The urinary tract is the body's filtering system for removal of liquid wastes.

Because we have a shorter urinary tract, women are especially susceptible to bacteria that may invade the urinary tract and multiply -- resulting in infection known as a urinary tract infection, or UTI. Although most UTIs are not serious, they can be a painful nuisance. Approximately 50 percent of all women will have at least one UTI in her lifetime with many women having several infections throughout their lifetime. Fortunately, these infections are easily treated with antibiotics. Some women are more prone to recurrent UTIs than others and for them it can be a frustrating battle. What Causes Urinary Tract Infections? The most common cause of UTIs are bacteria from the bowel that live on the skin near the rectum or in the vagina, which can spread and enter the urinary tract through the urethra. Once these bacteria enter the urethra, they travel upward, causing infection in the bladder and sometimes other parts of the urinary tract. Sexual intercourse is a common cause of urinary tract infections because the female anatomy can make women more prone to urinary tract infections. During sexual activity, bacteria in the vaginal area are sometimes massaged into the urethra. Women who change sexual partners or begin having sexual intercourse more frequently may experience bladder or urinary tract infections more often than women who are celibate or in monogamous relationships. Although it is rare, some women get a urinary tract infection every time they have sex. Another cause of bladder infections or UTI is waiting too long to urinate. The bladder is a muscle that stretches to hold urine and contracts when the urine is released. Waiting too long past the time you first feel the need to urinate can cause the bladder to stretch beyond its capacity. Over time, this can weaken the bladder muscle. When the bladder is weakened, it may not empty completely and some urine is left in the bladder. This may increase the risk of urinary tract infections or bladder infections. Other factors that also may increase a woman's risk of developing UTI include pregnancy, having urinary tract infections or bladder infections as a child, menopause, or diabetes. What Are the Symptoms of Urinary Tract Infections? Symptoms of UTI or bladder infection are not easy to miss and include a strong urge to urinate that cannot be delayed, which is followed by a sharp pain or burning sensation in the urethra when the urine is released. Most often very little urine is released and the urine that is released may be tinged with blood. The urge to urinate recurs quickly and soreness may occur in the lower abdomen, back, or sides. This cycle may repeat itself frequently during the day or night--most people urinate about six times a day, when the need to urinate occurs more often a bladder infection should be suspected.

When bacteria enter the ureters and spread to the kidneys, symptoms such as back pain, chills, fever, nausea, and vomiting may occur, as well as the previous symptoms of lower urinary tract infection. Proper diagnosis is vital since these symptoms also can be caused by other problems such as infections of the vagina or vulva. Only your physician can make the distinction and make a correct diagnosis. How Is a Diagnosis of UTI Made? The number of bacteria and white blood cells in a urine sample is the basis for diagnosing urinary tract infections. Urine is examined under a microscope and cultured in a substance that promotes the growth of bacteria. A pelvic exam also may be necessary. Note: If you have recurrent UTIs and bladder infections, you may be interested in purchasing an at-home test for UTI, which is available over-the-counter (OTC) without a prescription. The test consists of a dipstick that changes color when you have a urinary tract infection. The test detects the presence of nitrite. Bacteria changes normal nitrates in the urine to nitrite. The test, which works best on first morning urine, is about 90% reliable.

Urinary tract infection - adults

URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/000521.htm A urinary tract infection, or UTI, is an infection that can happen anywhere along the urinary tract. Urinary tract infections have different names, depending on what part of the urinary tract is infected.
y y y y

Bladder -- an infection in the bladder is also called cystitis or a bladder infection Kidneys -- an infection of one or both kidneys is called pyelonephritis or a kidney infection Ureters -- the tubes that take urine from each kidney to the bladder are only rarely the site of infection Urethra -- an infection of the tube that empties urine from the bladder to the outside is called urethritis

Causes
Urinary tract infections are caused by germs, usually bacteria that enter the urethra and then the bladder. This can lead to infection, most commonly in the bladder itself, which can spread to the kidneys. Most of the time, your body can get rid of these bacteria. However, certain conditions increase the risk of having UTIs.

