Managing a Urinary Tract Infection (UTI)
Understanding a Urinary Tract Infection (UTI)
A urinary tract infection (UTI) is an infection in any part of the urinary system: the kidneys, ureters, bladder
and urethra; the most common infections occurring in the bladder and the urethra. Urinary tract infections (UTIs) are very common and they impact quality of life and increase healthcare costs.
About 50% of South African women will get at least one UTI in their lifetime, while 20 – 40% will have recurrent infections. Community-acquired urinary tract infections (CAUTIs) occur mostly in women of child-bearing age, and less often in older men.
What is the Urinary Tract?
The urinary tract makes and stores urine, one of the body’s liquid waste products. It includes the:
• Kidneys, which removes waste and water from the blood
• Ureters, which carry urine from the kidneys to the bladder
• Bladder, which stores the urine before it leaves the body
• Urethra, which carries the urine from your bladder to outside.
The body makes urine when waste products and excess water is removed from your blood by the kidneys. If everything is normal, urine moves through your urinary system without any contamination. However, when bacteria get into the urinary system from outside of the body, it causes inflammation and infection: a urinary tract infection (UTI).
A Urinary Tract Infection (UTI) is an infection in the urinary system. When the infection affects:
• your urethra, it’s called urethritis,
• your kidneys, it’s called pyelonephritis, or
• your bladder, it’s called cystitis
UTIs can occur anywhere in the urinary system, but is most common in the bladder. If you get two UTIs in six months, or three in a year, this would be considered having recurrent UTIs.
Symptoms of a Urinary Tract Infection (UTI)
UTIs cause the lining of the urinary tract to become inflamed, and you could experience the following
• A strong urge to urinate that doesn’t go away
• Urinating often, and passing small amounts of urine
• Pain in the side (flank), abdomen or pelvic area
• Pressure in the lower pelvis
• Abnormal urine colour: cloudy-looking or urine that appears red, bright pink or cola-coloured
• Incontinence (urine leakage)
• A burning feeling when urinating or painful urination (dysuria)
• Strong or foul-smelling urine
• Pelvic pain, in women — especially in the centre of the pelvis and around the area of the pubic bone
• Pain during sex
• Penis pain
• Fatigue
• Fever
• Vomiting
• Feeling tired, shaky, confused, or weak (more common in older women)
If the infection is located in a certain area of the urinary system, you’ll mostly likely experience these
| Location of the infection |
Kidneys (Pyelonephritis) | Bladder (Cystitis) | Urethra |
| Symptoms |
– Back or side pain – Fever – Shaking and chills – Nausea – Vomiting |
– Pelvic pressure – Lower belly pain – Frequent, painful urination – Cloudy/ bloody urine |
– Burning and discharge with urination |
In some cases, UTIs don’t cause symptoms. In older adults, UTIs can be mistaken for other conditions.
What causes a Urinary Tract Infection (UTI)
UTIs are caused when microorganisms – usually bacteria – enter the urinary tract through the urethra and
begin to spread, causing inflammation and infection. The most common UTIs occur mainly in women, and
affect the bladder and urethra:
• Infection of the bladder. More than 90% of bladder infections (cystitis) cases are caused by
Escherichia coli (E. coli), a type of bacteria normally found in the gastrointestinal (GI) tract. But
sometimes other bacteria are the cause.
• Infection of the urethra. This type of UTI can happen when GI bacteria spreads from the anus to the
urethra. An infection of the urethra can also be caused by sexually transmitted diseases, including
herpes, gonorrhoea, chlamydia and mycoplasma.
Risk factors
Risk factors for UTIs that are specific to women include:
• Female anatomy. A woman’s shorter urethra means that its less distance for bacteria to travel to
reach the bladder. This is because the urethra (tube the carries urine out of the body) in females is
shorter and closer to the anus, where E. coli bacteria are common.
