Urinary tract infections (UTIs) are infections affecting the urinary system. They most commonly involve the bladder, but infection can also affect the kidneys and, in men, the prostate. UTIs are usually straightforward to treat, but recurrent infections or infections associated with obstruction, stones or incomplete bladder emptying may require further investigation to identify and address the underlying cause.
What is a urinary tract infection?
A urinary tract infection occurs when bacteria enter and multiply within the urinary tract. A bladder infection is often referred to as cystitis, while infection involving the kidney is known as pyelonephritis. In men, urinary symptoms can also be caused by infection or inflammation of the prostate (prostatitis), which may require a different approach to treatment.
What are the symptoms of a UTI?
Symptoms of a bladder infection may include:
- Pain or burning when passing urine (dysuria)
- Passing urine more frequently
- An urgent need to pass urine
- Pain or discomfort in the lower abdomen or above the pubic bone (suprapubic pain)
- Cloudy or strong-smelling urine
- Blood in the urine (haematuria)
Some patients develop more general symptoms, including feeling unwell or fever.
A kidney infection will usually cause more significant illness and may be associated with:
- Pain in the side or back (loin pain)
- Fever or chills
- Nausea or vomiting
- Feeling generally unwell
A kidney infection can be serious and may require urgent medical assessment.
How are UTIs diagnosed?
Diagnosis is based on your symptoms, examination and urine testing.
Urine testing
A urine sample can look for evidence of infection, including white blood cells and bacteria. Where appropriate, a urine culture can identify the specific bacteria responsible and determine which antibiotics are likely to be effective. This can be particularly important in recurrent infections or when symptoms do not improve with initial treatment.
Blood tests and imaging
Blood tests may be required if you are significantly unwell or there is concern about infection involving the kidneys.
Additional investigations, such as an ultrasound or CT scan of the urinary tract, may be appropriate where there is concern about:
- Kidney or ureteric stones
- Urinary obstruction
- Impaired drainage of the kidneys
- Structural abnormalities
- Complications of infection
How are UTIs treated?
Most uncomplicated UTIs can be treated with antibiotics. The choice of antibiotic depends on the likely cause of the infection, previous urine cultures, local resistance patterns and individual patient factors. Symptoms will often begin to improve within a few days of starting effective treatment.
It is important to complete the prescribed course of antibiotics and to seek further medical advice if symptoms fail to improve or worsen. Infections involving the kidneys or prostate may require a different antibiotic, a longer course of treatment and, in some cases, hospital assessment.
What causes recurrent UTIs?
Some people experience repeated urinary tract infections. Recurrent UTI is usually defined as at least three symptomatic, medically confirmed infections within a 12-month period, or two within six months. Recurrent infections are much more common in women, partly because the female urethra is considerably shorter. In men, recurrent UTIs are less common and may warrant investigation for an underlying cause.
Possible contributing factors include:
- Incomplete emptying of the bladder
- Bladder outflow obstruction due to an enlarged prostate
- Urinary tract stones
- Abnormalities of the urinary tract
- Impaired drainage from the kidneys
- Prostate infection or inflammation
- Sexual intercourse
- Conditions that affect the immune system, including diabetes
Identifying and treating an underlying cause can be an important part of preventing further infections.
Recurrent UTIs in men
A recurrent UTI in a man should not simply be treated with repeated courses of antibiotics without considering why the infections are occurring. In some patients, infection may be associated with bladder outflow obstruction or incomplete bladder emptying. Residual urine within the bladder can provide an environment in which bacteria are more likely to persist or multiply.
Other patients may have urinary tract stones or an abnormality affecting the drainage of urine. Assessment may therefore include measurement of the urine flow rate and a bladder scan after urination to determine how effectively the bladder is emptying. Further investigations may be recommended depending on the history and initial findings.
When should I seek urgent medical attention?
A UTI can occasionally become more serious, particularly when infection involves the kidney or when urine drainage is obstructed.
Seek urgent medical advice if you develop:
- High fever or shaking chills
- Severe loin or back pain
- Persistent vomiting
- Significant deterioration or feeling very unwell
- Confusion or marked weakness
- Difficulty passing urine
An infected, obstructed kidney can occasionally lead to sepsis and requires urgent treatment.
Can UTIs be prevented?
Prevention depends on the reason infections are recurring.
General measures may include:
- Maintaining good fluid intake
- Avoiding prolonged periods without passing urine
- Addressing incomplete bladder emptying
- Treating bladder outflow obstruction where appropriate
- Treating urinary tract stones where appropriate
- Identifying and managing other underlying causes
For patients with recurrent infections, prevention should be tailored to the individual rather than relying solely on repeated courses of antibiotics.
Frequently asked questions
Is cloudy or smelly urine always a UTI?
No. Changes in urine appearance or smell can occur for a number of reasons and do not necessarily indicate infection. Urinary symptoms and appropriate urine testing are important when determining whether a UTI is present.
Can an enlarged prostate cause recurrent UTIs?
Yes. An enlarged prostate can cause bladder outflow obstruction and incomplete bladder emptying. Residual urine may increase the risk of recurrent infection in some men.
Can kidney stones cause UTIs?
Yes. Stones can be associated with urinary infections, and some stones can harbour bacteria. A stone that obstructs the urinary tract can make an infection particularly serious.
Do I need further tests if I keep getting UTIs?
Sometimes. The need for further investigation depends on your age, symptoms, frequency of infections and other risk factors. In men with recurrent UTIs, it is particularly important to consider whether there is an underlying problem affecting bladder emptying, urinary drainage or the prostate.
Do I need a GP referral?
You do not usually need a GP referral to arrange a private consultation. However, some private medical insurers require a GP referral or pre-authorisation before they will cover the cost of an appointment or treatment. If you are using private medical insurance, please check your policy requirements with your insurer before booking.
How quickly can I be seen?
Appointments are arranged as quickly as possible, with urgent symptoms prioritised.
Will I see a consultant?
Yes. You will be seen directly by Mr Ellis at every appointment.
At a glance
| Also called | Cystitis, urinary infection, bladder infection |
|---|---|
| Common symptoms | Burning when passing urine, frequency, urgency, suprapubic discomfort, cloudy or strong-smelling urine |
| Kidney infection symptoms | Fever, chills, loin pain, nausea or feeling significantly unwell |
| Investigated with | Urine testing and culture; further investigations where appropriate |
| Treatment | Antibiotics, with treatment tailored to the site and cause of infection |
| Important in recurrent infection | Consider incomplete bladder emptying, prostate problems, stones or urinary tract abnormalities |
| Urgency | Routine for uncomplicated symptoms; urgent assessment if fever, significant illness, loin pain, vomiting or difficulty passing urine |
Recurrent or troublesome urinary infections?
Most urinary tract infections can be treated effectively. However, if infections keep returning, it is important to consider whether there is an underlying reason. A specialist assessment can help determine the cause of recurrent infection and whether further investigation or treatment is appropriate.
