Urinary Tract Infection (UTI)

A urinary tract infection, or UTI, happens when germs invade your urinary tract and start to grow there. 

Your urinary tract is the system that makes, stores, and removes urine from your body. It consists of four parts: 

1. The kidneys, which make urine

2. The ureters, which carry urine from the kidneys to the bladder

3. The bladder, which stores urine 

4. The urethra, the tube that releases urine from the bladder when you pee

An infection can happen in any part of the urinary tract, but it’s most common in the bladder.

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Common urinary tract infection symptoms

The most common symptoms of UTI are:

• Pain or burning when you pee 

• An urgent need to pee 

• A need to pee frequently

• Cloudy, pink, or blood-tinged urine

• Pain in the lower abdomen, where the bladder sits

Sometimes, the kidneys and ureters are called the “upper” urinary tract, and the bladder and urethra are called the “lower” urinary tract. An infection of the upper urinary tract — called pyelonephritis — is much more serious than an infection of the lower one. Pyelonephritis causes fevers, vomiting, and back or side pain.

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What causes a UTI?

Most UTIs are caused by bacteria in the urinary tract. In the vast majority of cases, the bacteria is E. coli, which normally lives in our intestines and helps us digest food. 

UTIs happen when bacteria from the gut find a way to enter the urinary tract and grow there. This is more common in women, and this is due to female anatomy. The urethra (the peeing tube) is very short, so bacteria don’t have far to travel from the outside world up into the bladder. 

Having sex is one way that bacteria moves from the intestinal tract to the urinary tract, so people who’re sexually active are at higher risk. 

Urinary catheters, which are medical devices that empty the bladder, can also cause UTIs. If you develop UTI symptoms after having surgery or using a urinary catheter, it could be because the catheter carried germs into your bladder and gave those germs a place to grow. 

Finally, UTIs can occasionally be caused by bacteria entering the kidneys through the bloodstream. This is more likely to happen in people who have other medical problems, such as: 

• A suppressed immune system

• Endocarditis (infection in the heart)

• Sepsis (severe infection in the body)

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UTI diagnosis

To get a UTI diagnosis, urine is collected and tested for signs of a UTI using one of three different tests.

Urine dipstick test

The most common test for a UTI is a urine dip or dipstick test. This type of test is quick and performed right in a healthcare professional’s office. This test can pick up on signs of inflammation in the urine, like: 

• Leukocyte esterase (which comes from white blood cells)

• Nitrites (which are made by some bacteria)

• Blood

Although a urine dip test can be done quickly, it isn’t always the best test for a UTI. Things like menstrual blood and sexually transmitted infections (STIs) can sometimes interfere with the results.

Urinalysis

A urinalysis takes about 1 day to complete. Urine is tested for signs of infection and inspected under a microscope. This type of test can find: 

• Red and white blood cells

• Bacteria

• Yeast

The results from a urinalysis can be more specific than those from a dipstick. However, it isn’t the fastest or the most accurate test for detecting a UTI.

Urine culture

A urine culture is the most accurate test for a UTI. It allows laboratory professionals to study the bacteria causing infection and to find out which antibiotics are likely to best treat it. 

However, a urine culture takes several days to complete. Waiting for results before treatment (antibiotics) in someone with a UTI would mean extra days of discomfort, along with the risk of a mild infection getting worse. For this reason, a urine culture isn’t usually done in otherwise healthy people who have clear UTI symptoms.

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Medications

Some mild UTIs can resolve without the need for antibiotics. But if symptoms don’t settle within a few days, you will need a 3- to 5-day course of antibiotics to treat the infection and prevent complications. 

Some people with more complicated UTIs — such as those with other medical problems, or young kids — often need a longer course of treatment.

When a lower UTI is left untreated, it can cause pyelonephritis. This is an infection that involves the kidneys, and it usually requires treatment in the hospital. 

