Urinary tract infections (UTIs): What to do when ur*ine trouble!

The urinary tract is composed of the urethra, bladder, ureters and kidneys. The blood is filtered through the kidneys to remove waste products and excess water, forming urine. This then travels along the ureters to the bladder, where it is stored until the person passes the urine out of their body via the urethra.

Urinary tract infections (UTIs) can occur in any of these four areas. Depending on the location, the infection may be labelled as urethritis (urethra), cystitis (bladder), ureteritis (one or both ureters) or a kidney infection. (1)

Classic symptoms include a frequent, urgent need to pass urine (often in small amounts), a stinging or burning pain when passing urine, and lower abdominal pain. However, the urine may also contain blood and may have an unpleasant smell and/or a cloudy appearance. The person affected may feel generally unwell, and elderly sufferers sometimes even experience confusion. (1)

What causes UTIs?

The most common cause of a UTI is when faecal bacteria such as E. coli from the back passage get into the urethra. This happens more frequently in women than men, because there is a shorter distance between the openings of the urethra and back passage. Furthermore, the urethra itself is shorter in women, meaning the bacteria don’t have as far to travel to reach the bladder and higher portions of the urinary tract, leading to infection. (1) The urinary tract is usually a sterile (bacteria free) environment, so it can be quickly overwhelmed by invasive bacteria which have no competition for space and nutrition.

Other causes include conditions in which block part of the urinary tract, such as kidney stones; an enlarged prostate in men, which can make complete emptying of the bladder hard; a poorly functioning immune system, which increases a person’s susceptibility to bacterial infections; using a catheter; and pregnancy. (1)

How are UTIs treated?

For women, sodium or potassium citrate sachets are available that can be used at the first sign of a UTI. They help to reduce the acidity of the urine, therefore easing symptoms while the body fights the infection. One sachet is dissolved in a glass of water and taken three times a day for two days. If the symptoms persist or recur after this course, a GP appointment must be made as antibiotics may be needed to clear up the infection.

Men, pregnant women and children must be booked in to visit their GP upon the development of any UTI symptoms. Anyone with lower back or side pain, a raised temperature, chills, nausea, vomiting or diarrhoea related to a UTI should make an emergency appointment with their GP, as the infection may have spread up the urinary tract to the kidneys, which will need urgent treatment. (1)

Trimethoprim is the antibiotic of first choice for simple UTIs affecting the urethra and/or bladder. Nitrofurantoin, cephalosporins or norfloxacin can be used as an alternative if the former is unsuitable, or the higher portions of the urinary tract are affected. Courses of antibiotics must always be completed, even if symptoms have ceased, otherwise the infection may not be fully treated and may recur.

Paracetamol may also be taken for pain relief. (1)

Can UTIs be prevented?

There is no failsafe way to prevent UTIs, but there are steps that can be taken to make developing a UTI less likely. Always wipe from the front to the back after using the toilet, to prevent transfer of faecal bacteria to the urinary tract. Wear loose fitting, breathable underwear and try to use fragrance free body washes and soaps in the intimate area. Drink plenty of water, try not to hold in urine for too long and be sure to completely empty the bladder when you go to the toilet. Also, pass urine as soon as possible after sex to flush out any bacteria that have entered the urethra. (1)

If, despite following these steps, you still suffer with recurrent UTIs, your doctor may prescribe low dose antibiotics to help keep them at bay, or refer you to a specialist for further investigation.

National Health Service. Urinary tract infections (UTIs) [cited 24 September 2017]. Available from: https://www.nhs.uk/conditions/urinary-tract-infections-utis/

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 26/09/17