Urinary Tract Infection (UTI)
A urinary tract infection happens when bacteria, usually E. coli from the bowel, travel up the urethra into the bladder. The typical symptoms are burning or stinging when passing urine, needing to go far more often and urgently than usual, passing only small amounts, lower abdominal discomfort, and urine that is cloudy or smells strong. That is a bladder infection, and in an otherwise healthy non-pregnant woman it is usually treated with a short course of antibiotic. What changes the picture completely is fever, shivering, pain in the back or side, vomiting, or confusion in an older person: those mean the infection has reached the kidney, which needs same-day assessment and sometimes admission. In Pakistan a urine culture matters more than in the countries most guidelines are written for, because resistance to the antibiotics most often bought without a prescription — particularly ciprofloxacin and cotrimoxazole — is now very high, and a culture is what identifies a drug that will actually work. Any infection in a man, in pregnancy, in a child, or a third episode in a year deserves investigation rather than another course. Drinking enough, not holding urine, and treating constipation genuinely reduce recurrence; cranberry products may reduce how often infections return but do not treat one that is already present.
Health writers · Aslam Clinic
What a UTI is
The urinary tract is the kidneys, the two ureters that carry urine down from them, the bladder that stores it, and the urethra that empties it. Urine is normally sterile. An infection begins when — in about four cases out of five, E. coli from the bowel — get into the urethra and climb into the bladder.
An infection confined to the bladder is called cystitis. It is uncomfortable and disruptive but not dangerous in a healthy adult. An infection that travels further up to the kidney is called pyelonephritis — a infection — and that is a different illness: it makes you systemically unwell, it can scar the kidney, and it can lead to . Telling the two apart is the most useful thing you can do with your own symptoms.
Women get bladder infections far more often than men, for anatomical reasons rather than hygiene ones: the female urethra is short, and its opening sits close to the anus. Roughly half of women have at least one in their lifetime, and many have several.
Symptoms, and telling bladder from kidney
| What to compare | Bladder infection (cystitis) | Kidney infection (pyelonephritis) |
|---|---|---|
| Burning on passing urine | Usually present, often the main complaint | Often present, sometimes absent |
| Frequency and urgency | Marked, with small volumes each time | Present, but not the worst part |
| Fever | Usually none, or barely raised | Common, often 38-40 degrees Celsius, with shivering |
| Pain | Low, just above the pubic bone | In the back or flank, on one side, sometimes radiating to the groin |
| Nausea and vomiting | Unusual | Common |
| How you feel overall | Uncomfortable but functioning | Genuinely unwell, exhausted, sometimes confused |
| What it needs | A short antibiotic course, ideally culture-guided | Same-day assessment, a longer course, and sometimes admission for intravenous treatment |
How it is diagnosed
In a woman with no other health problems who has burning, frequency and urgency together and no vaginal discharge, the symptoms alone are accurate enough to start treatment. Everyone else needs a urine sample.
- . A strip dipped in a fresh sample. Nitrites and leucocyte esterase both positive makes an infection very likely; both negative in a person with mild symptoms makes it unlikely. Blood and protein are often present and mean little on their own.
- Midstream urine culture and sensitivity. The sample is taken mid-flow after cleaning, ideally the first urine of the morning, and grown in the laboratory. It identifies the organism and, crucially, which antibiotics still kill it. Results take two to three days.
- Blood tests — and — when the kidney is involved, to judge severity and check kidney function.
- of the kidneys, ureters and bladder where infections keep coming back, in any man, in any child, when a stone or obstruction is suspected, or when a kidney infection is slow to settle.
- Blood sugar. Recurrent urine infections are a recognised way that undiagnosed first announces itself, and a fasting sugar or is worth doing.
Treatment
Antibiotics are the treatment, and the choice is a prescriber's decision guided by the culture and by what is known about local resistance. A short course of three to seven days is usual for a bladder infection in a woman; a kidney infection needs a longer course, often seven to fourteen days, and sometimes intravenous treatment in hospital first. Men are generally treated for longer because the prostate is often involved.
- Take the whole course at even intervals, even after the symptoms have gone — which is usually within 48 hours.
- Paracetamol at the usual doses for the pain and any fever.