• Pregnancy. During pregnancy the risk increases because of: changing hormone levels, changes to the
vaginal microbiome and not emptying the bladder completely (due to the pressure of the womb on
the bladder).
• Sexual activity. Being sexually active and having a new sexual partner also increases risk.
• Certain types of birth control. Diaphragms, unlubricated condoms or condoms treated with
spermicide also increases the risk.
• Menopause. After menopause, the decrease in estrogen affects the urinary tract, increasing the risk
of UTIs.
Other risk factors for UTIs include:
• Urinary tract problems. Some babies are born with problems with their urinary tracts, and may have
trouble urinating. Urine can back up in the urethra, which can cause UTIs.
• Blockages in the urinary tract. Kidney stones or an enlarged prostate can trap urine in the bladder.
• A weakened immune system. Diabetes and other diseases can weaken the immune system.
• Diabetes. It can lower the immune system and cause nerve damage, making it harder to completely
empty the bladder.
• Catheter use. Using a catheter, by those in hospital, or who have difficulty controlling urination or
who are paralysed.
• A recent urinary procedure. Urinary surgery or a medical exam of your urinary tract that involves
medical instruments can both increase the risk of developing a UTI.
• Older adults. They are at a higher risk for developing bladder infections. This could be due to medical
conditions such as an enlarged prostate or a bladder prolapse (where the bladder falls out of its usual
position) or not emptying out the bladder fully.
Diagnosis
UTIs are diagnosed using the following tests:
• Urinalysis. This tests for the number of white and red blood cells found in your urine which indicate
an infection.
• Urine culture. This tests for the type of bacteria causing the infection, which helps determine the
most appropriate treatment.
You may get more advanced tests if you belong to one of these groups:
• Children
• Men (because they get less bladder infections, and it could be a sign of something else).
• People who have kidney damage.
• Women who get three or more bladder infections in a year or have blood in the urine.
• Cystoscopy. This test uses a cystoscope (a special instrument fitted with a lens and a light source) to
see inside the bladder from the urethra.
• Imaging: Ultrasound/ CT scan/ MRI. Imaging tests are used to capture an image of the internal
organs which indicates to a structural problem in the urinary tract. These are often used for patients
with recurring UTIs.
Your doctor may also check for other health conditions like diabetes.
Complications of a Urinary Tract Infection (UTI)
If you receive proper treatment, they rarely lead to complications. However, if the UTI is left untreated or
medication was stopped early, the following complications can arise:
• Recurring infections – two or more within six months or three or more within a year. Women are
more prone to having repeated infections.
• Permanent kidney damage from a kidney infection.
• A narrowed urethra in men from having repeated infections of the urethra.
• Sepsis, a potentially life-threatening complication of an infection especially when the infection moves
to the kidneys.
There are specific complications during pregnancy.
UTIs and pregnancy
UTI’s are often picked up in prenatal urine tests even when there are no symptoms. For those who are
pregnant and have symptoms of a UTI, see your doctor immediately. Pregnancy is a major risk factor for UTIs, and they can be effectively treated with antibiotics. However, if the UTI is left untreated or if it’s not treated properly, the infection could spread and cause the following complications:
1. Risk to the baby. UTIs are caused by different types of bacteria, but group B Strep (GBS) is linked to unique problems during pregnancy. GBS normally lives in the digestive tract and vagina, without any issues. During pregnancy, though, GBS can cause:
• Chorioamnionitis (infection of the fluid and membranes around a developing baby)
• Sepsis
• Pneumonia
• Stillbirth
Furthermore, the baby can also be at risk of:
• Premature birth (birth of the baby before 39 weeks)
• Low birth weight (smaller than 2.5kg at birth)
• Infection. Bacteria from the mother’s urinary tract could cause an infection in the baby after birth.
2. Risk to the mother. This includes:
• Pyelonephritis (kidney infection): this complication is more likely to happen during pregnancy than at
any other time because of pressure on the bladder from the growing baby.
