Urinary tract infection

A urinary tract infection develops when bacteria, most often from the gut flora, enter through the urethra and multiply in the bladder. Inflammation of the bladder, cystitis, is by far the most common form and stays confined to the lower urinary tract.

Women are affected much more often than men, because the female urethra is shorter and bacteria reach the bladder more quickly. In men, urinary tract infection is less common and is always a reason for a urological examination, as it is more often caused by an obstruction to the flow of urine or inflammation of the prostate.

How it shows

Typical signs are a burning sensation when passing urine, a frequent and urgent need to pass urine with only small amounts coming out, pressure or pain above the pubic bone, and cloudy, stronger-smelling urine. Sometimes there is also blood in the urine.

In older people, an infection often shows itself differently: with confusion, sudden weakness, falls or a general decline without burning when passing urine. In them, it makes sense to consider an infection even without the classic signs.

Burning when passing urine is not always an infection. Similar symptoms can also come from irritation of the urethra, sexually transmitted infections, a dry lining after the menopause and certain skin conditions in the genital area. A urine test helps to tell these apart.

What makes it more likely

In women, common factors are sexual activity, the use of spermicides, the menopause and the associated changes in the lining, and incomplete emptying of the bladder. In both sexes, diabetes, stones in the urinary tract, weakened immunity and a permanent urinary catheter are important.

Holding in urine and drinking too little make it easier for an infection to take hold, but they are often overestimated as a cause. Recurrent infections are rarely solved by drinking water alone.

In men past middle age, an infection is often caused by an enlarged prostate with urine left in the bladder. Stagnant urine is a favourable environment for bacteria, so infections tend to recur unless the obstruction is dealt with.

Fever with pain in the lower back cannot wait until next week

When an infection is joined by a fever above 38 degrees, chills, pain in the lower back or vomiting, the inflammation has most likely reached the kidney. Pyelonephritis needs to be seen the same day, not booked into the next free appointment. Seek emergency medical help.

If this is accompanied by confusion, marked weakness, rapid breathing, cold and mottled limbs or a drop in blood pressure, call 112. These can be signs that the infection has spread into the blood.

Immediate care is also needed for pregnant women with signs of a urinary tract infection, people with a single kidney or a transplanted kidney, and those who cannot pass urine. In babies and young children with a high fever and no clear cause, a urinary tract infection should be considered quickly.

How it is diagnosed

The basis is a urine test. A rapid test shows signs of inflammation, while a urine culture identifies the bacterium and its sensitivity to antibiotics. A culture is especially important for recurrent infections, in men, in pregnancy and when the first treatment does not work.

Collect a midstream sample after washing and hand it in as soon as possible. A sample that has stood at room temperature for several hours often gives an unusable result.

For recurrent infections, in men and when stones or an obstruction are suspected, the urologist performs an ultrasound of the urinary tract, a measurement of the urine left after passing urine and, if needed, further tests. The aim is not to confirm the infection again but to find the reason why it keeps coming back.

Treatment and recurrent infections

Uncomplicated inflammation of the bladder is treated with a short course of antibiotics, and the choice is adjusted to the urine culture result. Finish the prescribed treatment even if the symptoms go away on the second day. Do not take leftover antibiotics from last time on your own.

Mild symptoms without fever sometimes pass even without an antibiotic, with rest, enough fluids and painkillers. This approach is not suitable for men, pregnant women, people with diabetes or anyone with a fever or pain in the lower back.

With recurrent infections, the focus shifts from the individual episode to the pattern. The timing of symptoms in relation to sexual intercourse and the menopause is reviewed, bladder emptying is assessed, and depending on the doctor's judgement, preventive measures may be considered and, for women after the menopause, local hormonal treatment of the lining.