Urinary tract infections (UTIs or pokenga pūaha mimi), also known as cystitis or a bladder infection, can affect any part of your urinary system – kidneys, ureters, bladder and urethra.
Key points about UTIs
- About 1 in every 2 women will have at least one UTI in their lifetime. The most common is cystitis, an infection that affects your bladder.
- Symptoms of a UTI include burning or pain when peeing and needing to pee more often and more urgently.
- Antibiotics are usually used to clear the infection.
- Self-care includes taking pain relief and drinking plenty of water. There is no strong evidence that cranberry products help.
- In rare cases, the infection can spread to your kidneys. This is known as pyelonephritis and needs urgent medical care.
What is a UTI?
A UTI is an infection in some part of your urinary system. Your urinary system includes all the organs involved in making and releasing urine (pee):
- Kidneys – these filter your blood to remove waste and extra water to make urine (pee).
- Ureter – two thin tubes of muscle, one on each side of your bladder, through which urine flows from your kidneys to your bladder.
- Bladder – where you store urine until you need to pee.
- Urethra – when you pee, urine passes along your urethra, a central tube that carries urine out of your body.
What causes a UTI?
An infection in your urinary system may be caused by:
- bacteria from your anal area (bottom) entering your bladder via your urethra – the urethra is shorter in women than in men so it is easier for bacteria to reach the bladder and cause infection
- bacteria introduced when the urethra is pushed on during vaginal sex
- problems in the structure of your kidneys, bladder or tubes
- irritation of the urethra by chemicals (eg, soaps, perfumes, vaginal hygiene sprays)
- ulcers or inflammation near your urethra
- sexually transmitted infection (STI), eg, chlamydia.
Who is at risk of developing a UTI?
UTIs can occur at any age and are more common if you:
- are female (4 times more common than in men)
- are pregnant (read more about UTI in pregnancy)
- are sexually active
- have unprotected anal sex
- use spermicide with contraception
- have been through menopause – the changes in the tissues of your vagina and urethra after menopause make it harder for them to defend against infection
- have diabetes
- have a catheter in your bladder
- have abnormalities in your kidneys, bladder or urinary system
- have an immune system that is not working well (eg, due to HIV/AIDS or medicine that suppresses the immune system).
What are the symptoms of a UTI?
Typical symptoms of a UTI include:
- pain or burning during or immediately after peeing
- fever, tiredness or shakiness
- an urge to pee more often
- passing small amounts of pee more frequently
- pressure in your lower belly
- urine that smells bad or looks cloudy or reddish
- getting out of bed often to pee at night.
Fever, pain or ache in your centre back or shaking may indicate that the infection has gone to your kidneys (pyelonephritis). If this happens, see your doctor urgently.
Recognising UTI symptoms in children
Older children with UTIs can describe pain felt when peeing. Younger children may not be able to do this. Watch for other symptoms, such as fever, tiredness, feeding difficulties, loss of appetite, nausea (feeling sick) and vomiting (being sick), tummy pain, waking at night, bed wetting or loss of bladder control during the daytime.
How is a UTI diagnosed?
See your doctor if:
- you're a man with symptoms of a UTI
- you're pregnant and have symptoms of a UTI
- your child has symptoms of a UTI
- you're caring for an older adult who may have a UTI
- you have not had a UTI before
- you have blood in your pee
- your symptoms do not improve within a few days
- your symptoms come back after treatment.
Your doctor will ask about your symptoms and do a urine test. The urine is tested in the clinic for signs of infection. UTIs in men are unusual and usually need more tests. See urinary problems in men.
How is a UTI treated?
Pain relief only
Allowing your immune system to fight the infection (by taking only pain relief and not using antibiotics) is not recommended in New Zealand health guidelines. Studies have shown antibiotics reduce how long you have symptoms on average by around 2 days and reduce the risk of pyelonephritis. However, about one in every 2 to 3 women who decide to just use non-steroidal anti-inflammatories (NSAIDs) for pain relief do not end up needing antibiotics. Talk to your doctor about what is best for you.