• Chorioamnionitis
• Preeclampsia (high blood pressure during pregnancy). This often begins with high blood pressure and
protein in the urine, and occurs in the second half of the pregnancy.
Treatment of a Urinary Tract Infection (UTI)
UTIs are treated effectively with antibiotics. When diagnosed with a UTI, it’s important to get treatment
1. Simple UTIs
Simple UTIs are treated with antibiotics; these are commonly used:
• Trimethoprim and sulfamethoxazole
• Fosfomycin
• Nitrofurantoin
• Cephalexin
• Ceftriaxone
For a complicated UTI or kidney infection, the group of antibiotics called fluoroquinolones are used; these
include ciprofloxacin, levofloxacin and others.
2. Chronic UTI infections
When UTIs are recurrent, your doctor may prescribe:
• Low-dose antibiotics which can be taken for six months or longer
• A non-antibiotic prophylaxis treatment such as vaginal estrogen therapy if you’re post-menopausal
For severe infections, you many need IV antibiotics from a hospital.
Living & managing
If you’ve been diagnosed with a UTI, the following can assist with your recovery:
• Avoid having sex.
• Drink lots of water.
• Avoid alcohol, caffeine and spicy foods, as they can aggravate your symptoms.
• Take a pain reliever.
• Use a heating pad on your lower belly.
• For women with recurrent UTIs, a vaginal probiotic suppository may help. These probiotics include
the bacteria Lactobacilli, which offer health benefits due to vaginal re-colonisation with Lactobacilli.
Prevention of a Urinary Tract Infection (UTI)
These are general tips for preventing a UTI:
1.Drink plenty of water. Water helps dilute the urine and increases the frequency of urination. This
allows bacteria to be flushed from the urinary tract before an infection can begin.
2.Urinate when you need to. The longer urine stays in the bladder, the more time bacteria have to
grow.
3.Wipe from front to back. Do this after a bowel movement and urinating. It helps prevent the spread
of bacteria from the anus to the vagina and urethra.
4.Urinate soon after having sex. Also drink a full glass of water to help flush bacteria.
5.Wash with waterthe area around the vagina before and after sex, and after a bowel movement.
6.Practise good hygiene habits on your period. When women are on their period, they should change
pads and tampons frequently to prevent infections.
7.Change nappies or incontinence pads promptlyonce soiled.
8.Shower instead of bathing.
9.Avoid potentially irritating feminine hygiene products. Using hygiene sprays, douches and powders
in the genital area can irritate the urethra.
10. Change your birth control method. Diaphragms can contribute to bacterial growth, and unlubricated
condoms and condoms treated with spermicide can irritate your urinary tract.
11. Avoid wearing tight clothing. Looser clothing will keep you dry and prevent bacterial growth. Change out of wet bathing suits and workout clothes quickly.
12. Wear cotton underwear. This will prevent extra moisture from getting trapped around your urethra.
13. Consider an estrogen-containing vaginal cream. Specific to post-menopausal women, these vaginal creams change the pH of the vagina and reduces the risk of developing a UTI.
