At the counter of the pharmacy, your UTI conversation often starts with “Can you give me something strong, I know exactly what this is”
In many cases, the individual is correct. The burning, urgency and painful pressure above the pubic bone can be unforgettable after experienced
However, not every burning sensation is a UTI, and not every UTI is a simple bladder infection that can safely wait until Monday.
The first step to knowing which is which is recognising the difference
When it is probably the bladder
Bladder infections often develop quickly. Urination starts burning, but you desperately want to go, yet only a few drops come out. Ten minutes later you’re back in the same position, your bladder demanding a second refill.
You may have dull pressure low in your abdomen, your urine can be cloudy, strong smelling, or have a few drops of blood
A smell on its own is not particularly informative. Morning urine tends to be more concentrated and can smell strong. Coffee, asparagus and certain vitamins can also contribute to a strong smell. Cloudiness urine can have other causes
It is the combination with burning and urgency that is important
Vaginal itch or unusual discharge can change the picture. Thrush, bacterial vaginosis and sexually transmitted infections can cause irritation around the time of urination. In men, penile discharge or testicular discomfort makes urethritis or a sexually transmitted infection more likely.
Taking an antibiotic “just in case” can cause a delay in correct diagnosis.
Fever is where I call it a minor UTI
A bladder infection usually leaves the bathroom as misery, but a kidney infection can make your whole body feel unwell
Watch out for fever, shaking chills, vomiting, or pain in the kidney area (side of the back, just below the ribs). The pain can be deep and more on one side, and is a reason to get further assessment promptly. Pregnant women should also contact a clinician earlier, even with mild symptoms. UTIs during pregnancy are more likely to become kidney infections
Men, children, people with a urinary catheter and anyone with kidney stones or a compromised immune system should also have a more careful assessment.
If someone is confused, faint, barely passing urine, or unable to keep fluids down, this is not a home-remedy problem
The urine sample is not a pointless bureaucracy
With classic symptoms in an otherwise healthy nonpregnant woman, a clinician may treat without waiting for a culture
A culture becomes more useful when the infection has recurred, the first antibiotic did not work, or the symptoms suggest the infection has reached the kidneys. It is commonly requested for men and during pregnancy
The sample should be gathered ideally before commencing antibiotics. One way to do this is to start urinating into the toilet, then catch the middle stream in a clean container, and finish into the toilet again. This reduces the chances of confusing skin bacteria with bacteria in the urine
The lab can sort out which bacteria is present and what antibiotics are likely to work. This information is important if your usual antibiotic doesn’t
Finding bacteria in the urine does not always require treatment. Many older adults have bacteria in their urine without burning, urgency, fever or other urinary symptoms. Antibiotics are rarely useful in this situation, and may cause diarrhoea, drug reactions and resistance
Pregnancy is an exception, bacteria without symptoms are usually treated due to different risk factors
There is no magic “UTI antibiotic”
For a simple bladder infection, options can include nitrofurantoin, trimethoprim-sulfamethoxazole or fosfomycin depending on allergies, kidney function, pregnancy status, local resistance patterns and a previous culture
Kidney infections require a different approach, sometimes needing hospitalisation
This is why using up leftover capsules from a dental infection is a bad idea. The drug may not work against the bacteria in the urinary tract, the dose might be wrong, and there’s rarely enough left to complete treatment
A list of antibiotic medications can explain the different families, but symptoms and a urine culture are much more informative than picking the name you recognise
Cipro is sometimes used for kidney or complicated urinary tract infections, but is not the “strong antibiotic” of default for every bladder infection, and has important warning about side effects
Once treatment has begun, burning pain should usually ease within a day or two. If not, or if symptoms become worse, contact the person who prescribed it. Simply adding an extra antibiotic is not a good idea
Cranberry juice is not treatment
Cranberry has a potential role in prevention. Products can modestly reduce the number of UTIs in some women. It will not clear the bacteria from an infected bladder
The same goes for D-mannose. Heavily marketed, recent well-designed research has not found a convincing benefit for preventing recurrent UTIs
Drink enough to be comfortably hydrated. Forcing down litre after litre will not wash away an established infection, and usually makes an already irritable bladder work harder
A heating pad can help with discomfort low in the abdomen, and phenazopyridine can reduce burning for a day or two while the antibiotic takes effect. It turns the urine bright orange and can stain fabrics, which can be confusing if nobody mentions it. Phenazopyridine does not kill bacteria, so feeling better after taking it does not mean the infection is gone
When UTIs keep coming back
Two infections in six months, or three within a year is seen as recurrent UTI
Before embarking on months of prevention, be sure the infections were real ones. Repeated discomfort with negative urine cultures can be caused by vaginal dryness, pelvic-floor tension, bladder pain syndrome or another condition
Some women notice infections after sex. Avoiding spermicide can help if it appears to be a trigger. Urinating after sex is reasonable, although the evidence that it prevents every infection is not strong
After menopause, vaginal estrogen can reduce recurrence for appropriate patients. Others may need a preventive antibiotic after sex, or on a regular schedule. That should be a decision made with a clinician, based on proven infections
UTIs are not a sign of poor hygiene. Harder scrubbing or using scented intimate washes can irritate the skin and worsen burning
A simple bladder infection is unpleasant but usually settles with the correct treatment. What to remember is the change of territory: burning and urgency suggests the bladder; fever, vomiting and pain beneath the ribs suggest the infection has creeped up to the kidneys
That is when waiting is not a good idea.
