What is Urinary Tract Infection?
Urinary tract infection (UTI) is an infection of one or more components
of the urinary tract. Urinary tract is made up of two sections: the lower
urinary tract and the upper urinary tract. Lower urinary tract contains
the bladder and urethra. Upper urinary tract contains two kidneys and the
tube that connects them, called the ureters.
Urine does not normally contain microorganisms. Most urinary tract infections
are due to bacteria that enter the opening of the urethra. Bacteria stick
to the walls of the urethra, multiplying and moving up the urethra to the
bladder. Most UTIs remain in the lower urinary tract where they cause annoying
symptoms, such as a burning sensation during urination. These infections
are easily treated in most cases.
If a lower urinary tract infection is not treated, the infection may spread
up through the ureters, and into the kidneys. A kidney infection is more
dangerous, and can lead to permanent kidney damage. In some cases a urinary
tract infection may lead to an infection in the bloodstream (sepsis, septicemia)
that can be life threatening.
Some Facts About Urinary Tract Infections
- Urinary tract infection is second only to respiratory infection as
the most common type of infection.
- Every year, urinary tract infections are responsible for nearly 10 million
- About 80 to 90 percent of UTI are caused by one type of bacteria.
- Women develop UTI much more often than men. 20% of women in the United
States develop this condition and 20% of those have a recurrence.
- Urinary tract infection is less common in men and boys than in women
and girls but is more likely to be serious.
- Men are more likely to get a UTI once past the age of 50.
- One to two percent of children develop urinary tract infections.
- UTI in children is more common in those under the age of 2.
- Urinary tract infections can be treated effectively with antibiotics.
In general, the farther the organ is in the urinary tract from the place
where the bacteria enter, the less likely the organ is to be infected.
Urinary tract infections include:
- Urethritis is an infection or inflammation of the urethra. This
can be due to other things besides the organisms usually involved in UTI's.
In particular, many sexually transmitted diseases (STD's) appear initially
- Cystitis is an infection of the bladder and is the most common
form of UTI. Cystitis can often occur at the same time as urethritis.
It can be aggravated if the bladder does not empty completely when you
- Ureteritis is infection of a ureter. This can occur if the bacteria
entered the urinary tract from above, or if the ureter-to-bladder valves
don't work properly and allow urine to "reflux" from the bladder into
- Pyelonephritis is an infection of the kidney. This can happen
with infection from above, or if reflux into the ureters is so bad that
infected urine refluxes all the way to the kidney. Kidney infections can
cause kidney damage or even failure if left untreated for an extended
period of time.
Bacteria are the primary organisms that cause UTIs. Most common bacteria
that cause UTIs include: Escherichia coli and Staphylococcus saprophyticus.
About 80-90% of urinary tract infections are caused by Escherichia coli
(E. coli). This bacterium is normally found in the digestive tract and is
present on the skin around the rectal area. About 10-20% of urinary tract
infections are caused by the Staphylococcus saprophyticus. Infections caused
by this bacteria have a seasonal variation, with a higher incidence in the
summer and fall than in the winter and spring.
And about 5% or less of urinary tract infections are caused by other bacteria.
Gram-negative microorganisms causing UTIs include Proteus, Klebsiella, Citrobacter,
Enterobacter, and Pseudomonas spp. Gram-positive microorganisms such as
Enterococcus faecalis can also infect the urinary tract.
Microorganisms such as Chlamydia and Mycoplasma may also cause UTIs in
both men and women. Unlike E. coli, Chlamydia and Mycoplasma may be sexually
transmitted, and infections require treatment of both partners.
Risk factors for UTIs are factors that do not seem to be a direct cause
of the disease, but seem to be associated in some way. Having a risk factor
for UTIs increases the chances of getting a condition but does not always
lead to UTIs.
Some factors that may contribute to urinary tract infections are:
- Structure of the female urinary tract. In general, the higher
risk in women is mostly due to the shortness of the urethra, which is
1.5 inches compared to 8 inches in men. Bacteria from fecal matter can
be easily transferred to the vagina or the urethra.
