Everything you need to know about UTIs: from spotting the symptoms to fixing it

Anyone who’s ever had cystitis will wince at the memory. And when Erin* felt that all-too-familiar burning sensation, it brought a sense of dread. 

“In my 20s I used to get cystitis a lot and learnt the hard way how to prevent attacks – but to get it again in my 50s was a shock,” she says. But urinary tract infections (UTIs) aren’t just a young woman’s game – menopausal women and older men are also susceptible to them. 

Bacterial cystitis is one of the most common UTIs in Britain, particularly among women – about 50 per cent will experience it at some point in their life. 

Suspected UTIs like cystitis are responsible for 3 per cent of all GP consultations in England, which could be as many as 10.2 million GP consultations each year in the UK. So what are the various types of UTI and how can they be prevented?

What is a UTI?

A UTI is an infection of any part of the urinary tract and is the most common bacterial infection overall for men and women in all patient-care settings. UTIs are much less common in men (who account for 20 per cent of all occurrences) than women, of whom 50 per cent will experience acute UTI and 20-30 per cent will have a recurrence. 

What are the symptoms of a UTI?

Signs and symptoms of a UTI involve pain or burning when you pass urine (which is called dysuria), urine that looks dark, cloudy or smells bad, pressure in your lower stomach, and an urge to pee more often and more urgently than usual. You may also find your urine has blood in it. 

What is the urinary tract?

The urinary tract is the body’s drainage system for removing urine and consists of the kidneys, the bladder and the tubes leading to and from these organs – the ureters and the urethra. Most infections involve the lower urinary tract – the bladder and the urethra.

Causes of UTIs

Bacteria such as e-coli are the most common cause. “The gut plays a big role in UTIs, as bad bacteria from the back passage can find their way to the opening of the urethra,” says Prof Jennifer Rohn, the head of the Centre for Urological Biology at UCL. This can happen while having sex, wiping from back to front after using the lavatory, putting in a tampon or using a contraceptive diaphragm, for example. “If the bugs travel up the urethra to the bladder wall, they can attach themselves and multiply,” she adds. 

While there are multiple other factors involved, sex is often to blame for a UTI. “Bacteria from the back passage live in and around the perineum, the area in between the anus and the vagina, and having sex can move these bacteria internally towards where the urethra opening lies. This makes it a lot easier for them to climb up the urethra and colonise the bladder and the tissues of the urinary tract,” says Dr Lucy Wilkinson. This is the root cause of infections, and e-coli, which lives in the human intestinal tract, causes more than 90 per cent of bladder infections.

The reason women are more likely to get a urinary infection than men is down to anatomy. “A woman’s water pipe, the urethra, is a lot shorter than a man’s, making it much easier for the bugs to get into the bladder, where they shouldn’t be,” says Mary Garthwaite, a former consultant urologist and the chair of The Urology Foundation. 

Who is the most prone to these infections?

There are certain stages in a woman’s life when UTIs can become a major problem, such as pregnancy and the menopause. “When you are pregnant there is an alteration of your physiology, but also of your anatomy, which makes you slightly more prone to UTIs. Then, during perimenopause and postmenopause, hormonal changes alter the normal bacterial environment in the perineum area, meaning there are less of the good bugs that protect us from UTIs,” says Garthwaite. 

Little girls can get UTIs simply from wiping from back to front after going to the lavatory, and some are very prone to this, which makes good hygiene essential.

UTIs rarely affect men before the age of 50. “As men get older, there is a risk of what we call ‘bladder outlet obstruction’ in their prostate, which can make it hard to empty their bladder, increasing the incidence of UTIs,” says Garthwaite. 

Infections are also really common in elderly women. “But they don’t always get that typical burning sensation; feeling inexplicably under the weather and experiencing confusion are more common symptoms in older women,” says Wilkinson. 

“In old age there is almost gender parity in UTIs,” says Rohn. “The incidence increases with age in both sexes, and this is likely down to the immune system becoming increasingly ineffective.” 

Getting a diagnosis

Your GP or practice nurse will do a urine dip test, using a test strip dipped into a sample of your urine in the sterile container provided. “This test gives your GP a rough idea of whether there might be a UTI, but it can’t rule one out. Only sending a urine sample – catching the middle of the urine flow (an MSU test) as it reduces the risk of the sample being contaminated with bacteria from your hands and the skin around the urethra – to a laboratory will give definite results, and it takes a couple of days to grow the culture and test what antibiotics it will be sensitive to,” says Garthwaite. 

Can a UTI go away on its own?

Over-the-counter medicines like Cystopurin or Effercitrate can help relieve symptoms. “Ask your pharmacist for a medication that changes the pH of your urine, which takes the edge off the stinging and burning. This and increasing your fluid intake might buy enough time for your body to clear the infection itself, without any antibiotics,” says Garthwaite. “Drinking more water is really difficult to practise when you have these symptoms, because peeing hurts, but every time you do so you’re flushing out as many bacteria as you can,” she adds.

But if it doesn’t clear up on its own, you’ll need antibiotics. And the good news is that for many sufferers, antibiotics for UTIs can now be prescribed by some pharmacists or even an online pharmacy. 

For Erin, for whom the long and painful waits for medication of the past are still seared onto her brain, this was a revelation. She was afraid she would miss work because of the infection and couldn’t leave the house for long because she needed to pee so frequently. “I knew antibiotics were the only answer but it was a Friday – how on earth would I get to see a doctor for a prescription and be fit to work by Monday?” she says. “Thanks to an online pharmacy prescription, I had medication three hours after requesting it. Two days later, the infection was gone.”

If you try to flush out the bugs without medication, do look out for changes in your symptoms, says Emma Louise, a urology nurse and the managing director of Women’s Health Clinic. “If you have any symptoms of fever, like shaking and going hot and cold, or you feel sick, or have blood in your urine and it’s dark and offensive-smelling, it’s essential to get medical help.”