14. Limit alcohol, as it may irritate your bladder.
15. Limit your intake of sugary food or drinks, as sugar encourages bacteria growth.
Sources
Fourie, J L, Ciaassen, F M, & Myburgh, J J. (2021). Causative pathogens and antibiotic resistance in community-acquired urinary tract infections in central South Africa. SAMJ: South African Medical Journal, 111(2), 124-128. https://dx.doi.org/10.7196/samj.2021.v111i2.14905
Source: https://www.shutterstock.com/image-vector/medical-education-chart-biology-urinary-system-
638539345
2022. Available from https://my.clevelandclinic.org/health/diseases/9135-urinary-tract-infections
2. Fourie, J L, Ciaassen, F M, & Myburgh, J.J. (2021). Causative pathogens and antibiotic resistance in
community-acquired urinary tract infections in central South Africa. SAMJ: South African Medical
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Available from https://www.webmd.com/women/guide/your-guide-urinary-tract-infections
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November 2022. Available from https://www.mayoclinic.org/diseases-conditions/urinary-tract-
infection/symptoms-causes/syc-20353447
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22 November 2022. Available from https://www.mayoclinic.org/diseases-conditions/urinary-tract-
infection/diagnosis-treatment/drc-20353453
6. McGee, K. R. (2022). Why Urinary Tract Infections Are More Common During Pregnancy—And How to
Treat Them. GoodRx Health [Online]. Accessed on 22 November 2022. Available from
https://www.goodrx.com/health-topic/parenthood-pregnancy/pregnancy-and-uti
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tract-infections
9. Wawrysiuk, S., Naber, K., Rechberger, T. et al. (2019). Prevention and treatment of uncomplicated
lower urinary tract infections in the era of increasing antimicrobial resistance—non-antibiotic
approaches: a systemic review. Archives of Gynecology and Obstetrics. 300 (821–828).
https://doi.org/10.1007/s00404-019-05256-z
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2022. Available from https://www.webmd.com/a-to-z-guides/understanding-bladder-infections-
diagnosis-and-treatment
Sources
Fourie, J L, Ciaassen, F M, & Myburgh, J J. (2021). Causative pathogens and antibiotic resistance in community-acquired urinary tract infections in central South Africa. SAMJ: South African Medical Journal, 111(2), 124-128. https://dx.doi.org/10.7196/samj.2021.v111i2.14905
Source: https://www.shutterstock.com/image-vector/medical-education-chart-biology-urinary-system-
638539345
2022. Available from https://my.clevelandclinic.org/health/diseases/9135-urinary-tract-infections
2. Fourie, J L, Ciaassen, F M, & Myburgh, J.J. (2021). Causative pathogens and antibiotic resistance in
community-acquired urinary tract infections in central South Africa. SAMJ: South African Medical
Journal, 111(2), 124-128. https://dx.doi.org/10.7196/samj.2021.v111i2.14905
3. Kovacs, J. (2021). Urinary Tract Infections (UTIs). WebMD [Online]. Accessed on 22 November 2022.
Available from https://www.webmd.com/women/guide/your-guide-urinary-tract-infections
4. Mayo Clinic. (2022). Urinary Tract Infection Symptoms & Causes. Mayo Clinic [Online]. Accessed on 22
November 2022. Available from https://www.mayoclinic.org/diseases-conditions/urinary-tract-
infection/symptoms-causes/syc-20353447
5. Mayo Clinic. (2022). Urinary Tract Infection Diagnosis & Treatment. Mayo Clinic [Online]. Accessed on
22 November 2022. Available from https://www.mayoclinic.org/diseases-conditions/urinary-tract-
infection/diagnosis-treatment/drc-20353453
6. McGee, K. R. (2022). Why Urinary Tract Infections Are More Common During Pregnancy—And How to
Treat Them. GoodRx Health [Online]. Accessed on 22 November 2022. Available from
https://www.goodrx.com/health-topic/parenthood-pregnancy/pregnancy-and-uti
8. Office on Women’s Health. (2021). Urinary tract infections. Office on Women’s Health [Online].
Accessed on 22 November 2022. Available from https://www.womenshealth.gov/a-z-topics/urinary-
tract-infections
9. Wawrysiuk, S., Naber, K., Rechberger, T. et al. (2019). Prevention and treatment of uncomplicated
lower urinary tract infections in the era of increasing antimicrobial resistance—non-antibiotic
approaches: a systemic review. Archives of Gynecology and Obstetrics. 300 (821–828).
https://doi.org/10.1007/s00404-019-05256-z
10. WebMD. (2021). How Do I Know If I Have a Bladder Infection? [Online]. Accessed on 22 November
2022. Available from https://www.webmd.com/a-to-z-guides/understanding-bladder-infections-
diagnosis-and-treatment
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