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Urinary tract infection (UTI) is a common infection that usually occurs when bacteria enter the opening of the urethra and multiply in the urinary tract. The urinary tract includes the kidneys, the tubes that carry urine from the kidneys to the bladder (ureters), the bladder, and the tube that carries urine from the bladder (urethra).

The special connection of the ureters at the bladder help prevent urine from backing up into the kidneys, and the flow of urine through the urethra helps to eliminate bacteria. Men, women, and children develop UTIs.


Causes Urinary Tract Infection (UTI)

Escherichia coli (E. coli) causes about 80% of urinary tract infections (UTIs) in adults. These bacteria are normally present in the colon and may enter the urethral opening from the skin around the anus and genitals. Women may be more susceptible to UTI because their urethral opening is near the source of bacteria (e.g., anus, vagina) and their urethra is shorter, providing bacteria easier access to the bladder.

Other bacteria that cause urinary tract infections include Staphylococcus saprophyticus (5 to 15% of cases), Chlamydia trachomatis, and Mycoplasma hominis. Men and women infected with chlamydia trachomatis or mycoplasma hominis can transmit the bacteria to their partner during sexual intercourse, causing UTI.

Sexual intercourse triggers UTI in some women, for unknown reasons. Women who use a diaphragm develop infections more often, and condoms with spermicidal foam may cause the growth of E. coli in the vagina, which may enter the urethra.

Urinary catheterization (i.e., insertion of a small tube into the bladder through the urethra to drain urine) can also cause UTI by introducing bacteria into the urinary tract. The risk for developing a UTI increases when long-term catheterization is required.

In infants, bacteria from soiled diapers can enter the urethra and cause UTI. E. coli may also enter the urethral opening when young girls do not wipe from front to back after a bowel movement.


Signs and Symptoms of Urinary Tract Infection (UTI)

Symptoms of urinary tract infections (UTIs) in young children include the following:

* Diarrhea
* Excessive crying that cannot be resolved by typical measures (e.g., feeding, holding)
* Loss of appetite
* Fever
* Nausea and vomiting

Older children may experience the following symptoms with UTI:

* Flank or lower back pain (with a kidney infection)
* Frequent urination
* Inability to produce more than a small amount of urine at a time
* Incontinence
* Pain in the abdomen or pelvic area
* Painful urination (dysuria)
* Urine that is cloudy or has an unusual smell

Symptoms of lower UTI (e.g., cystitis, urethritis) in adults include the following:

* Back pain
* Blood in the urine (hematuria)
* Cloudy urine
* Inability to urinate despite the urge
* Fever
* Frequent need to urinate
* General discomfort (malaise)
* Painful urination (dysuria)


Urinary Tract Infection (UTI) Diagnosis

A clean-catch urine specimen is obtained to diagnose a urinary tract infection (UTI). This test involves cleansing the area around the urethral opening and collecting a mid-stream urine sample, preventing bacteria in the genital area from contaminating the sample.

Urinalysis is performed to determine the level of white blood cells that destroy harmful bacteria (leukocytes) in the urine. A large number of these cells may indicate bacterial infection.

A culture and sensitivity (induced growth of the bacteria) may be done to determine the type of bacteria and how to treat the infection.


Urinary Tract Infection (UTI) Treatment

Bladder infections, kidney infections, and other urinary tract infections are often treated with antibacterial drugs. The type of drug used and the duration of treatment depend on the type of bacteria. Most UTIs are treated with trimethoprim-sulfamethoxazole (e.g., Bactrim®, Cotrim®, Septra®), amoxicillin (e.g., Amoxil®, Trimox®), or fluoroquinolones (e.g., Levaquin®, Cipro®). The infection may improve within a couple of days, but 1 to 2 weeks of medication may be prescribed to prevent a kidney infection.

UTIs that are caused by bacteria such as chlamydia trachomatis and mycoplasma hominis require a longer course of treatment with tetracycline (e.g., Achromycin®), trimethoprim-sulfamethoxazole, or doxycycline (e.g., Periostat®).

Infections complicated by bladder outlet obstructions (e.g., bladder stones, benign prostatic hyperplasia [BPH, enlarged prostate]) and other risk factors (e.g., spinal cord injury) may require surgery to correct the cause of UTI.


Urinary Tract Infection (UTI) Prevention

The following measures can reduce the risk for bladder infections and other UTIs:

* Avoid products that may irritate the urethra (e.g., bubble bath, scented feminine products).
* Cleanse the genital area before sexual intercourse.
* Change soiled diapers in infants and toddlers promptly.
* Drink plenty of water to remove bacteria from the urinary tract.
* Do not routinely resist the urge to urinate.
* Take showers instead of baths.
* Urinate after sexual intercourse.
* Women and girls should wipe from front to back after voiding to prevent contaminating the urethra with bacteria from the anal area.
* Stop smoking (nicotine irritates the bladder).