Urinary tract infections are common and can be painful. If you have symptoms of a UTI see your doctor right away.

A Woman's Urinary Tract

The urinary tract is made up of the following parts:

Two kidneys, which produce urine Two tubes called ureters that take urine from the kidneys to the bladder The bladder, where urine is stored The urethra, which carries urine from the bladder out of the body

The urinary tract has a lower part and an upper part. The lower tract is made up of the urethra and the bladder. The upper urinary tract consists of the kidneys and ureters. Infections of the bladder or urethra rarely cause long-term problems, but they can be annoying.

Types of Urinary Tract Infections

Most UTIs start in the lower urinary tract. Bacteria can enter through the urethra and spread upward to the bladder. This causes cystitis, a bladder infection. In some cases, urethritis, an infection of the urethra, occurs at the same time. Bacteria that have infected the bladder may travel up the ureters to the kidneys. This can cause pyelonephritis, a kidney infection. An infection in the upper tract may cause a more severe illness than infection in the lower tract.

Women are more likely than men to get UTIs because the urethra is shorter in a woman than in a man. That means bacteria can reach the bladder more easily.

Causes

There are many reasons why a woman may get a UTI. The most common causes include bacteria from the rectum and vagina, sex, or abnormalities in the urinary tract.

Bacteria

Bacteria from the bowel live on the skin near the rectum or in the vagina. These bacteria can spread and enter the urinary tract through the urethra. If they move up the urethra, they may cause infections in the bladder and, sometimes, in other parts of the urinary tract.

Sex

Women's anatomy makes them prone to getting UTIs after having sex. The opening of the urethra is in front of the vagina. During sex, bacteria near the vagina can be massaged into the urethra by the penis, fingers, or devices.

Urinary tract infections also tend to occur in women who change sexual partners or begin having sex more often. Using spermicides or a diaphragm also can cause more frequent UTIs.

Abnormalities in the Urinary Tract

Infections also can occur when urine backs up instead of flowing out from the bladder. When this occurs, the bladder does not empty completely. This may be caused by:

• Blockage (a stone) in the kidneys, bladder, or ureters made of a hard mass of crystals that blocks the flow of urine through the urinary tract
• A narrowed tube (or a kink) in the urinary tract
• Diverticula—small pockets that bulge out of the bladder wall or out of the urethra and hold urine
• Problems with your pelvic muscles or nerves

Other Causes

Certain other factors increase your chance of getting a UTI. You are more likely to get an infection if you:

• Are pregnant
• Had UTIs as a child
• Are past menopause
• Have diabetes

Symptoms

Symptoms of UTIs can come on quickly. One sign is a strong urge to urinate that cannot be delayed (urgency). As urine flows, a sharp pain or burning, called dysuria, is felt in the urethra. The urge to urinate then returns minutes later (frequency). Soreness may be felt in the lower abdomen, in the back, or in the sides.

Other symptoms may show up in the urine. It may:

• Have a strong odor
• Look cloudy
• Sometimes be tinged with blood

If the bacteria enter the ureters and spread to the kidneys, symptoms also may include:

• Back pain
• Chills
• Fever
• Nausea
• Vomiting

Symptoms linked with a UTI, such as painful voiding, can be caused by other problems (such as an infection of the vagina or vulva). Tests may be needed to confirm the diagnosis. Be sure to let your doctor know if you have any of these symptoms.

Diagnosis

The key to treating a UTI is a prompt diagnosis. Your doctor may first do a simple test, called urinalysis, to find out whether you have a UTI. For this test, you will be asked to provide a urine sample. This sample will be studied in a lab under the microscope for the presence of white and red blood cells and bacteria. Normal urine should not have bacteria or blood cells in it. If either of these shows up in the urine, you may have a UTI.

The urine sample also may be grown in a culture (a substance that promotes the growth of bacteria) to see which bacteria are present. The sample also may be tested with different antibiotics to see which one destroys the bacteria best. This is called a sensitivity test.

