The vast majority of urinary infections in adults
are treated by primary care physicians (GPs).
As a general rule, urologists only become
involved if further investigations are required,
or if other causes have been identified.
Referral may be considered for:
Most urine infections are caused by a bacterium
called E coli Other types of bacteria may be
responsible, and the type of organism can
sometimes give a pointer to the underlying
problem (e.g. kidney or bladder stones
may be associated with a bacterium called
Proteus).
What causes urinary infection?
Most urine infections occur when bacteria
enter your bladder through your urethra
(waterpipe); Risk factors include:
- • Sexual intercourse
- • Passing urine infrequently
- • Incomplete bladder emptying
- • Stones
- • Poorly-draining or misshapen kidneys
- • Catheters
Most urine infections are caused by a
bacterium called E coli (illustrated right).
Other types of bacteria may be responsible,
and the type of organism can sometimes
give a pointer to the underlying problem
(e.g. kidney or bladder stones may be
associated with a bacterium called Proteus).
How will I know if I have an urinary infection?
Symptoms can vary from very mild to severe,
depending on whether the infection is confined
to your bladder (cystitis) or has affected your
kidney(s) as well (pyelonephritis):
Symptoms of bladder infection(Cystitis)
- • Passing urine frequently
- • Urgency (a pressing need to pass urine)
- • Pain in your lower abdomen (tummy)
- • Pain in your urethra (waterpipe)
- • Bloodstained urine
Symptoms of kidney infection (pyelonephritis)
- • Fever
- • Shaking (rigors) and chills
- • Pain in your flank (kidney area)
- • (± symptoms of bladder infection)
How will my urinary infection be confirmed?
The simplest and most important test is analysis
of a sample of your urine; this can normally be
done at your GP surgery using a special “dipstick”
technique. The stick test also looks for other
abnormalities in your urine (e.g. protein, sugar,
bilirubin). The results are available immediately,
but does not identify the bacteria involved.
A more thorough microbiological test, called “
microscopy, culture and sensitivity (MC&S)”,
is sometimes performed; this requires a
mid-stream sample of your urine to be collected
into a sterile container, usually at your GP surgery.
The result takes 48-72 hours to become available
How will my urinary infection be treated?
- • Increasing the amount of fluid you drink
- • Taking regular painkillers (e,g, paracetamol) -
- this also helps reduce any fever
- • Taking agents which alkalinise your urine
- (e.g. bicarbonate of soda or preparations which
- you can buy from any chemist) - these neutralise
- the acidity of your urine and improve the burning
- when you pass urine
Antibiotics are the most effective treatment for
urinary infection. The type and dose will depend
on various factors, including:
- • Your previous history
- • Other medications (drugs) you may be taking
- • The likely type of bacteria
- • The result of urine microscopy, culture & sensitivity
- • Previous bacterial sensitivities
- • The severity of the infection
- • How unwell you are
Bladder infection (cystitis) usually responds rapidly
to a short course of antibiotics, but kidney infection
(pyelonephritis) generally requires a longer course
of treatment. In the UK, antibiotics may only be
prescribed by a medically-qualified doctor, or by
a nurse with special training.
In severe infections, where you are unwell with
severe dehydration, sickness or inability to keep
down any fluids you take by mouth, hospital
treatment with antibiotics by injection may be
necessary.
Will I need further tests?
A single episode of cystitis in a woman that
settles quickly on treatment, does not usually
need any further investigation.
Recurrent cystitis, pyelonephritis and all urinary
infections in men or children should be investigated.
Ultrasound scanning is the main method of
investigation, looking particularly at bladder
emptying. For men (who get stones more
commonly than women) a plain abdominal
X-ray may be used to exclude stones, together
with a flow rate test to look for prostate obstruction.
If any kidney abnormalities are seen on ultrasound
scanning, further imaging using CT scanning is often needed.
How can I prevent infections in the future?
The most important and effective measures are
lifestyle changes, including:
• Drinking enough fluid to make you need to pass
urine every two to three hours
• Keeping your urine acidic by taking regular
Vitamin C, either as fruit juice or in tablet form;
• Passing urine as soon as possible after sexual
intercourse;
• Avoiding strong soaps in the bath; and
• Avoiding constipation
Cranberry products (juice or tablets) are not
currently recommended to prevent urinary
infections. Analysis of the most recent medical
studies suggests that they are not as effective
as was once thought.
You can download a self help sheet through the
following link: https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Recurrent%20cystitis.pdf
Is there anything else I can do?
Antibiotic prophylaxis
When lifestyle alterations and increasing your fluid
intake on their own do not work, taking a half or
quarter dose of an antibiotic, usually last thing at
night, does help prevent further infections. This is
best started after a full treatment course for a proven
infecton, and may help prevent recurrence of the
infection. Your GP will be able to advise you about this.
Low-dose vaginal oestrogens
Weekly use of an oestrogen cream or tablet,
placed
into the vagina, can help reduce the number of
infections
suffered by some women after the menopause.
Oestrogens may be given more frequently for the
first
four to six weeks of treatment.
D-mannose
This is an alternative therapy that you can buy over
the counter at health food shops or via the internet.
Small studies have suggested that taking two
grams every day can help prevent urine infection
, but more evidence is needed before we know if
this is really true. For the time being, it is well-
tolerated and seems safe to take.
Are there any newer approaches available?
Despite all the measures described above, some
patients with normal investigations continue to get
infections, and this can be very debilitating.
There are some novel treatments currently being
trialled in local urology departments for intractable
cystitis. These include:
- • Vaccine treatments;
- • Urinary antiseptics taken by mouth; and
- • Chemical treatments put directly into your
- bladder through a small catheter.
If your symptoms cannot be controlled by the
measures outlined above, you should discuss
a hospital referral, to see a urologist, with your GP.
Some/all of these resources are links to external sites,
NHS Choices
NHS-approved information about urinary tract infection
in adults & children
NICE guidance for UTI in adults
Official guidance on UTI from the
National Institute for Heath & Clinical Excellence
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