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

A  urinary tract infection (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).
• Ureters – 2 thin tubes of muscle, one from each of your kidneys, which take the urine from your kidneys to your bladder.
• Bladder – where you store urine until you need to pee.
• Urethra – a central tube that carries urine from your bladder out of your body.  

When the infection is just in your bladder (cystitis) and urethra (urethritis), it's called a lower UTI. If it travels up to affect 1 or both kidneys as well (pyelonephritis) then it's called an upper UTI. This can be more serious than a lower UTI, as the kidneys can become damaged by the infection and you can become very unwell with sepsis (a life-threatening reaction to the infection in your blood).

If you're feeling generally unwell, have a fever or you have pain in your flank (on your back below your ribs) you should see your healthcare provider for urgent treatment. 

Image credit: 123rf

An infection in your urinary system may be caused by: 

• Sexual intercourse.
• Problems in the structure of your kidneys, bladder or tubes.
• Irritation of your urethra by chemicals (eg, soaps, perfumes, vaginal hygiene sprays, spermicidal lubes).
• Ulcers or inflammation near your urethra.
• Unprotected sex.
• Sexually transmitted infection (STI), eg, chlamydia.
• Not emptying your bladder completely.
• Radiation therapy which can irritate the lining of the bladder.
• Bacteria from your anal area (bottom) entering your bladder via your urethra. The urethra is shorter in women than in men, so it's easier for bacteria to reach the bladder and cause infection in women. The picture below shows how this can happen.

Image credit: 123rf

UTIs can occur at any age and are more common if you:

• are pregnant (read more about UTI in pregnancy)
• have had UTIs in the past
• have diabetes, kidney failure or a weakened immune system
• have other urinary tract problems such as urinary stones or inadequate emptying of your bladder
• have a condition that makes it difficult to fully empty your bladder, eg, constipation or a vaginal prolapse (cystocoele)
• have been through menopause – the changes in your vagina and urethra after menopause make it harder for them to defend against infection
• use a urinary catheter (a long, thin tube used to drain urine)
• engage in unsafe sex.

If you have any symptoms of a UTI, you should see your healthcare provider. Your symptoms could mean that you have a UTI or another condition like an STI 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 notice
• suprapubic pain (pain just above your pubic bone)
• urine that smells bad or looks cloudy or reddish.

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

Call Healthline or see your doctor urgently if you have any of the following symptoms: 

• a very high temperature, or you're feeling hot and shivery
• a very low temperature – below 36ºC
• confusion, drowsiness or you have difficulty speaking
• you have not been for a pee (mimi) all day
• pain in the lower tummy or in the back, just under the ribs
• blood in your pee.

These symptoms suggest a kidney infection (pyelonephritis), which can be serious if it's not treated quickly.

To diagnose a UTI, your healthcare provider will examine you and ask you questions about your general health. Sometimes that might be enough to diagnose a UTI, or they may want you to provide a urine sample to identify which bacteria is causing the infection. Your healthcare provider may also check your temperature and heart rate and do a blood test. This is to make sure you don't have pyelonephritis (a kidney infection).

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

Antibiotics

UTIs are treated with antibiotics, the common ones are nitrofurantoin, cefalexin and trimethoprim. Usually, a 3–5 day course of antibiotics is needed to treat the infection and to 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 you are advised 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 if they get worse, see your healthcare provider as soon as possible.

If you keep getting UTIs (recurrent UTIs are defined as more than 3 in 1 year), or you're at higher risk of complications, your healthcare provider may arrange for some extra tests. There may be other treatments to try, depending on the likely cause of your UTI. Sometimes a low-dose antibiotic may be recommended for a few months. However, this is not the first option for treatment, as over-using antibiotics can mean bacteria aren't sensitive to certain antibiotics anymore, creating antibiotic resistance. 

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

Many pharmacists are now able to sell antibiotics for the treatment of UTIs in women. Macrobid (nitrofurantoin capsules) and trimethoprim tablets are available without a prescription for women 16–65 years of age, if they're not pregnant and don't have any other complicating factors. Only pharmacists who have completed additional training can supply these medicines. Read more about Macrobid (nitrofurantoin capsules) and trimethoprim. 

Pain relief only is not recommended

When there's evidence of infection with bacteria (not just urinary symptoms), allowing your immune system to fight the infection (by only taking pain relief and not using antibiotics) isn't recommended. Antibiotics can reduce how long you have symptoms by about 2 days on average, and can reduce the risk of complications like pyelonephritis. Paracetamol and ibuprofen can be taken with antibiotics if needed to manage pain. Ibuprofen is the preferred choice for this kind of pain. 

• Take paracetamol or ibuprofen for pain.
• Drink plenty of water so you don't get dehydrated. This also helps to flush out the bacteria.
• Avoid getting constipated by eating plenty of fibre (eg, fruit and green vegetables) and drinking enough fluid.
• There's no evidence that it helps to take products that alkalise your urine (eg, Ural®). If you're taking antibiotics they can actually reduce the effect of the antibiotic.
• Take showers instead of baths.
• Wear loose cotton underwear.
• Avoid perfumed bubble bath, soap or talcum powder.
• Avoid wearing tight, synthetic underwear (such as nylon) or tight trousers.
• If you get recurrent infections and you're post-menopausal (you've stopped having periods), ask your healthcare provider about vaginal oestrogen.

When you pee

• Don’t hold your pee in if you feel the urge to go, and try to fully empty your bladder when you pee.
• Try peeing twice to make sure your bladder's empty.
• Always wipe from front to back to reduce the chance of bacteria getting from your bottom into your urinary system. 

Sex

• 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.
• Use lubricating jelly during sex.
• 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's no evidence that they work. Read more about cranberries and UTIs and D-mannose and UTIs.

Apps reviewed by Healthify

You may find it useful to look at some Women's health apps.