Here are some of the antibiotics commonly used to treat UTIs in adults:

• Nitrofurantoin (Furadantin, Macrobid, Macrodantin)

• Trimethoprim / sulfamethoxazole (Bactrim, Sulfatrim) 

• Fosfomycin (Monurol)

• Ciprofloxacin (Cipro)

• Levofloxacin (Levaquin)

• Amoxicillin / clavulanate (Augmentin)

The choice of antibiotic for treating a UTI depends on a number of things. Your primary care provider or other prescriber will take into account: 

• The type of bacteria causing your infection

• Antibiotic resistance in your community

• The risks and benefits of different medications

• Your personal medical history

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Home remedies for UTI

Mild UTIs can resolve without treatment over a few days. So, some people choose to wait and see if their UTI symptoms settle on their own. 

Whether you’re trying to get by without antibiotics, or waiting for antibiotics to kick in, there are things you can do at home to help feel better faster:

• Hydrate: Make sure to drink enough water. Avoid alcohol, caffeine, and other drinks that irritate the bladder.

• Use heat: Gentle heat, like a hot water bottle or heating pad, can ease any discomfort you feel in your lower belly. 

• Consider supplements: Certain supplements — like Canephron N, D-mannose, and vitamin C — may help some people. The evidence for their use in treating and preventing UTIs is mixed, but they’re generally not harmful. 

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Over-the-counter UTI treatments

There are a number of over-the-counter (OTC) treatments that can help you feel better while you wait for your UTI symptoms to improve (either with or without antibiotics):

• Acetaminophen: Acetaminophen (Tylenol) can improve bladder pain when you have a UTI. Acetaminophen isn’t processed by your kidneys (it’s processed by your liver instead). So, it’s a safer choice than NSAIDs (see below) for people who have a kidney infection (pyelonephritis).

• NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Motrin or Advil), naproxen (Aleve), can help reduce bladder pain. Because these medications are processed by the kidneys, it’s best to avoid them if you have pyelonephritis.

• Phenazopyridine hydrochloride: Phenazopyridine (Azo, Pyridium, Uricalm) is a urinary analgesic. It works by numbing the inside of the bladder and urethra. Phenazopyridine isn’t an antibiotic and won’t kill bacteria or cure your infection. You shouldn’t need to take this medication for more than 2 days in a row. 

Remember, although painkillers can help your symptoms, they aren’t a complete treatment for a UTI by themselves. If your symptoms aren’t getting better after a few days, you’ll need to see your primary care provider for antibiotics, to keep the infection from getting worse. 

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UTI Prevention

If you’ve had a UTI before, the chances are good that you’ll have another one. In fact, 1 in 4 women with a first UTI get another UTI within 6 months. 

But there are things you can do to make this less likely:

• Stay hydrated: If you drink less than 1.5 L of water per day, increasing your daily fluid intake to 2 L or 3 L can reduce the risk of repeat UTI by as much as 50%. 

• Pee after sex: Although it has never been proven to have any benefit, many experts recommend urinating right after you have sex to help wash bacteria out. 

• Wipe front to back (if you have female genitals): It’s not been studied formally, but doing this may help avoid spreading bacteria from your anal area to your urethra.

• Consider changing your birth control: Nonoxynol-9, a common spermicide used in condoms and diaphragms, can increase the risk of UTI. Pick a form of contraception without this ingredient.

If you frequently get UTIs, it might be worth taking medication to reduce your risk. Talk to your healthcare team or other primary care provider to see whether a preventative (also called prophylactic) medication is right for you. Some options include: 

• Low-dose antibiotics

• An estrogen cream (like Estrace), estrogen-secreting vaginal ring (Estring, Femring), or tablet (Imvexxy, Vagifem, Yuvafem), which can help prevent UTIs around the time of menopause, when estrogen levels drop 

Plenty of OTC options are available to help prevent UTIs, although the evidence to support their use isn’t robust. A few of the most widely used include: 

• Cranberry supplements

• Probiotics

• D-mannose

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