Types of urinary tract infections

Cystitis

Bacterial cystitis is a urinary infection that affects the bladder and is one of the most common UTIs in the UK. 

Symptoms

A cystitis infection can begin with slight stinging in the urethra. You will usually experience pain and/or a sensation of burning when passing urine, and you may pee more often or feel like you need to. You may only pass a few drops or feel pain without passing any urine. You may also feel achy at the bottom of your back or have pelvic pain. 

Treatment

The first-choice treatment for cystitis is an antibiotic called nitrofurantoin, which has to be prescribed by a GP or an online pharmacy such as Boots. Some pharmacists can prescribe it in certain chemist’s too – it’s a good idea to check in advance.

Urethritis

Urethritis is an infection and/or inflammation of the urethra. Sexually transmitted bacteria, particularly chlamydia and gonorrhoea, typically cause urethritis. However, other types of bacteria can also be responsible.

Symptoms

Painful or burning urination and discharge from the urethra. Urethritis often has no noticeable symptoms.

Treatment

If diagnosed, this is treated with antibiotics. Your sexual partner will need to be treated too.

Vaginitis

Vaginitis is an inflammation of the vagina usually caused by bacteria, yeast (such as thrush) or viruses. Changes in the microorganisms in your vagina are caused by irritations from chemicals in creams, sprays or even clothing that come in contact with this area. Reduced oestrogen levels after menopause and some skin disorders can also cause irritation. 

Symptoms

Discharge, itching and soreness, as well as swelling and pain in and around the vagina. 

Treatment

This will depend on the cause – for example, antifungal medicine for thrush or hormone treatment for menopause symptoms.

Pyelonephritis

This is a bacterial infection causing kidney inflammation and is one of the most common diseases of the kidneys. Pyelonephritis occurs as a complication of a UTI. 

Symptoms

Fever, chills and pain in your lower back or side. “It can feel like being kicked by a horse all round your side,” says Louise. “There may be some pain on urination or you may find you can pee normally without it hurting. Long-term it can cause damage to kidneys if left untreated, and may require hospitalisation.” 

Treatment

If antibiotics based on your MSU (mid-stream specimen of urine) don’t work, this can be serious. “In the worst-case scenario, where you are really symptomatic, you may have to be admitted to hospital and given intravenous antibiotics,” says Louise. 

Prevention of UTIs

If you are prone to UTIs, the number-one priority is to optimise your fluid intake. “But also make sure you’re emptying your bladder properly,” says Garthwaite. “If you have an infection, research has shown that if you leave as little as 20ml of urine in your bladder and that urine has bacteria in it, the infection won’t budge.” 

So when you pee, go for the “double void”, she advises. “You may think you’ve finished, but relax and count to 10, and then have another go to ensure your bladder is empty.”

To flush out the bugs, peeing straight after sex is essential for women, as is wearing cotton underwear to avoid a build-up of sweat, which creates a breeding ground for bacteria. Use fragrance-free soaps and shower gels to avoid harsh chemicals that strip away the good bugs that protect the delicate vaginal area. And try taking D-mannose tablets, which is a monosaccharide that can inhibit bacterial adhesion to the inside of the urinary tract. Several clinical studies have shown the efficacy of these tablets in the prevention of recurrent UTIs. And vitamin C can acidify the urine, limiting the growth of bacteria that cause UTIs, so make sure you’re getting your daily dose.

Studies have found that ensuring a good level of probiotics in the gut can diminish the ability of pathogenic bacteria to bind, multiply and colonise, so include Greek yogurt, sourdough bread, miso and kimchi in your diet. 

And if you’re postmenopausal, your lack of natural oestrogen can make you more prone to UTIs, so do consider HRT to help reduce the number you get. “Oestrogen creates an environment that nurtures the ‘friendly’ bacteria in the vagina, which can normally help fend off the bad bugs,” says Prof Rohn. 

“Topical vaginal oestrogens like Gina – available without a prescription – can help reset the balance and prevent UTIs, both by keeping the tissues healthy and creating a healthy environment for the friendly bacteria to flourish,” says Wilkinson. “HRT isn’t suitable for everyone, so it’s sensible to check with your doctor before starting.”

Can men get UTIs?

Garthwaite says: “We probably underestimate how many men get UTIs, partly because they don’t necessarily get all the acute symptoms that women do – they may just feel a bit weak and under the weather, rather than having the key symptoms of stinging sensation when you pee and needing to pee a lot.”

What can you do if you experience recurring UTIs?

“Uromune is a new vaccine not yet approved in the UK but available in specialist clinics to prevent recurrent UTIs in women who have no other options,” says Rohn. And getting prescribed a small dose of antibiotics to take every night can prevent recurring infections. “Many people resort to daily low-dose prophylactic antibiotics given over the long term,” she adds. However, any increased resistance of the urinary bacteria to antibiotics will require surveillance.

Recurrent UTIs or kidney infections such as pyelonephritis may warrant further investigations such as ultrasound, radiological investigation into the whole urinary tract or even a camera into the bladder, under the care of urologists.

How to get rid of a UTI without seeing a doctor

If flushing it out with lots of fluids doesn’t work, unfortunately the only option is to get a prescription from a pharmacist (only some provide this service, so check in advance) or an online pharmacy such as Boots or Superdrug (if, after filling out an online form, you are considered suitable). “In the meantime, take paracetamol or ibuprofen for the discomfort – whichever is medically suitable for you. If you can’t get to see your GP, use out-of-hours services and walk-in centres to get a diagnosis and treatment. Ultimately this is the only way you’ll get rid of a tenacious urinary infection,” says Wilkinson.

* Name has been changed