital setting, about 75 percent result from catheterization.
Some people are inherently more at risk of developing complicated UTIs, which are infections that carry a higher risk of treatment failure. In the United States, over 626,000 people are admitted to the hospital each year for complicated UTIs, accounting for about 1.8 percent of all admissions. The following populations are more at risk of complicated UTIs:
- Those with recurrent UTIs: Recurrent UTIs are defined as at least two infections within six months or three within a year. Recurring UTIs are more likely to occur in sexually active young women and those with anatomical abnormalities in the urinary tract.
- Immunocompromised patients.
- Males.
- Pregnant women.
- People with a presence of obstructing ureteral stones.
- Those with long-term urinary catheter use.
- People with treatment-resistant recurring UTIs.
How Are UTIs Diagnosed?
If your doctor suspects you have a UTI, a urinalysis will first be ordered. During this urine test, you urinate into a cup, which is sent to the lab to test for nitrites, leukocyte esterase, and white blood cells. If there is frequent recurrence or resistance to treatment, additional tests such as the following may be required:
- Urine culture: This test requires a urine sample that will be tested for different types of bacteria. Results take one to three days to allow bacteria to grow in culture plates, and, ultimately, their sensitivity to different antibiotics is tested.
- Kidney ultrasound: For children especially, other tests, including a kidney ultrasound, may be required.
- Voiding cystourethrogram (VCUG): A VCUG may also be needed for children. A VCUG is a type of X-ray that examines the urinary tract. A catheter is inserted into the urethra, and the bladder is filled with dye. X-rays are then taken as the bladder fills and drains. This test helps diagnose vesicoureteral reflux and other problems with structure.
- Computed tomography (CT) scan: This imaging test is more precise than a regular X-ray. It may be used to find structural issues.
- Magnetic resonance imaging (MRI): This may be required for recurrent UTIs to detect structural abnormalities in the urinary tract.
- Cystoscopy: This test requires a thin instrument with a lens inserted into the urethra so the doctor can view the bladder. It may be necessary for recurrent UTIs or infections that are unresponsive to treatment.
What Are the Complications of UTIs?
If a UTI goes untreated and worsens, the following complications may occur:
- Kidney infection: A kidney infection may result if the bacteria causing a lower UTI travel up the upper urinary tract and into the kidneys. Symptoms of a kidney infection may include nausea, vomiting, fever, chills, and back or side pain.
- Sepsis: If a kidney infection is not treated, it can lead to sepsis, a life-threatening condition.
- Kidney damage: Severe untreated UTIs may cause permanent kidney damage with loss of efficient filtering function.
- Narrowed urethra: This may occur in men with repeated urethral infections. It is more common in men than women. One reason is that the male urethra is much more likely to be infected by sexually transmitted diseases during intercourse. An enlarged or infected prostate can further complicate this narrowing.
- Premature infant delivery: Women who get UTIs when they’re pregnant may deliver a baby early or with a low birth weight.
What Are the Treatments for UTIs?
UTIs are typically treated with antibiotics. The antibiotics most commonly used for simple UTIs include the following:
- Doxycycline.
- Ciprofloxacin/levofloxacin.
- Trimethoprim and sulfamethoxazole.
- Fosfomycin.
- Nitrofurantoin.
- Cephalexin.
- Ceftriaxone.
Typically, these antibiotics are prescribed for about a week. Patients should always complete the entire round of antibiotics prescribed, even if they feel better, to prevent symptom recurrence and the growth of antibiotic-resistant bacteria. In the case of recurrent UTIs, low-dose antibiotics may be necessary over a more extended period.
How Does Mindset Affect UTIs?
Although a positive mindset alone cannot prevent UTIs, it has been shown that lower urinary tract symptoms are associated with anxiety and depression.
“The exact nature of the association between bladder symptoms and psychosocial measures remains unknown and is likely due to a complex interplay between heritability, psychosocial factors, and environmental stress,” according to researchers at the University of Southern California. Addressing symptoms alone may not be sufficient for some patients whose urinary tract difficulties may be tied to anxiety, depression, or stress, they wrote.
Promptly treating UTIs with medication and pursuing long-term solutions to recurrent UTIs help mitigate distress in patients with this condition. Those patients whose symptoms seem to be connected to stress may want to seek counseling or look into other ways to improve their mental health to help cope with or manage UTIs.
What Are the Natural Approaches to UTIs?
Some studies have shown that drinking cranberry juice may decrease occurrences of UTIs in women. Cranberries contain A-type proanthocyanidins (PACS), anthocyanins, benzoic acid, D-mannose, and ursolic acid. PACS have been shown to prevent the bacterium E. coli from adhering to uroepithelial cells in the urinary tract.
