Brief overview
- Symptoms: pain and burning when urinating, frequent urge to urinate, feeling ill, in more complicated cases: Fever, chills, flank pain (pyelonephritis)
- Treatment: Depends on the cause, generally: drink plenty of fluids, frequent urination, rest; otherwise usually antibiotics or other medication as well as herbal alternatives
- Causes and risk factors: Mostly infection by intestinal bacteria due to proximity to the anal region, female anatomy of the short urethra; risk factors include: Immunodeficiency, pregnancy, metabolic diseases, outflow obstructions
- Diagnosis: Based on symptoms, urine and blood tests, ultrasound examination (sonography)
- Course of the disease and prognosis: Good prognosis for uncomplicated urinary tract infections, usually complete recovery with antibiotics
- Prevention: General measures such as drinking plenty of fluids, regular emptying of the bladder, healthy diet; drug-based prevention with antibiotics or herbal preparations, oestrogen, mannose or immunotherapy possible for recurrent urinary tract infections
What is a urinary tract infection?
Typical symptoms of a urinary tract infection are new pain when urinating, such as a burning sensation, and a frequent and strong urge to urinate.
Due to the short urethra, it is mainly women who suffer from a urinary tract infection. It is the most common reason for incapacity to work among women. More than half of women suffer from a urinary tract infection at least once in their lives. The older women are, the more frequently UTIs occur. Men usually only fall ill at an older age, when age-related urinary flow disorders occur.
Classification of urinary tract infections
Doctors differentiate between urinary tract infections according to different aspects:
- Where does the infection occur? In the upper urinary tract (pyelonephritis) or in the lower urinary tract (urethra, bladder, prostate)?
- Does the infection cause symptoms? Is there a symptomatic UTI or so-called asymptomatic bacteriuria (pathogens are present in the urinary tract but do not cause any symptoms)?
- Are there certain risk factors, such as narrowing of the urethra, pregnancy or immunodeficiency, which may or may not lead to a complicated urinary tract infection (uncomplicated UTI)?
What are the symptoms?
Like most bacterial infections, urinary tract infections cause redness and swelling of the tissue.
Typical urinary tract infection symptoms are pain and burning when urinating, blood in the urine and a general feeling of illness. In severe cases, the urinary tract infection is sometimes accompanied by fever and chills. If the infection spreads to the renal pelvis, flank pain is a typical sign of the disease.
Many sufferers who repeatedly suffer from urinary tract infections recognize the first signs of a urinary tract infection early on and know how to avert the threat of cystitis with the help of home remedies.
Home remedies have their limits. If the symptoms persist over a longer period of time, do not improve or even get worse, you should always consult a doctor.
You can find out which home remedies can help with cystitis in some cases in the article Cystitis – home remedies.
How is it treated?
Doctors usually base their treatment on so-called guidelines. These are treatment recommendations from expert groups for a specific disease, which are based on the latest scientific findings.
Your doctor will provide the appropriate treatment for the urinary tract infection. He or she will usually prescribe medication (such as antibiotics or painkillers) and general measures that are important for a urinary tract infection. These include the following:
- Drinking plenty of fluids (at least two liters per day) to flush out the urinary tract
- Empty the bladder regularly and frequently
- Heat applications, for example in the form of hot water bottles
- Bed rest if it is a case of pyelonephritis
If you suffer from heart failure, it is important that you clarify the daily amount of fluids with your doctor. Some people with heart failure have a drinking limit.
If you have a mild, uncomplicated inflammation of the bladder, doctors sometimes recommend symptomatic treatment with painkillers such as ibuprofen, but not for pregnant women.
If the urinary tract infection requires treatment with antibiotics, the doctor will decide which antibiotic to use based on various factors. The antibiotic therapy sometimes depends on this:
- whether symptoms are present
- whether the urinary tract infection is complicated or uncomplicated
- the exact location of the inflammation
- the severity of the infection
In the case of an uncomplicated urinary tract infection, the doctor usually prescribes short-acting antibiotics for one to three days, which bring about a reliable cure quite quickly.
If there are no symptoms such as pain during the urinary tract infection despite the pathogen being detected, treatment with antibiotics is not absolutely necessary in most cases. Exceptions are pregnant women and people who are about to undergo surgery on the urinary tract or if there is a risk of the infection spreading with the urinary tract infection.
If there is a complicated urinary tract infection, doctors will also prescribe antibiotics. However, the treatment usually takes longer and other antibiotics are usually also used. In pregnant women and children, for example, doctors only use certain antibiotics that are better tolerated by these groups of people to treat a urinary tract infection.
What causes a urinary tract infection?