Women tend to get them more often because their urethra is shorter and closer to the anus than in men. Because of this, women are more likely to get an infection after sexual activity or when using a diaphragm for birth control. Menopause also increases the risk of a UTI. The following also increase your chances of developing a UTI:
y y y y y y y y y y

Diabetes Advanced age (especially people in nursing homes) Problems emptying your bladder completely (urinary retention) A tube called a urinary catheter inserted into your urinary tract Bowel incontinence Enlarged prostate, narrowed urethra, or anything that blocks the flow of urine Kidney stones Staying still (immobile) for a long period of time (for example, while you are recovering from a hip fracture) Pregnancy Surgery or other procedure involving the urinary tract

Symptoms
The symptoms of a bladder infection include:
y y y y y

Cloudy or bloody urine, which may have a foul or strong odor Low fever (not everyone will have a fever) Pain or burning with urination Pressure or cramping in the lower abdomen (usually middle) or back Strong need to urinate often, even right after the bladder has been emptied

If the infection spreads to your kidneys, symptoms may include:

y y y y y y y y

Chills and shaking or night sweats Fatigue and a general ill feeling Fever above 101 degrees Fahrenheit Flank (side), back, or groin pain Flushed, warm, or reddened skin Mental changes or confusion (in the elderly, these symptoms often are the only signs of a UTI) Nausea and vomiting Severe abdominal pain (sometimes)

Exams and Tests

A urine sample is usually collected to perform the following tests:
y

Urinalysis is done to look for white blood cells, red blood cells, bacteria, and to test for certain chemicals, such as nitrites in the urine. Most of the time, your doctor or nurse can diagnose an infection using a urinalysis.

Urine culture - clean catch may be done to identify the bacteria in the urine to make sure the correct antibiotic is being used for treatment.

CBC and a blood culture may be done. The following tests may be done to help rule out problems in your urinary system that might lead to infection or make a UTI harder to treat:
y y y y y

CT scan of the abdomen Intravenous pyelogram (IVP) Kidney scan Kidney ultrasound Voiding cystourethrogram

Treatment
Your doctor must first decide whether you have a mild or simple bladder or kidney infection, or whether your infection is more serious. MILD BLADDER AND KIDNEY INFECTIONS Antibiotics taken by mouth are usually recommended because there is a risk that the infection can spread to the kidneys.
y

For a simple bladder infection, you will take antibiotics for 3 days (women) or 7 - 14 days (men). For a bladder infection with complications such as pregnancy or diabetes, OR a mild kidney infection, you will usually take antibiotics for 7 - 14 days. It is important that you finish all the antibiotics, even if you feel better. If you do not finish all your antibiotics, the infection could return and may be harder to treat.

Commonly used antibiotics include trimethoprim-sulfamethoxazole, amoxicillin, Augmentin, doxycycline, and fluoroquinolones. Your doctor will also want to know whether you could be pregnant. Your doctor may also recommend drugs to relieve the burning pain and urgent need to urinate. Phenazopyridine hydrochloride (Pyridium) is the most common of this type of drug. You will still need to take antibiotics. Everyone with a bladder or kidney infection should drink plenty of fluids. Some women have repeat or recurrent bladder infections. Your doctor may suggest several different ways of treating these.
y

Taking a single dose of an antibiotic after sexual contact may prevent these infections, which occur after sexual activity.

y y

Having a 3-day course of antibiotics at home to use for infections diagnosed based on your symptoms may work for some women. Some women may also try taking a single, daily dose of an antibiotic to prevent infections.

See also: Catheter-associated UTI MORE SEVERE KIDNEY INFECTIONS If you are very sick and cannot take medicines by mouth or drink enough fluids, you may be admitted to the hospital. You may also be admitted to the hospital if you:
y y y y y

Are elderly Have kidney stones or changes in the anatomy of your urinary tract Have recently had urinary tract surgery Have cancer, diabetes, multiple sclerosis, spinal cord injury, or other medical problems Are pregnant and have a fever or are otherwise ill

At the hospital, you will receive fluids and antibiotics through a vein. Some people have urinary tract infections that keep coming back or that do not go away with treatment. Such infections are called chronic UTIs. If you have a chronic UTI, you may need antibiotics for many months, or stronger antibiotics may be prescribed. If a structural (anatomical) problem is causing the infection, surgery may be recommended.

Outlook (Prognosis)
A urinary tract infection is uncomfortable, but treatment is usually successful. Symptoms of a bladder infection usually disappear within 24 - 48 hours after treatment begins. If you have a kidney infection, it may take 1 week or longer for your symptoms to go away.

Possible Complications
y y y

Life-threatening blood infection (sepsis) - risk is greater among the young, very old adults, and those whose bodies cannot fight infections (for example, due to HIV or cancer chemotherapy) Kidney damage or scarring Kidney infection

When to Contact a Medical Professional

Contact your health care provider if you have symptoms of a UTI. Call right away if the following symptoms develop:
y y y

Back or side pain Chills Fever

Vomiting

These may be signs of a possible kidney infection. Also call if you have already been diagnosed with a UTI and the symptoms come back shortly after treatment with antibiotics.