- Sexual intercourse. For many women, sexual intercourse seems
to trigger an infection. During sexual intercourse bacteria in the vaginal
area is sometimes massaged into the urethra by the motion of the penis.
Urinating after intercourse seems to decrease the likelihood of developing
a urinary tract infection. Nearly 80% of all urinary tract infections
occur within 24 hours of intercourse.
It is important to note, however, that UTIs are not sexually transmitted
- Irregular urination. Infrequent visits to the bathroom can cause
a woman to be more susceptible to urinary tract infections. The urine
that stays in the bladder is more likely to grow bacteria and cause infections.
- Birth control methods. Using a diaphragm for birth control, or
spermicides with a diaphragm or on a condom. Women who use a diaphragm
develop infections more often. If your diaphragm is not fitted properly,
it may place pressure on the bladder and thus increase your chances of
infection. The chemicals in spermicides may irritate vaginal tissues.
Condoms with spermicidal foam may cause the growth of E. coli in the vagina,
which may enter the urethra. Unlubricated condoms increase irritation
and help bacteria cause symptoms of a UTI.
- Insufficient water intake will cause less urination,
which flushes out the system. Bacteria that enter the bladder have more
time to multiply and to take hold, causing an infection.
- Inadequate personal hygiene. Bacteria from fecal matter or vaginal
discharges can enter the female urethra because its opening is very close
to the vagina and anus.
- Catheters or tubes placed in the bladder. One of the most common
sources of infection is catheters, or tubes, placed in the bladder. Urinary
catheterization can cause UTI by introducing bacteria into the urinary
tract. The risk for developing a UTI increases when long term catheterization
- History of previous UTIs. About 80% of women with cystitis develop
recurrences within two years.
- Menopause. Studies indicate that between 20% and 25% of women
over 65 years old have UTIs. In general, biologic changes due to menopause
put older women at particular risk for primary and recurring UTIs. With
estrogen loss, the walls of the urinary tract thin out, weakening the
mucous membrane and reducing its ability to resist bacteria. Also, estrogen is essential to maintain the normal acidity of vaginal fluid.
- Age. A man's risk for UTI increases with age. Men become more
susceptible to UTIs after 50 years of age, when they are more likely to
develop prostate problems.
- Medications that lower immunity.
Health conditions that cause an increased risk for developing a UTI include:
- Anatomical problems, such as narrowing of the urethra or ureters.
- Urine retention - the condition when the bladder does not empty completely.
- Vesicoureteral reflux - the abnormal flow of urine from the bladder
back to the ureters.
- Kidney disorders. Nearly any kidney disorder increases the risk for UTIs.
- Kidney stones. In some cases, kidney stones can cause urinary tract
obstruction that leads to infection, particularly pyelonephritis. Symptoms
of severe urinary tract infection in people with a history of kidney stones
may indicate obstruction, which is a serious condition.
- Spinal cord injuries.
- Diabetes causes changes to the immune system, damage to the kidneys
and often results in sugar in the urine, which promotes the growth of bacteria.
- Any condition that suppresses the immune system.
- In men, an enlarged prostate may inhibit the flow of urine.
In general, the most common symptoms of a urinary tract infection involve the process of urination. Symptoms of UTI may include the following signs:
- The urge to urinate frequently, which may recur immediately after the bladder is emptied.
- Painful burning sensation. (If this is the only symptom, then the infection is most likely urethritis, an infection limited to the urethra.)
- Discomfort or pressure in the lower abdomen.
- Cramping in the pelvic area or back.
- Cloudy or murky urine, which may have a strong smell. This is a very reliable indicator of urinary tract infections. Murky urine may be caused by the presence of bacteria, mucus, blood cells, or epithelial cells.
- Fever is not common if the infection is in the lower urinary tract (urethra or bladder), but may be present, especially if the infection has spread to the kidneys.
Symptoms of kidney infections tend to affect the whole body and be more severe:
- Increased need to urinate at night.
- Chills and persistent fever (typically lasting more than 2 days).
- Pain in the flank (pain that runs along the back at about waist level).
- Vomiting and nausea.