While cranberry capsules may be taken instead of or in addition to juice, ensuring the product contains about 175 milligrams of cranberry compounds per gram is advised. Less than that may prove ineffective, according to a Reuters article.
Other researchers have explored probiotics to prevent UTIs in women. “There are increasing signs that it may be possible to use probiotics as a first step in regulating the [urinary microbiota] so as to reduce the risk of or as a treatment for certain urinary diseases,” according to researchers in Turkey. Still, more clinical trials are needed to determine the actual effectiveness of probiotics. The Reuters article further notes that Lactobacillus, represented in most probiotics, can strongly inhibit E.coli.
D-mannose is an ingredient in many brands of UTI supplements. This substance, found in cranberries and other fruits, is thought to prevent bacteria from adhering to cells in the urinary tract. A recent review of investigations into the use of D-mannose noted that research shows it “may help to improve clinical/symptomatic recovery rate from UTI—sometimes even faster than some of the used antibiotics—and/or may especially have potential as a prophylactic by decreasing the risk for [recurrent UTIs].” Supplements may come in powder or capsule form.
Additionally, these researchers observed that supplementing antibiotics with D-mannose “may increase treatment success.” They also noted, “for prophylaxis in reducing [recurrent UTI], D-mannose appears to have great potential with minimal side effects.”
Other natural compounds that may help treat UTIs include the following:
- Uva ursi (bearberry leaf): Uva ursi is another often-used ingredient in natural UTI treatments. It is approved in Germany to treat bladder infections. Uva ursi should not be used for more than two weeks, as it may damage the kidneys and liver. There have also been reports of carcinogenicity with prolonged use due to hydroquinone, uvi ursi’s antibacterial metabolite.
- Garlic: Garlic’s antibacterial traits are primarily attributed to its component allicin. It also has anti-inflammatory properties and has shown promise in treating UTIs, as demonstrated in at least two case studies.
- Green tea: The polyphenols in green tea were shown to have antibacterial activity against E. coli in animal studies and boost the effects of antibiotics often prescribed for UTIs.
- Curcumin: In one controlled clinical trial, curcumin (the compound in turmeric that gives it its color), in combination with other botanicals, was shown to prevent recurrent UTIs in postmenopausal women. It also inhibits the biofilm development of the pathogens involved in causing UTIs.
- Blueberry: Blueberries have similar properties to cranberries regarding their effects on UTIs. Their tannins impair bacterial adhesion to the bladder walls. Some may prefer blueberry juice to cranberry, as it is less bitter.
- Berberine: An active alkaloid in medicinal plants like goldenseal, berberine has been used to treat UTIs due to its antibacterial properties. It works by interfering with the adherence of bacteria like E. coli to the bladder walls.
The group Pelvic Awareness Project recommends women with active UTIs avoid consuming acidic fruits, spicy foods, sugar and starch, and artificial sweeteners—which all may irritate the bladder—as well as alcohol and caffeine, which can lead to dehydration. Regardless of which route one takes in treating his or her UTI, hydration is of utmost importance to flush the bacteria from the system.
How Can I Prevent UTIs?
A study of Taiwanese Buddhists found that their vegetarian diet reduced the risk of UTIs caused by infection with E. coli, presumably because meat (beef, poultry, and pork) is more likely to be infected with E. coli, and that eliminating meat from the diet lessens the amount of this bacteria in the stool. However, this strategy addresses only one route of bacterial infection that may lead to UTIs.
More practical ways to help prevent UTIs include the following:
- Drink plenty of water.
- Urinate often. Don’t hold it in longer than necessary, and always fully empty your bladder.
- Balance your pH with a healthy diet: When urine becomes too acidic, it can irritate the bladder walls. But when it becomes too alkaline, it can encourage bacterial growth. Balance your intake of acidic foods, like citrus and coffee, with your intake of alkaline foods, like vegetables and noncitrus fruits. Avoid processed foods and refined sugars altogether, if possible.
- Practice good hygiene (girls and women should wipe “front to back” after using the toilet).
- Urinate before and after sexual intercourse to flush out bacteria.
- Avoid using spermicides if they have caused UTIs in the past.
- For postmenopausal women: Ask your doctor if estrogen therapy would be helpful.
- Take probiotics and eat fermented foods like yogurt, sauerkraut, and kimchi.
- Drink unsweetened cranberry or blueberry juice. Avoid cocktail blends, which typically contain added sugars and other irritating ingredients.
- Consider supplementing with D-mannose.
Medically reviewed by Beverly Timerding, MD.
