Urinary tract infection (UTI) in men | Pokenga pūaha mimi

A UTI is a bacterial 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.

When the infection is just in the bladder (cystitis) and urethra (urethritis), it is called a lower UTI. If it travels up to affect one or both kidneys as well (pyelonephritis) then it is called an upper UTI. An upper UTI can be more serious than a lower UTI as the kidneys can become damaged by the infection.

Image credit: BruceBlaus Wikimedia Commons

An infection in your urinary system may be caused by: 

• problems in the structure of your kidneys, bladder or tubes
• an enlarged prostate
• bacteria from your anal area (bottom) entering your bladder
• unprotected sex
• a sexually transmitted infection (STI), eg, chlamydia
• radiation therapy which can irritate the lining of the bladder.

A UTI is uncommon in men because the urethra is long so bacteria have a harder time travelling up to the bladder.

UTIs are more common if you:

• are over 60 years of age
• have had UTIs in the past
• use a urinary catheter  (a long thin tube used to drain urine)
• have diabetes, kidney failure or a weakened immune system
• have other urinary tract problems such as urinary stones or inadequate emptying of the bladder
• have a condition that makes it difficult to fully empty the bladder such as constipation
• engage in unsafe sex.

If you have any symptoms of a UTI, you should see a doctor. Your symptoms could mean that you have a UTI or another condition, eg, a sexually transmitted infection STI,  prostatitis or pyelonephritis.

Symptoms of a UTI include:

• pain or burning during or immediately after peeing (dysuria)
• needing to pee more often than usual during the night (nocturia)
• pain in your lower tummy (abdomen)
• feeling the need to pee more often
• needing to pee without much warning
• suprapubic pain (pain just above the pubic bone of the pelvis)
• recent antibiotic use
• urine that smells bad or looks cloudy or reddish.

Older men may have no symptoms or fever. Often the only symptoms are being more muddled, sleepier, incontinent, off food, or just generally unwell. Confusion and sleepiness can put older adults at risk of falls.

To diagnose a UTI, your GP will examine you and ask you questions about your general health. Sometimes that might be enough to diagnose a UTI. Your doctor may want you to do a urine sample to identify what bacteria is causing the infection. Other tests could include a blood test, and checking your temperature and heart rate.

The main aims of treatment are to relieve your symptoms, treat the infection and prevent the infection spreading to your kidneys.

Antibiotics

UTIs are generally treated with antibiotics such as nitrofurantoin, cefalexin or trimethoprim. 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.

If your doctor advises you to take antibiotics, it's important to finish the whole course of antibiotics, even if you start to feel better before the course is finished. If your symptoms continue for more than 2 days after starting treatment, or you get worse, see your doctor as soon as possible in case you need a different antibiotic or the infection has spread to your kidneys.

If you have recurrent UTIs (you keep getting them), or are at higher risk of complications, your doctor may give you a low dose antibiotic to take for a few months. How long you need to take the antibiotic depends on how frequently your UTIs happen.

Can I get antibiotics for a UTI from my pharmacy without a prescription?

No. Because UTIs in men are rare, it is important to see your doctor for checks and treatment.

Pain relief only is not recommended

Allowing your immune system to fight the infection (by taking only pain relief and not using antibiotics) is not recommended. Antibiotics can reduce the length of time you have symptoms by about 2 days, and they also reduce the risk of developing complications like pyelonephritis.

• Take your antibiotics as prescribed.
• 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®). If you are taking antibiotics they can actually reduce the effect of the antibiotic.
• Avoid being constipated by eating plenty of fibre (such as fruit) and drinking enough fluid.
• Don't hold your pee in if you feel the urge to go.
• Try to empty your bladder fully when you pee. Try sitting when you pee or peeing twice to make sure your bladder is empty.
• Pee as soon as possible after sex.
• Don't use condoms or diaphragms with spermicidal lube on them – try non-spermicidal lube or a different type of contraception.
• Stay safe when you are having unprotected sex or are changing partners.

Cranberry, probiotics, D-mannose

You may see some of these options recommended for preventing UTIs but there is no evidence that they work. Read more about cranberries and UTIs and D-mannose and UTIs.