When an infection does not clear up with treatment, you have had several UTIs in a row, or you have pain, fever, and chills, your doctor may need to examine your urinary tract more closely for signs of a more serious problem. He or she may use one of these tests:

• Intravenous pyelogram (IVP)—A special dye is injected into the body. As it passes to the urinary tract, X-ray images of the bladder, kidneys, and ureters are taken.
• Ultrasound exam—Images of the urinary tract are shown on a monitor.
• Cystoscopy—A thin, lighted tube with a lens at the end is passed through the urethra to check for any abnormalities.
• Computed tomography (CT)—Small X-ray beams rotate around the body and transmit images of body tissues in cross sections into a computer.
• Cystourethrography—A dye is put into the bladder and X-ray images are taken as you void.

Antibiotics are used to treat UTIs. The type, dose, and length of the antibiotic treatment depends on the type of bacteria causing the infection and on your medical history.

If you often get UTIs through sexual activity, you may be given an antibiotic to take in single doses after you have sex. If you have had more than two infections in 1 year, you may be given a daily dose for a few months.

In most cases, treatment is quick and effective. Most symptoms go away in 1–2 days. Be sure to take all the medication even though your symptoms may go away before you finish your prescription. If you stop treatment early, the infection may still be present or it could come back after a short time. About a week after you finish treatment, a urine test may be done to see if the infection is cured.

How to Provide a Urine Sample For urinalysis it is important to provide a clean sample of urine. Your doctor or nurse will explain how to do this. Open the sterile cup and place it at easy reach (place cap with bottom turned up). Separate the labia with one hand, and with the other hand, clean your genital area with a special wipe. Be careful to wipe from front to back and do not touch or wipe your rectum. While still holding the labia open, pick up the opened container with your other hand, then pass a little bit of urine into the toilet and catch the rest into the cup. Do not touch the inside of the lid or the inside of the cup at any time. This helps ensure that bacteria from other areas and from your hands do not get into the sample. If they do, they may affect the test results.

For more severe infections, such as a kidney infection, you may need to stay in the hospital. These infections take longer to treat and you may need to take medication intravenously (through an IV line).

Recurrent Infections

Urinary tract infections that come back a week or two after treatment are called recurrent infections. They can be frustrating, annoying, and difficult to treat.

The cause of recurrent UTIs may be difficult to find. Often the cause of the current infection is different from the cause of the last infection. Sometimes the cause is unknown.

Prevention

There are a number of ways to prevent UTIs:

• After a bowel movement or after urinating, wipe from front to back.
• Wash the skin around the rectum and the genital area.
• Avoid using douches, powder, and deodorant sprays.
• Drink plenty of fluids (including water) to flush bacteria out of your urinary system.
• Empty your bladder as soon as you feel the urge or about every 2–3 hours.
• Try to empty your bladder before and after sex.
• Wear underwear with a cotton crotch.

Finally...

Urinary tract infections are common and can be painful. If you have symptoms of a UTI, see your doctor right away. With prompt, proper treatment, these infections can be treated with success.

Glossary

Bladder: A muscular organ in which urine is stored.

Computed Tomography: A type of X-ray procedure that shows internal organs and structures in cross section.

Kidneys: Two organs that cleanse the blood, removing liquid wastes.

Recurrent Infections: Infections that occur more than once, usually within a short time, although they may be spread out over several months.

Ultrasound: A test in which sound waves are used to examine internal structures.

Ureters: A pair of tubes, each leading from one of the kidneys to the bladder.

Urethra: A short, narrow tube that carries urine from the bladder out of the body.

This Patient Education Pamphlet was developed under the direction of the Committee on Patient Education of the American College of Obstetricians and Gynecologists. Designed as an aid to patients, it sets forth current information and opinions on subjects related to women's health. The average readability level of the series, based on the Fry formula, is grade 6–8. The Suitability Assessment of Materials (SAM) instrument rates the pamphlets as "superior." To ensure the information is current and accurate, the pamphlets are reviewed every 18 months. The information in this pamphlet does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice may be appropriate.

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