- Drink more than usual, enough to keep the urine pale. It does not cure the infection but it makes the symptoms more bearable and helps flush the bladder.
- Go back if you are not improving after 48 hours on the antibiotic, or at any point if fever, loin pain or vomiting appears. That is the point at which the culture result matters, and it is often the point at which the drug needs changing.
- Do not buy an antibiotic without a prescription for this, and do not use the leftover half-course from last time. Both are among the main drivers of the resistance that then makes your own next infection harder to treat.
Some situations are different
- Pregnancy. Every suspected infection is cultured and treated, and so is bacteria found in the urine with no symptoms at all — the one situation where that is treated. Several common antibiotics are not used in pregnancy, so this is never a self-treated problem. A repeat culture after treatment is standard.
- Men. A urinary infection in a man is uncommon and is treated as complicated: it needs a culture, a longer course, and usually a scan and a prostate assessment. It is not cystitis with a different pronoun.
- Children. Any urine infection in a child under two, or a second one at any age, needs a culture and usually imaging, because it can be the first sign of a structural problem in the urinary tract that is treatable if found early. Fever without an obvious cause in a small child should include a urine test.
- After menopause. Falling oestrogen thins the tissues around the urethra and makes recurrent infection much more common. Topical vaginal oestrogen reduces recurrence substantially and is a genuine option worth asking about.
- Older people with a catheter. Bacteria are always present in the urine of someone with a long-term catheter, and treating that without symptoms does harm without benefit. Cloudy or smelly urine alone is not a reason for an antibiotic.
When infections keep coming back
Recurrent means two or more infections in six months, or three or more in a year. It is common, it is not a sign that anything is seriously wrong in most women, and it is worth investigating properly once rather than treating repeatedly.
- Confirm it. Cultures during at least a couple of the episodes, so that the diagnosis is not being assumed from symptoms that might have another cause.
- Look for a reason. An for stones or incomplete bladder emptying, blood sugar for , and a check for constipation, which is a genuinely common and reversible contributor.
- Address the behaviours that help. Fluid intake, not delaying passing urine, emptying the bladder after sex, and treating constipation.
- Vaginal oestrogen after menopause, which has good evidence.
- Preventive antibiotics (), either a small nightly dose for several months or a single dose taken after sex, are an option for people whose lives are being disrupted. They work, and they carry a resistance cost, so they are a considered decision rather than a first step.
What you can do yourself
- Drink enough to keep your urine pale. In a Punjab summer that means considerably more than in winter, because concentrates the urine and slows the flushing of the bladder. There is trial evidence that increasing fluid intake reduces recurrent infections in women who drink little.
- Do not hold urine. Go when you need to, and take the time to empty completely.
- Empty the bladder after sex, and wash before and after.
- Wipe from front to back.
- Treat constipation. A loaded bowel presses on the bladder and stops it emptying, and it is one of the commonest reversible causes of recurrent infection in both children and adults.
- Avoid perfumed soaps, sprays and douches in the genital area. They irritate rather than protect.
- Cotton underwear and loose clothing in hot weather, which reduces the damp warmth bacteria prefer.
What does not help
- Cranberry as a cure. Cranberry juice or capsules may modestly reduce how often infections come back in women who get them frequently, which is a reasonable thing to try. They do not treat an infection that has already started, and they are not a substitute for an antibiotic.
- D-mannose. Popular and heavily marketed. The better recent trials have not shown a benefit in preventing recurrence.
- Alkalinising sachets and urine-alkaliser syrups. They may ease the burning a little. They do nothing to the infection and can interact with some antibiotics.
- Half a course of somebody else's antibiotic. It rarely clears the infection and reliably selects for resistant bacteria.
When to see a doctor
See a doctor for burning and frequency that has not settled within a day or two, for any urinary symptom in a man, a child or a pregnant woman, for blood in the urine, and for a third infection within a year. Ask for a culture before treatment starts.
Go the same day for fever, shivering, loin pain, vomiting or new confusion, and go to an emergency department if you cannot pass urine at all, or if you feel very unwell with a fast pulse and cold skin.
Common questions
Still not sure what to do?
Reading about a symptom only goes so far. A doctor who can ask you questions and examine you will get further in ten minutes than any article can.