Antibiotics are recommended for most cases of UTIs. Usually, a 3–5 day course of antibiotics is needed to treat the infection and reduce the risk of it spreading to your kidneys and causing pyelonephritis. Your symptoms should begin to improve within the first 2 days of taking antibiotics.
You must finish all the antibiotics to get rid of the bacteria. Stopping antibiotics early could cause the infection to come back. If your symptoms continue for more than 2 days after starting treatment, or you get worse, see your doctor as soon as possible.
If you have recurrent UTIs (you keep getting them), or are at higher risk of complications, you may need to have a repeat urine test a few weeks after treatment to make sure the infection has gone. Your doctor or nurse will let you know if you need to do this.
Can I get antibiotics for a UTI from my pharmacy without a prescription?
Many pharmacists are now able to sell an antibiotic called trimethoprim for the treatment of UTIs. This is available without a prescription to women aged 16–65 years, who are not pregnant and do not have any other complicating factors.
What self-care can I do with a UTI?
- Take paracetamol or ibuprofen for pain.
- Drink plenty of water so you don't get dehydrated. This helps to flush out the bacteria.
- There is no evidence that it helps to take products that alkalise your urine (such as Ural®).
- Cranberry juice is not a recommended treatment as there have been no randomised controlled trials to show that it is effective.
What can I do to prevent UTIs?
- Do wipe from front to back when you go to the toilet.
- Do try to fully empty your bladder when you pee.
- Do drink plenty of fluids.
- Do take showers instead of baths.
- Do wear loose cotton underwear.
- Do pee as soon as possible after sex.
- Do change your baby's or toddler's nappies regularly.
- Don't use perfumed bubble bath, soap or talcum powder.
- Don't hold your pee in if you feel the urge to go.
- Don't wear tight, synthetic underwear, such as nylon.
- Don't wear tight jeans or trousers.
- Don't use condoms or diaphragms with spermicidal lube on them – try non-spermicidal lube or a different type of contraception.
Cranberry, probiotics, D-mannose, methenamine (Hiprex)
You may see some of these options recommended for preventing UTIs. They all have unproven benefit but are generally well tolerated, except for high dose cranberry. Methenamine (Hiprex) is funded by Pharmac.
- Your kidneys and how they work National Institute of Diabetes and Kidney and Digestive Disease, US, 2018
- Cystitis in women Patient Info, UK, 2018
- Managing urinary tract infections in children BPAC, NZ, 2012
- Urinary tract infections (UTIs) NHS, UK, 2017
- Urinary tract infection (lower) – antimicrobial prescribing NICE, UK, 2018
- Can D-mannose treat a UTI? Medical News Today, UK, 2018
- Urinary symptoms in adults Waitematā District Health Board, NZ, 2017
- Urinary tract infection (UTI) in males MedScape, 2018
- Lema VM, Lema APV. Sexual activity and the risk of acute uncomplicated urinary tract infection in premenopausal women: Implications for reproductive health programming Obstet Gynecol Int J. 2018 Feb 08;9(1):00303.
- Cranberries for preventing urinary tract infections Cochrane Database of Systematic Reviews, 2012.
- Schwenger EM, Tejani AM, Loewen PS. Probiotics for preventing urinary tract infections in adults and children. Cochrane Database of Systematic Reviews 2015, Issue 12. Art. No.: CD008772. DOI: 10.1002/14651858.CD008772.pub2.
- Gágyor I, Bleidorn J, Kochen MM et al. Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: randomised controlled trial BMJ. 2015;351:h6544.
- Kronenberg A, Bütikofer L, Odutayo A, et al. Symptomatic treatment of uncomplicated lower urinary tract infections in the ambulatory setting: randomised, double blind trial BMJ 2017;359:j4784.
|Jeremy Steinberg is a GP with special interests in musculoskeletal medicine, evidence-based medicine and use of ultrasound. He's been reviewing topics for Health Navigator since 2017 and in his spare time loves programming. You can see some of the tools he's developed on his website.