Do I have a urinary tract infection? Symptoms, signs, and when to worry
The urinary tract starts at the kidneys, where urine is produced. Urine then travels to the bladder in the ureters, leaves the bladder in the urethra, and is expelled when the bladder nerves sense it is full. The bladder is the storage organ for urine, and is the most common location in the body to have an infection.1
Urinary tract infections (UTIs) occur when bacteria, including normal bacteria present in the bowel and vagina, enter the urethra.2 The most common organism or bacteria to come from the gut is E.coli, which is present in every woman’s gut, but can cause infection in the urinary tract. Most antibiotics prescribed for a UTI act against E.coli.3
UTIs are more common in women than men as women have a shorter urethra, meaning a smaller distance for bacteria to travel to the bladder. In women the anus is also closer to the urethra, so bacteria from the gut can be introduced to the urinary tract much more easily than in men. By the age of 26, one third of women will have experienced a UTI.4 Between 30% and 60% of women will experience a UTI in their lifetime,5 and the chance of a repeat infection within six months is 25%.6
There are three different types of UTI: urethritis (infection of the urethra), cystitis (infection of the bladder), and pyelonephritis (infection of the kidney). Both urethritis and cystitis are very similar in terms of symptoms, however, with urethritis there may be urethral discharge present. Pyelonephritis is a sign of a more serious ascending infection (where the infection travels up the urinary tract).
How do I recognise UTI symptoms?
In terms of urethritis, the most common symptom is pain on urination. There may also be a feeling of difficulty in starting urination. Urethritis may also cause itching or pain when not passing urine. You may notice discharge (often white) in the urethral opening or vagina.
With cystitis, there may be a sensation of pressure on your bladder, the feeling you need to urinate more frequently, and more urgently, together with having to get up to visit the toilet in the night more than you usually would. Urine may also leak out, or there may be urinary incontinence present. Women may experience a dull, period pain-like ache three inches below the belly button in a band across the lower abdomen, and this ache may also spread around to the back on both sides (where the kidneys are located). Women may notice their urine turning darker or becoming malodorous and cloudy. Passing urine can be difficult, since the sensation of burning or stinging may also be present.
Despite going to the toilet more often, women may still feel as though the bladder has not completely emptied. The urge to urinate may still be there, which causes discomfort or a spasm-like pain from the bladder if a woman strains to attempt to pass urine.
What are the symptoms of a UTI infecting my kidneys?
Both bacteria and viruses can move upwards from the bladder to the kidneys or can be carried through the bloodstream from other parts of the body. Signs of the UTI developing in the kidneys (pyelonephritis) include a high fever (38 degrees celsius) and a cramp-type pain that arrives in waves and then subsides, on both sides of the lower back, which may spread down towards the front of the thighs. The pain may be so unbearable as to cause a woman to pace around. There may be associated nausea and vomiting. Occasionally, this develops into confusion, or delirium, with the affected person perhaps losing track of time, or not knowing where they are. This confusion tends to be more pronounced in the elderly population. If you are experiencing any of these symptoms you should go to A&E immediately. Pyelonephritis is treated with antibiotics, and, if necessary, fluid replacement into the veins.
Which conditions can mimic a UTI?
Should you notice that you are running to the toilet much more frequently than usual over a period of weeks or months, and are feeling lethargic and more thirsty than usual, you should be aware that these can be symptoms of diabetes. Other clues pointing towards diabetes include being overweight, having an immediate family member with diabetes, or having other medical conditions such as an overactive or underactive thyroid.
If you have the above symptoms, you should visit your GP, who will perform a very quick dipstick test on your urine sample. This can determine if you have sugar present in your urine, which is one of the signs of diabetes.
Alternatively, feeling unable to control passing urine, or experiencing a leak of urine is actually very common in women, is very treatable, and doesn’t necessarily mean you have a UTI. It is known as urinary incontinence, and the causes can vary from childbirth, to menopause, to an overactive bladder, or a bladder with weak muscles.
With urinary incontinence, there is no pain on passing urine, no abdominal pain, and no change in colour or smell of urine. You may notice leaking urine when laughing or sneezing. Alternatively, you may experience leaking urine when your bladder is full but you have been unable to make it to the toilet in time; this is known as urge incontinence.
All GPs see women with urinary incontinence for a wide variety of reasons, and there are a number of options available to treat it. For example, you may be advised to do bladder retraining exercises, or cognitive behavioural therapy may be prescribed.
Chronic or long term inflammation of the bladder is called interstitial cystitis and can mimic the symptoms of a UTI. The cause of long-term inflammation is currently not fully understood. In addition to more than six weeks experiencing increased day and night time frequency of passing urine (which can be up to 60 times per day), and pain on passing urine, the distinguishing features often include pain during sex and a negative urine dipstick test (i.e there is no infection present).
Therefore, if your urinary frequency and painful urination has lasted over six weeks, and subsequently severely disrupts daily life, then your GP should be consulted. Treatment includes anti-inflammatory medicines, and you may be referred to a specialist urologist for further investigation.
What should I do if I think I have a UTI?
If there is a slight discomfort when passing urine, or increased frequency of urination, then this should alert women to the early signs of a UTI. If they are identified early on, the best plan is to visit your local pharmacy, where pharmacists are trained to recognise cystitis symptoms. Treatment for manageable UTIs that are caught early includes plenty of fluid intake spread throughout the day, anti-inflammatory medicines such as ibuprofen (which also acts to reduce a fever), and potassium citrate solution, which makes your urine alkali, thus easing the burning sensation on urination.
If your symptoms persist for more than 24 hours, then you will need to visit your GP who will test the urine. If infection is present you will most likely be prescribed antibiotics, normally either trimethoprim or ciprofloxacin.
If your symptoms do not improve after five days of antibiotics you will need to go back to your GP because unsuccessful antibiotic treatment, which may be due to antibiotic resistance, can lead to permanent kidney scarring.
If at any point you develop severe pain in your lower abdomen (perhaps spreading to your back or the top of your thighs), which is not relieved by potassium citrate or ibuprofen, includes a fever of 38 degrees Celsius, and if you are confused about where you are or what time of day it is, then you should attend A&E, as these are signs the infection has spread to the kidneys (pyelonephritis).
- M. Gilbert et al., ‘Transient microbiota exposures activate dormant Escherichia coli infection in the bladder and drive severe outcomes of recurrent disease’, PLoS Pathogens, vol. 13, no. 3, 2017.
- Pinart et al., ‘Optimal dosage and duration of pivmecillinam treatment for uncomplicated lower urinary tract infections: a systematic review and meta-analysis’, Int Journal of Infectious Diseases, 2017, available online at http://dx.doi.org/10.1016/j.ijid.2017.03.012, (accessed 31 March 2017).
- L Boeri et al., ‘Six Out of Ten Women with Recurrent Urinary Tract Infections Complain of Distressful Sexual Dysfunction – A Case-Control Study’, Scientific Reports, 7, no. 44380, 2017.
- M Gilbert et al., ‘Transient microbiota exposures…’.