"Don't Ignore the Urge" and Other Tips for Saying Goodbye to UTIs

Medically reviewed by Justin Nguyen, MD

Over eight million people per year pay a visit to their medical provider for urinary tract infections (UTIs). UTIs arise when bacteria occurring in the gut colonize the genitalia and invade the urinary tract — including the bladder, kidneys or urethra. 

These are the three types of infections:

• Urethritis: infection of the urethra
• Cystitis: infection of the bladder
• Pyelonephritis: infection of the kidneys

As reported by the American Urological Association, around 60 percent of women and 12 percent of men will contract a UTI in their lifetime, and these infections must be taken seriously. 

SYMPTOMS IN ADULTS

Uncomplicated UTIs are confined to the bladder (cystitis) and do not cause systemic symptoms, such as fevers or rigors. Classic symptoms of acute uncomplicated UTIs in adults include the following:

• Burning with urination
• Increased urinary frequency and urgency
• Discomfort/pressure in the bladder (suprapubic area)

Complicated UTIs occur when the infection extends beyond the bladder involving the kidneys (pyelonephritis) or bloodstream (bacteremia). Complicated UTIs require urgent medical attention. Symptoms of a complicated UTI include the following:

• Fevers
• Rigor/chills
• Costovertebral angle tenderness or flank 
• Malaise or weakness

Not everyone experiences the classic symptoms of a UTI. Patients who are older, debilitated or immunocompromised (for example, renal transplant patients) may experience “atypical” UTI symptoms. The urinary symptoms may be less obvious (for example a dull burning with urination) or completely absent. In patient’s with neurogenic bladder, who have altered bladder function due to a neurologic condition such as spinal cord injury, UTI’s may present as increased urinary incontinence or muscle spasticity. Generalized symptoms may be more predominant, including fever, chills and/or weakness.

WHEN TO VISIT A MEDICAL PROVIDER

Anytime patients suspect a UTI, they should seek medical care. While a UTI can be empirically treated based on symptoms and a physical exam, urine testing is strongly recommended. A urinalysis is a urine test that analyzes various urine components and can quickly provide results within minutes to hours. Urinalysis is helpful to indicate the presence of a UTI, but a urine culture is required to confirm the diagnosis. Urine cultures identify the organism causing the UTI as well as the most effective treatment. They take up to 72 hours to finalize and treatment is often started while the results are pending. Other laboratory and imaging studies may be obtained to assist with the diagnosis in more complicated cases. 

POTENTIALLY DEADLY HAZARDS

UTIs are often viewed as minor issues, but they can escalate into serious conditions, such as pyelonephritis — a kidney infection that may result in sepsis or multi-organ failure. Paying attention to early signs of infection and seeking medical attention early can help prevent UTI  progression and serious complications. Patients experiencing more advanced symptoms, including fever, chills, flank pain and/or malaise should go to the emergency department as these symptoms could indicate a life-threatening infection.

RISK FACTORS

Female Anatomy and Biologic Sex

Females are at increased risks of UTIs largely due to anatomic factors. The female urethra is shorter than the male urethra, allowing bacteria to more easily enter and infect the urinary tract. 

Age

Women are more likely to develop UTIs after menopause due to thinning of the genital membranes as well as changes in the genital microbial flora. Older men are more prone to UTIs due to prostate enlargement (BPH) and incomplete bladder emptying.

Genetics

A family history of UTIs in female relatives is associated with increased UTI susceptibility in women including recurrent as well as complicated infections. Individuals with genetic predisposition to UTIs have intrinsically less effective UTI defense mechanisms.

Immunocompromised

Patients who are immunocompromised, including renal transplant patients, are at increase for complicated UTIs.

Diabetics

Diabetics are more susceptible to UTIs and are more likely to develop complicated UTIs. Diabetes increases sugar content in the blood and urine, weakens the immune system and can alter the bladder function by damaging nerves.

Sex 

While sexual activity can increase the risk of a UTI, UTIs are not a sexually transmitted infection (STI). STIs are transmitted by a partner while UTIs are generally caused when bacteria around the patient’s genitalia and anus are introduced into the urinary tract, which can occur during sexually activity. Vaginal, anal and oral sex can all increase the risk of UTIs.

