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Urinary Tract Infections (UTIs)

Edited by Lauren Dayes



Urinary tract infections (UTIs) are one of the top reasons that Canadians receive antibiotics. This is largely because of how common these infections are, and the bothersome symptoms that come with them. UTIs are bacterial infections in the organs responsible for producing and transporting urine (ie. the kidneys, ureter, bladder, and urethra). There are two types of UTIs: Cystitis, an infection of the bladder also known as a lower UTI, and pyelonephritis, an infection in the kidneys also known as an upper UTI.



Causes


E. Coli is the most likely culprit of a UTI. However, if you have had frequent UTIs or a UTI resistant to treatment, your doctor may want you to get your urine tested to see if there is a less common bacterium causing the infection.


For biological females, factors that increase the risk of getting a UTI include spermicide use, a family history of UTIs, previous UTIs, sexual intercourse (especially with a new sexual partner within the past year) and being post-menopausal. For biological males, risk factors include being uncircumcised, having a previous urinary tract surgery, having a recent procedure such as a catheterization or prostate biopsy, having an enlarged prostate, engaging in sexual intercourse with an infected female, engaging in anal intercourse, or being over the age of 65.


Biological females are generally more prone to UTIs than males. This is due to the anatomy of the urinary tract; females tend to have a urethra that is much shorter than males. As a result, bacteria have a much shorter distance to travel to reach the bladder and cause an infection.



Symptoms


The symptoms of a UTI depend on where the infection is located. For a lower UTI, symptoms may include painful urination, always feeling the urge to urinate, pain in the pubic area, or seeing blood in the urine. Upper UTIs also present with the these same symptoms, along with generalized symptoms such as fever, fatigue, weakness, and lower back pain.


Cloudy and odorous urine may cause someone to suspect that they are experiencing a UTI, however it is not a definite sign. See your health care provider if you have cloudy and odorous urine without any other UTI symptoms for further investigation.



Complicating Factors


Lower UTIs are often classified as being either “complicated” or “uncomplicated.” Clinicians classify them this way to determine the intensity of treatment and degree of monitoring required. Lower UTIs are “complicated” if any of the following apply while experiencing the UTI: Poorly controlled diabetes, male sex, a blockage in the ureters, having an indwelling urinary catheter, kidney stones, being immunocompromised, having a spinal cord injury, or being pregnant. Patients with complicated UTIs are at a higher risk of treatment failure, so they require more intense treatment and closer monitoring.



Treatment


In some cases, a urine sample may be sent to a lab to determine which bacteria is present in the urine and how to best treat it. This includes patients with upper UTIs, complicated lower UTIs, UTIs that occur very frequently, severe symptoms, pregnant individuals, and those who have recently travelled outside of North America. For most uncomplicated UTIs, a urine sample is not required and treatment can be started based on symptoms alone.


Since UTIs are bacterial infections, treatment requires antibiotics. The type of antibiotic that is prescribed depends on whether the infection is in the upper or lower urinary tract, and whether the UTI is complicated or uncomplicated. Treatments usually last 5-7 days, but the duration may be as short as 1 day or as long as 14 days depending on the type of infection. Most antibiotics for UTIs are taken by mouth, but there are injectable options for patients with more severe infections that may require hospitalization.



Prevention


Although there is not a lot of evidence surrounding strategies that can prevent UTIs from occurring, these tips pose virtually no harm and may be tried in those who experience frequent UTIs:

  • Drinking plenty of fluids

  • Avoiding the use of spermicides or spermicide-coated condoms

  • Urinating after sexual activity

  • Wiping from front to back (in biologic females) after defecation


While commonly used for UTI prevention, evidence surrounding cranberry juice is weak. Many commercially available cranberry juices have a high amount of sugar. Cranberry powder capsules, and other similar products also lack evidence.


For individuals with consistently recurring UTIs, continuous antibiotic use may be needed. This may include long-term treatment with antibiotics for up to 6 months, or a “pill in pocket” method where individuals have antibiotics ready on-hand to use at the first sign of a UTI. These methods are usually used for biological females with more than three UTIs per year.



Urinary tract infections are common bacterial infections that can cause very bothersome symptoms. Some individuals are more prone to these infections than others. Treatment of these infections depends on the location and severity of the infection, and typically involves antibiotics for 1-14 days depending on the agent used. See your health care provider if you are experiencing symptoms of a UTI so you can receive the care and support that you need.



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References

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  3. Scholes D, Hooton, TM, Roberts PL, Gupta K, Stapleto AE, Stamm WE. Risk Factors Associated with Acute Pyelonephritis in Healthy Women. Annals of Internal Medicine. 142(1): 20-27. Published January 4, 2005. doi: 10.7326/0003-4819-142-1-200501040-00008

  4. Storme O, Saucedo JT, Garcia-Mora A, Dehesa-Davila M, Naber KG. Risk factors and predisposing conditions for urinary tract infection. Therapeutic Advances in Urology. 11(1756287218814382). Published Online May 2, 2019. doi: 10.1177/1756287218814382

  5. Jump RLP, Crnich CJ, Nace DA. Cloudy, Foul-Smelling Urine Not a Criteria for Diagnosis of Urinary Tract Infection in Older Adults. The Journal of Post-Acute and Long-Term Care Medicine. 17(8): 754. doi: 10.1016/j.jamda.2016.04.009

  6. Nicolle L. Urinary Tract Infection. In: Compendium of Pharmaceuticals and Specialities. Canadian Pharmacists’ Association. Updated April 12, 2021. Accessed March 24, 2022. https://www-e-therapeutics-ca.login.ezproxy.library.ualberta.ca/search

  7. Abbo LM, Hooton TM. Antimicrobial stewardship and urinary tract infections. Antibiotics. 3(2): 174-192. Published May 5, 2014. doi: 10.3390/antibiotics3020174

  8. Urinary Tract Treatment Recommendations in Adult Patients. In: Bugs and Drugs. Alberta Health Services. Updated March 2022. Accessed March 2022. https://www.bugsanddrugs.org/

  9. Oghenekome AG, Tonkin-Crine S, Butler CC, Heneghan CJ, Boylan AM. Non-antibiotic treatment of acute urinary tract infection in primary care: a qualitative study. British Journal of General Practice. Published March 21, 2022. doi: 10.3399/BJGP.2021.0603

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