Prevention
Lifestyle changes may help prevent some UTIs. After menopause, a woman may use estrogen cream in the vagina area to reduce the chance of further infections. BATHING AND HYGIENE
y y y y y y

Choose sanitary pads instead of tampons, which some doctors believe make infections more likely. Change the pad each time you use the bathroom. Do not douche or use feminine hygiene sprays or powders. As a general rule, do not use any product containing perfumes in the genital area. Take showers instead of baths. Avoid bath oils. Keep your genital area clean. Clean your genital and anal areas before and after sexual activity. Urinate before and after sexual activity. Wipe from front to back after using the bathroom.

CLOTHING
y y

Avoid tight-fitting pants. Wear cotton-cloth underwear and pantyhose, and change both at least once a day.

DIET
y y y

Drink plenty of fluids (2 to 4 quarts each day). Drink cranberry juice or use cranberry tablets, but NOT if you have a personal or family history of kidney stones. Do NOT drink fluids that irritate the bladder, such as alcohol and caffeine.

Alternative Names
Bladder infection - adults; UTI - adults; Cystitis - bacterial - adults; Pyelonephritis - adults; Kidney infection - adults
Urinary Tract Infections Overview

A urinary tract infection (UTI) is an infection involving the kidneys, ureters, bladder, or urethra. These are the structures that urine passes through before being eliminated from the body.

The kidneys are a pair of small organs that lie on either side of the spine at about waist level. They have several important functions in the body, including removing waste and excess water from the blood and eliminating them as urine. These functions make them important in the regulation of blood pressure. Kidneys are also very sensitive to changes in blood sugar levels and blood pressure. Both diabetes and hypertension can cause damage to these organs.

Two ureters, narrow tubes about 10 inches long, drain urine from each kidney into the bladder.

The bladder is a small saclike organ that collects and stores urine. When the urine reaches a certain level in the bladder, you experience the sensation that you have to void, then the muscle lining the bladder can be voluntarily contracted to expel the urine.

The urethra is a small tube connecting the bladder with the outside of the body. A muscle called the urinary sphincter, located at the junction of the bladder and the urethra, must relax at the same time the bladder contracts to expel urine.

Any part of this system can become infected. As a rule, the farther up in the urinary tract the infection is located, the more serious it is.
y

The upper urinary tract is composed of the kidneys and ureters. Infection in the upper urinary tract generally affects the kidneys (pyelonephritis), which can cause fever, chills, nausea, vomiting, and other severe symptoms.

The lower urinary tract consists of the bladder and the urethra. Infection in the lower urinary tract can affect the urethra (urethritis) or the bladder (cystitis).

Urinary tract infections are usually referred to as simple or complicated.

y

Simple infections occur in healthy urinary tracts and do not spread to other parts of the body. They usually go away readily with treatment.

Complicated infections are caused by anatomic abnormalities, spread to other parts of the body, are worsened by underlying medical conditions, or are resistant to many antibiotics. They are more difficult to cure.

In the United States, urinary tract infections account for more than 7 million visits to medical offices and hospitals each year.
y

Urinary tract infections are much more common in adults than in children, but about 1%-2% of children do get urinary tract infections. Urinary tract infections in children are more likely to be serious than those in adults and should not be ignored (especially in younger children).

Urinary tract infection is the most common urinary tract problem in children besides bedwetting.

Urinary tract infection is second only to respiratory infection as the most common type of infection.

These infections are much more common in girls and women than in boys and men younger than 50 years of age. The reason for this is not well understood, but anatomic differences between the genders (a shorter urethra in women) might be partially responsible.

About 40% of women and 12% of men have a urinary tract infection at some time in their life.

Urinary Tract Infection Causes

The urine is normally sterile. An infection occurs when bacteria get into the urine and begin to grow. The infection usually starts at the opening of the urethra where the urine leaves the body and moves upward into the urinary tract.
y

The culprit in at least 90% of uncomplicated infections is a type of bacteria called Escherichia coli, better know as E. coli. These bacteria normally live in the bowel (colon) and around the anus.

These bacteria can move from the area around the anus to the opening of the urethra. The two most common causes of this are poor hygiene and sexual intercourse.

Usually, the act of emptying the bladder (urinating) flushes the bacteria out of the urethra. If there are too many bacteria, urinating may not stop their spread.

The bacteria can travel up the urethra to the bladder, where they can grow and cause an infection.

The infection can spread further as the bacteria move up from the bladder via the ureters.

If they reach the kidney, they can cause a kidney infection (pyelonephritis), which can become a very serious condition if not treated promptly.

