What to Know About Urinary Tract Infections

Discomfort in the lower abdomen. Cloudy urine. The feeling that you can’t empty your bladder, no matter how many times you’ve gone to the bathroom.

Those initial warning signs of a urinary tract infection (UTI) can be unpleasant and painful, especially for people who experience recurrent infections. And although they are common, UTIs can pose serious health risks if left untreated. “When you have a UTI, it’s important to see a doctor for treatment sooner rather than later,” explains Dr. Doreen E. Chung, a urologist at NewYork-Presbyterian/Columbia University Irving Medical Center.

Although both men and women can get UTIs, they are more common in women: According to a study from the National Institutes of Health, 50% to 60% of women will experience a urinary tract infection in her lifetime. Health Matters spoke with Dr. Chung to understand why this is, what causes UTIs, and how to prevent and treat them.

What is the urinary tract, and how does it get infected?
Dr. Chung: The urinary tract is the organ system that produces, stores, and expels urine. Most UTIs are caused by bacteria in the urine climbing into the bladder and multiplying.

Any type of foreign body in the urinary tract, such as kidney stones or tumors, can be a source of bacteria in the bladder. Not drinking enough water can also make someone more prone to getting UTIs. Everyone has a very low level of bacteria in the bladder, but constantly emptying your bladder and flushing out the bacteria makes it is less likely to multiply and cause an infection.

What are the first signs of a UTI?
One of the first signals is dysuria, or a burning sensation when you urinate. If you have a UTI, you might feel bladder discomfort, which makes you feel like you always need to urinate. Some people will rush to the bathroom and even leak before getting there in time. You might notice cloudy urine or an ammonia-like smell. Less commonly, you might have a fever or see blood in your urine.

Why are women more prone to UTIs?
Women are much more likely to have bacteria enter the bladder because they have shorter urethras than men, which means the bacteria have a shorter distance to travel. Women experience UTIs up to 30 times more often than men. Recurrent UTIs are categorized as more than three or more infections per year or two or more in six months. UTIs are uncommon in children and young men.

Both older women and men are also more at risk. Postmenopausal women are prone to UTIs because they have fewer good bacteria, called lactobacillus, in their vagina. Lactobacillus causes the vagina to be acidic, and that acidity is thought to prevent the bacteria from climbing into the urethra. Older men are more prone to UTIs because they have enlarged prostates, which causes incomplete emptying of the bladder.

Studies have shown that certain people also have a genetic predisposition to UTIs. For people who are immunocompromised, bacteria can spread more easily throughout the body, which may make them more prone to UTIs.

How are UTIs usually diagnosed and treated?
Urinary tract infections are diagnosed by a urine culture, or a urinalysis, which looks at red blood cells, nitrites, and leukocyte esterase (an enzyme produced by white blood cells) in the urine – all indicators of a UTI. Usually, simple urinary tract infections confined to the bladder (called cystitis) are treated with oral antibiotics. If you feel like you have a UTI, you should see a doctor for a formal urinalysis and culture. There are also over-the-counter test strips that can give you a rough idea as to whether you may have one before you see a doctor.

For pain, phenazopyridine, available over the counter, is a helpful medication that relieves pain in the urinary tract. One side effect is that it turns the urine bright orange.

What health issues can UTIs lead to?
The majority of infections are usually confined to the bladder; this type of infection is called cystitis. But the infection can sometimes include the urethra, or urethritis, which is more common in sexually transmitted diseases than regular urinary tract infections.

With cystitis, the infection can spread to your kidneys and cause a kidney infection called pyelonephritis. Pyelonephritis is more common among people who have trouble emptying their bladder or have kidney stones or blockage. Once the kidney is blocked and urine backs up and isn’t able to drain from the kidney, a serious infection can develop.

From there, a urinary tract infection can also spread to the bloodstream and cause bacteremia (bacteria in the bloodstream) or sepsis.

For men, an untreated UTI can lead to epididymo-orchitis — an infection of the testicles and the epididymis, which is the organ on top of the testicles — or an infection of the prostate.

These issues usually only occur if the patient is immunocompromised, has a blocked kidney, kidney stones, or anatomic anomalies of the urinary tract.

Can you prevent getting a UTI?
First, make sure you’re drinking at least two liters (between eight and nine cups) of water a day. If your urine isn’t light in color, you’re not hydrating enough. The more water you drink, the better you can flush out the bacteria and hopefully clear the infection faster. Try not to hold your urine whenever possible.

For many women, sexual activity is a risk factor for urinary tract infections. It’s effective to urinate after sexual activity to clear out any bacteria.

Cranberry has been shown in some studies to help prevent infections. There is an ingredient in cranberry juice called proanthocyanidin, or PAC, that may prevent the bacteria from climbing into the bladder. To be clear, you would have to drink a lot of cranberry juice to see an effect on the urinary tract, and even when choosing a cranberry supplement, you should check to make sure it contains a significant amount of PAC (at least 18 mg). People with kidney stones and interstitial cystitis, however, should check with their doctor before taking cranberry supplements because of the acidity.

There’s also a supplement called D-mannose, a type of simple sugar, that may help prevent infections. It’s unclear whether probiotics help prevent infections, but they certainly don’t hurt. In perimenopausal and postmenopausal women, it has been shown that vaginal estrogen helps prevent infections.

Doreen Chung, M.D., is a urologist at NewYork-Presbyterian/Columbia University Irving Medical Center and an associate professor of urology at the Columbia University Vagelos College of Physicians and Surgeons who specializes in male and female urinary incontinence, pelvic organ prolapse, female urology, and benign prostatic hyperplasia (BPH).