The intestinal bacteria pass from the anus into the external urethra and then ascend into the urinary tract and genital organs (urogenital tract). Incorrect hygiene after using the toilet is often responsible for this. In other cases, urinary tract inflammation occurs after unprotected sexual intercourse.
Women in particular are much more likely to contract a urinary tract infection. This is because women have a shorter urethra than men and the entrance to the urethra is closer to the anus. For this reason, germs enter the bladder more easily. Young women in particular are often affected by urinary tract infections.
Older people with a urinary catheter are also more likely to suffer from a urinary tract infection. Here, the bacteria use the catheter as a “guide rail”. Babies and children are also affected by urinary tract infections. Especially when they are in diapers, as it is very easy for bacteria to multiply rapidly and strongly in a moist environment.
Urinary tract infection – special risk factors
There are also certain factors that increase the risk of a urinary tract infection. These include
- Immunodeficiency, for example due to serious illnesses or medication such as immunosuppressants
- Metabolic diseases such as diabetes mellitus
- Urinary drainage disorders, for example due to urinary stones, tumors or an enlarged prostate
- Pregnancy
Are urinary tract infections contagious?
In principle, it is possible for bacterial infections of the urinary tract to be contagious. Especially if they occur in the lower urinary tract such as the urethra.
In most cases, however, infection occurs via the spread of the body’s own intestinal bacteria. For example, transmission during sex is also possible and is not linked to gender. In some cases, men are also infected during sexual intercourse, although this happens much less frequently than in women due to their longer urethra.
How is a urinary tract infection diagnosed?
It is usually possible for the doctor to diagnose a urinary tract infection based on the typical symptoms and using a urine test strip. The test strip detects various typical changes in the urine, such as the content of red and white blood cell components or certain products of bacterial metabolism (nitrate).
In many cases of urinary tract infection, the urine test strip shows a positive nitrite result. However, a negative nitrite test is not enough to rule out the disease. This is because there are some bacteria that do not produce nitrites.
The blood usually shows elevated inflammatory values such as an increase in C-reactive protein (CRP), erythrocyte sedimentation rate and white blood cells (leukocytosis). If a fever is present, doctors sometimes have a blood culture taken to determine the pathogens.
In some cases, doctors also carry out an ultrasound examination (sonography) to identify any urinary outflow obstructions. Other imaging procedures such as computer tomography or X-ray examinations with contrast medium are rarely necessary.
How does a urinary tract infection progress?
A urinary tract infection usually heals completely with the administration of antibiotics and the prognosis is good.
The kidneys are usually not damaged either. However, it is important that you consult a doctor if you suspect a urinary tract infection in order to avoid complications. Especially if left untreated, an ascending urinary tract infection can develop in some cases, resulting in inflammation of the renal pelvis.
The risk of a severe course and thus of urosepsis, a blood poisoning that begins with a urinary tract infection, is low under medical treatment. Urosepsis is a medical emergency that can be fatal under certain circumstances.
Can a urinary tract infection be prevented?
There are a few general measures that can prevent a urinary tract infection in some cases and help to keep the urinary tract healthy. There are also ways to prevent recurring urinary tract infections.
General measures to prevent a urinary tract infection
The following measures, among others, support the health of the urinary tract:
- Adequate fluid intake (flushes out any bacteria with the urine)
- Regular urination (counteracts the growth of bacteria)
- Healthy diet with plenty of vitamin C and ascorbic acid
- Urinate before and after sexual intercourse and use bladder-friendly contraception with condoms
- Toilet hygiene is particularly important for women (wipe from front to back and use pH-neutral washing lotion)
- Avoid cooling down (change wet underwear)
- Breathable underwear that can be washed at 60 degrees
Prevention of recurring urinary tract infections
If urinary tract infections occur repeatedly, especially in women, there are medication options for prevention. These include, for example
- Doctors sometimes prescribe low doses of antibiotics over a longer period of time (several months), especially for complicated UTIs.
- In addition, tablets for immune therapy are available for the prophylaxis of recurrent urinary tract infections, in which the immune system is stimulated by the administration of killed pathogens.
- Other preparations such as D-mannose and herbal alternatives such as bearberry leaves (do not take long-term!) or nasturtium and horseradish root (especially the combination of the two) are also suitable for recurrent urinary tract infections.
Doctors define a chronic or recurrent urinary tract infection as more than two urinary tract infections in six months or more than three urinary tract infections per year.
The intake of prebiotics or cranberry products may also have a prophylactic effect on recurring bladder infections. However, there is a lack of clear and sufficient scientific evidence for this.
It is best to discuss proper prevention with your family doctor, urologist or gynecologist.
