Urinary Tract Infections
A urinary tract infection (UTI) may involve the bladder (cystitis), urethra (urethritis), or kidneys (pyelonephritis).
Cystitis is the most common type of UTI in females and involves only the bladder. It is typically caused when bacteria that normally inhabit the rectum enter the opening of the tube that carries urine out of the body (urethra) and enter the bladder.
A UTI commonly occurs following sexual intercourse when bacteria can be pushed into the urethra. Although cystitis is frequently associated with sexual activity, it is not a sexually transmitted infection.
Urethritis is an inflammation of the urethra, and can cause burning with urination. Sometimes urethritis is due to chlamydia or gonorrhea. Genital herpes can cause symptoms similar to urethritis, because the sores are painful and can be irritated by urine.
A kidney infection, or pyelonephritis, is more serious and should be treated promptly, so it is important to be aware of its symptoms.
Symptoms
Cystitis
- burning or pain with urination (dysuria)
- feeling a need to urinate all the time (urgency)
- urinating small amounts frequently (frequency)
- appearance of blood in urine (hematuria)
- discomfort in the middle of the lower abdomen
Urethritis
- Symptoms may be less severe and more irregular than with cystitis.
Pyelonephritis
- symptoms of a bladder infection (sometimes)
- back pain, usually on one side, located at the level of the lower ribs
- fever greater than 101°F
- chills
- nausea and vomiting (sometimes)
- abdominal pain (sometimes)
Diagnosis
The diagnosis or detection of a UTI is made based on symptoms, a physical exam, and a laboratory examination of the urine (urinalysis). Finding bacteria and white blood cells in the urine is a strong indication of a UTI.
A urine culture may be done to identify the specific bacteria causing the infection, and results usually take 48 hours to return. A pelvic exam may be required to evaluate symptoms suggestive of vaginitis, urethritis, or herpes.
Treatment
- An antibiotic will be prescribed if a UTI is diagnosed. The full course of treatment should be taken as prescribed, even if symptoms resolve before treatment is completed. A small number of bacteria may remain and cause a recurrence of the infection if the full course of treatment is not taken.
- Treatment may include the local analgesic phenazopyridine. The medication is for comfort only and does not treat the infection itself. Phenazopyridine will turn the urine bright orange. The pain-relieving medication may be stopped when symptoms improve but antibiotics must be finished.
- Drinking two to three liters of liquid per day (noncaffeinated and nonalcoholic) will make urinating less painful.
- Avoid caffeine and alcohol because they irritate the bladder.
- Refrain from sexual activity until treatment is complete.
Prevention
- Urinate after intercourse to flush away any bacteria introduced into the urethra during sexual activity.
- Drink at least two liters of noncaffeinated, nonalcoholic fluids a day and empty the bladder every three to four hours while awake.
- Several small studies have suggested that consuming pure cranberry juice may be helpful in the prevention of UTIs. In the laboratory, cranberry juice appears to decrease the ability of bacteria to stick to the inner wall of the bladder. Further research is needed to confirm this effect.
When to consult a clinican
If symptoms of a UTI have not improved 48 hours after treatment began, return again after initial improvement, or if any of the following is experienced, consult a clinician.
- rash develops while on medication
- symptoms suggestive of a kidney infection develop, such as a fever over 101ºF, vomiting, severe abdominal or back pain
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