Hospitalization/Surgery

Surgery and hospitalization can increase the risk of UTIs due to exposure to hospital acquired infections, increased risk of urinary retention and catheterization. Various factors contribute to urinary retention and the need for catheterization including immobilization, anesthesia, constipation and narcotics use. One of the best ways to prevent urinary retention is to get out of bed and walk, as walking naturally improves bladder function. 

PREVENTION

1. Increase fluid intake to dilute the urine. While an optimal fluid intake has not been established, drinking more than one to two liters of water a day has been proven to reduce the risk of UTIs.
2. Void regularly or on a timed schedule at least every three to four hours to keep the bladder empty.  
3. Avoid spermicides, which are proven to increase the risk for UTIs.
4. Wipe from front to back to minimize bacterial transfer as the bacteria responsible for UTIs frequently originate from gastrointestinal tract.
5. Urination after sex may reduce the likelihood of developing a UTI.
6. Cranberry is proven to help prevent UTIs. Whole cranberries, cranberry beverages and cranberry supplements can all decrease UTI risk. Cranberry supplements are often recommended as an easy preventative measure although lack of standardization and variability between products makes it challenging to recommend a specific formulation.   
7. UTIs affect approximately eight percent of pregnancies and are associated with increased risks of pregnancy complications, including preterm birth and low birth weight. All pregnant women should have a screening urine culture performed to rule out a UTI, even if they do not have symptoms. 
    

TREATMENT OPTIONS

Oral antibiotics are used to treat suspected or confirmed uncomplicated UTIs. The urine is typically cleared of bacteria within hours, and symptoms often improve within 24 hours. Increased fluid intake and over-the-counter pain medications, including acetaminophen, non-steroidal anti-inflammatories (ibuprofen) and bladder analgesics (phenazopyridine) can also be used to treat symptoms. IV antibiotics and hospitalization are often required for more complicated UTIs.

Recurrent UTIs are preferably prevented with non-antibiotic prophylaxis, including cranberry products, methenamine and topical estrogen (in post-menopausal women).

In patients who have UTIs associated with sexual activity, post-coital one-time antibiotics taken immediately after sex can be an effective preventative measure.

Continuous low dose antibiotic prophylaxis are used in refractory cases of recurrent UTIs unresponsive to the above measures. In addition to the typical side effects of antibiotics, continuous antibiotic use increases the risk of developing future antibiotic-resistant infections.

Talk to your provider about the appropriate treatment for any issues you have with UTIs. WakeMed Primary Care, Urology and Urogynecology have a team of providers ready and waiting to support you in your journey to good health. 

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About Justin Nguyen, MD

Dr. Justin Nguyen is a urologist who specializes in minimally invasive techniques and advanced robotic surgery for the treatment of urologic cancer such as prostate, kidney and bladder cancer, kidney stone disease and benign prostatic hyperplasia (BPH). He also has clinical interests in men’s sexual health, infertility and general urology.

He earned his medical degree from the University of Texas Health Science Center at Houston McGovern Medical School and was inducted into the Alpha Omega Alpha Medical Honor Society. While in medical school, he was also awarded an NIH-NIDDK research grant and the Dierks Surgical Scholarship. He completed his internship in general surgery and residency in urology at Yale School of Medicine and Yale New Haven Hospital, where he received specialized training in advanced minimally invasive and robotic techniques.

In addition to his clinical work, Dr. Nguyen is passionate about education and research. During his time at Yale, he was awarded the Resident Academic Achievement Award and the Betsy Winters House Staff Award for his contributions to medical education. He is a member of the American Urological Association and has published peer-reviewed articles on various urologic conditions including prostate, kidney and bladder cancer.

Dr. Nguyen believes in a patient centered approach to medicine with an emphasis on establishing personal and collaborative relationships with his patients. He strives to deliver the best care possible, making a special effort to ensure his patients are well informed and fully understand their condition as well as the available treatment options. He is committed to providing compassionate and comprehensive urologic care to every patient he encounters. When not working, Dr. Nguyen enjoys hiking, visiting national parks, traveling, and rooting for the Longhorns during football season.