Urinary Tract Infections (UTI) in Adults

Urine infections are one of the most common reasons people see their GP. Most clear up quickly with a short course of antibiotics, but infections that keep coming back, or that affect the kidneys, need proper investigation to find and treat the cause.

Watch: Mr Subramonian discusses the management of urine infections with a GP (video below).

Book an appointment: The Priory Hospital, 0121 446 1668 · HCA Harborne Hospital, 0121 812 3051.

What is a urinary tract infection?

A UTI happens when bacteria get into the urinary tract, usually by travelling up the urethra (the tube that drains the bladder). An infection confined to the bladder is called cystitis. If the bacteria spread up to the kidney, it is called pyelonephritis, which is a more serious illness.

What causes it?

Most infections are caused by E. coli, a bacterium that normally lives in the bowel. Things that make infection more likely include:

Sexual intercourse
Not passing urine often enough, or not emptying the bladder fully
Kidney stones, or a kidney that does not drain properly
Having a urinary catheter
Changes after the menopause

Some bacteria, such as Proteus, are closely linked with kidney stones. Finding them on a urine test can be a clue that a stone is present.

Common symptoms

Bladder infection (cystitis)

Needing to pass urine often and urgently
Burning or stinging when passing urine
Pain low in the tummy
Cloudy or strong-smelling urine, sometimes with blood in it

Kidney infection (pyelonephritis)

High temperature, shivering or shaking
Pain in the side or back, just below the ribs
Feeling generally unwell or being sick, with or without bladder symptoms

Seek urgent help (same-day GP, NHS 111 or A&E) if you have a fever with shivers, pain in your side or back, are vomiting and cannot keep antibiotics down, or feel very unwell. A kidney infection, especially with a blocked kidney or a stone, can become serious quickly.

How is it diagnosed?

Urine dipstick: a quick test at the GP surgery that looks for signs of infection.
Urine culture: a clean mid-stream sample is sent to the laboratory to identify the bacteria and show which antibiotics will work. Results take about two days.
Scans: an ultrasound is used to check the kidneys and how well the bladder empties. A CT scan may be needed if a stone or blockage is suspected.

Treatment

Antibiotics are the main treatment. The choice depends on the type and severity of infection and, where available, the culture result.

Bladder infections usually need only a short course of antibiotics.
Kidney infections need a longer course, and severe cases may need a hospital stay with antibiotics into a vein.
Drinking plenty of fluids and taking simple painkillers such as paracetamol help with symptoms.
If an infected kidney is blocked by a stone, the blockage must be relieved urgently, usually with a stent or a drainage tube, before the stone is treated.

Reducing the risk of infection

Drink enough fluid to keep your urine pale
Pass urine regularly and empty your bladder fully, including soon after sex
Wipe from front to back after using the toilet
D-mannose or cranberry products help some people, although the evidence for them is limited

Recurrent urine infections

Having repeated bladder infections is common, particularly in women. Useful options include:

Hiprex (methenamine hippurate): a non-antibiotic tablet taken twice a day that makes the urine unfriendly to bacteria. It is very effective at preventing recurrent infections and avoids the need for long-term antibiotics.
Low-dose vaginal oestrogen cream or pessaries for women after the menopause
A low dose of antibiotic taken at night, or after sex, once any current infection has been treated
Newer treatments for difficult cases, such as bladder instillations or a urinary vaccine, available through specialist clinics

When should I see a urologist?

A single bladder infection in a woman that settles quickly does not usually need further tests. Investigation is recommended for:

Recurrent infections
Any kidney infection
Any urine infection in a man
Blood in the urine that persists after the infection has cleared

A urologist will look for underlying causes such as kidney stones, a bladder that does not empty properly, an enlarged prostate or a kidney that does not drain well, and treat them so the infections stop.

Why choose Birmingham Urology Clinic?

Mr Subramonian is a consultant urological surgeon with over 21 years of experience, a nationally recognised kidney stone specialist and a past Chair of the BAUS Section of Endourology. Infections caused by stones or poorly draining kidneys are a core part of his practice, so the underlying cause can be found and treated in one place.

Birmingham Urology Clinic