The following people are at increased risk of urinary tract infection:

y y

People with conditions that block (obstruct) the urinary tract, such as kidney stones People with medical conditions that cause incomplete bladder emptying (for example, spinal cord injury or bladder decompensation after menopause) People with suppressed immune systems: Examples of situations in which the immune system is suppressed are AIDS and diabetes. People who take immunosuppressant medications such as chemotherapy for cancer also are at increased risk. Women who are sexually active: Sexual intercourse can introduce larger numbers of bacteria into the bladder. Infection is more likely in women who have frequent intercourse. Infection attributed to frequent intercourse is nicknamed "honeymoon cystitis." Urinating after intercourse seems to decrease the likelihood of developing a urinary tract infection. Women who use a diaphragm for birth control

Men with an enlarged prostate: Prostatitis or obstruction of the urethra by an enlarged prostate can lead to incomplete bladder emptying, thus increasing the risk of infection. This is most common in older men. Males are also less likely to develop UTIs because their urethra (tube from the bladder) is longer. There is a drier environment where a man's urethra meets the outside world, and fluid produced in the prostate can fight bacteria.

Breastfeeding has been found to decrease the risk for urinary tract infections.

The following special groups may be at increased risk of urinary tract infection:

Very young infants: Bacteria gain entry to the urinary tract via the bloodstream from other sites in the body.

Young children: Young children have trouble wiping themselves and washing their hands well after a bowel movement. Poor hygiene has been linked to an increased frequency of urinary tract infections.

Children of all ages: Urinary tract infection in children can be (but is not always) a sign of an abnormality in the urinary tract, usually a partial blockage. An example is a condition in which urine moves backward from the bladder up the ureters (vesicoureteral reflux).

Hospitalized patients or nursing home residents: Many of these individuals are catheterized for long periods and are thus vulnerable to infection of the urinary tract. Catheterization means that a thin tube (catheter) is placed in the urethra to drain urine from the bladder. This is done for people who have problems urinating or cannot reach a toilet to urinate on their own.

Urinary Tract Infection Symptoms and Signs

Lower urinary tract infection (cystitis): The lining of the urethra and bladder becomes inflamed and irritated.
y

Dysuria: pain or burning during urination

Frequency: more frequent urination (or waking up at night to urinate, sometimes referred to as nocturia); often with only a small amount of urine

Urgency: the sensation of having to urinate urgently

Hesitancy: the sensation of not being able to urinate easily or completely (or feeling that you have to urinate but only a few drops of urine come out)

Cloudy, bad-smelling, or bloody urine

Lower abdominal pain

Mild fever (less than 101 F), chills, and "just not feeling well" (malaise)

Upper urinary tract infection (pyelonephritis): Symptoms develop rapidly and may or may not include the symptoms for a lower urinary tract infection.
y

Fairly high fever (higher than 101 F)

Shaking chills

Nausea

Vomiting

Flank pain: pain in your back or side, usually on only one side at about waist level

In newborns, infants, children, and elderly people, the classic symptoms of a urinary tract infection may not be present. Other symptoms may indicate a urinary tract infection.
y

Newborns: fever or hypothermia (low temperature), poor feeding, jaundice

Infants: vomiting, diarrhea, fever, poor feeding, not thriving

Children: irritability, eating poorly, unexplained fever that doesn't go away, loss of bowel control, loose bowels, change in urination pattern

Elderly people: fever or hypothermia, poor appetite, lethargy, change in mental status

Pregnant women are at increased risk for an UTI. Typically, pregnant women do not have unusual or unique symptoms. If you are pregnant, your urine should be checked during prenatal visits because an unrecognized infection can cause pregnancy complications or miscarriage. Although most people have symptoms with a urinary tract infection, some do not. The symptoms of urinary tract infection can resemble those of sexually transmitted diseases.
When to Seek Medical Care

Any adult or child who develops any of the symptoms of a urinary tract infection needs to be evaluated by a medical professional, preferably within 24 hours. Most medical offices can test urine for infection by using a quick urine "dipstick" test.
y

If you have symptoms of a lower urinary tract infection, call your health-care provider for an appointment, preferably on the very day that symptoms are recognized.

If you have symptoms of an upper urinary tract infection involving the kidneys, call your healthcare provider immediately. Depending on the situation, he or she will recommend either a visit to the office or to a hospital emergency department.

If you have symptoms of a lower urinary tract infection and any of the following applies to you, you may have a urinary tract infection that can potentially be serious. Go to a hospital emergency department right away.
y

Vomiting and inability to keep down clear fluids or medication

Not better after taking antibiotics for two days

Pregnant

Having diabetes or another disease that affects the immune system (for example, AIDS)

Taking medication that suppresses the immune system such as cancer chemotherapy

Infants, children, and elderly people with any of the signs and symptoms of UTI should go to an emergency department for evaluation.
y

Fever, lethargy, and poor appetite may indicate a simple lower urinary tract infection in these groups, but they may also be signs of something more serious.

Urinary tract infections have the potential to make these vulnerable people very ill.