Overview

Urinary tract infections are far more common of the bladder than of any other structure in the urinary tract. An infection that occurs in the lower urinary tract, most commonly of the bladder, is easily treated with a short course of usually 3 days of antibiotics. Less commonly the urinary tract infection is in the kidneys, which requires a longer course of antibiotics. Females are more likely to get urinary tract infections than males.

Symptoms

Bladder infection:

• Pain or burning when urinating
• Frequent need to urinate
• Urgent need to urinate
• Blood in the urine
• Discomfort in the middle of the lower abdomen (suprapubic pain)

Kidney infection:

• fever
• flank/side/back pain
• blood in the urine
• nausea or vomiting

Diagnosis

A history of painful urination, urgency, frequency can be indications of a urinary tract infection. Testing the urine by checking a 1) urine dipstick, 2) doing a microscopic exam of the urine looking for white blood cells (which the body formed to combat the bacterial infection), and 3) performing a urine culture (the bacteria are grown so we can determine the type of bacteria and which antibiotic best treats that bacteria) are ordered to evaluate for an infection. You may be examined for presence of fever or flank pain which would suggest the possibility of a kidney infection.

If the above tests show no evidence of an infection despite painful urination, urgency and frequency treatments other than antibiotics are indicated.

Treatment

Nitrofurantoin (Macrobid), trimethoprim-sulfamethoxazole (Bactrim), ciprofloxacin (Cipro) or levofloxacin (Levaquin). Pyridium to numb the bladder pain can be used for comfort for several days.

Self Care

If using spermicides and diaphragm for contraception explore other contraceptive. Although research has not proven 1) maintaining a good fluid intake or 2) emptying the bladder after intercourse to be helpful, these activities are often recommended. In a small research study cranberry decreased the bacterial adherence to the cells of the urinary tract, however the cranberry did not clearly reduce the number of urinary tract infections. Research is ongoing. It is reasonable to try cranberry tablets and evaluate whether there is reduced urinary tract infections.

Patients with cultures documenting recurrent urinary tract infections can be offered treatment with

1. daily low dose antibiotic for urinary tract infection suppression for 6 months;
2. if urinary tract infections are related to sexual activity a low dose antibiotic taken at the time of intercourse is helpful; or
3. self treatment with antibiotics is occasionally recommended when urine cultures are consistently positive.

Patients without urinary tract infections, who have symptoms of urgency, frequency and painful urination with negative urine cultures can stop cranberry intake and determine if their symptoms improve.

Additional Reading

Physicians