BURNING WHEN URINATING? DO YOU HAVE A URINARY TRACT INFECTION?

A urinary tract infection (or UTI for short) is a condition usually caused by pathogenic bacteria, and rarely by viruses or fungi. Urine is normally sterile, so when a microbe enters the urinary tract, it can cause an infection. UTIs are common and can happen to anyone.

Our urinary tract is made up of several parts: the kidneys, the ureters, the bladder, and the urethra. Doctors call the kidneys and the ureters the upper urinary tract, while the bladder and urethra are called the lower urinary tract. This is important since upper urinary tract infections tend to be more severe and require a longer treatment course.

Once diagnosed, urinary tract infections are treated with antibiotics administered either orally or through an IV line. The choice of treatment depends on several factors, most importantly the severity of the infection and the type of the germ causing it.

What are the symptoms of UTI?

There are several symptoms that might raise suspicion of a urinary tract infection. The severity of symptoms usually correlates with the severity of the infection and depends on the part of the urinary tract infected (upper or lower). Lower urinary tract infections (bladder and urethra) are usually less severe and cause more local symptoms:

• Burning sensation when you urinate
• Odorous urine
• Dark or cloudy urine color
• Pain in your pelvis (in women) or anal region (in men)
• Frequently feeling the need to pee (frequency)
• An intense sensation of needing to urinate (urgency)
• Penile or vaginal discharge (in urethral infections)

As opposed to lower urinary tract infections, upper urinary tract infections are more severe, and can even become life-threatening if the microbes disseminate into the blood. In addition to the symptoms of lower urinary tract infections, upper urinary tract infections can cause:

• Fever
• Chills
• Flank and back pain
• Nausea and vomiting
• Low blood pressure (in case of sepsis and shock)
• Confusion (in elderly patients)

Sepsis and shock is when the bacteria goes into your blood and causes a full-blown immune reaction, which can be harmful to your body. Symptoms and signs of sepsis and shock include low blood pressure, altered mental status, and multi-organ failure. Sepsis can be life-threatening and requires rapid in-hospital treatment.

What are the risk factors for developing urinary tract infections?

Doctors have identified a few factors that may put you at risk of developing urinary tract infections. These include:

• Age: People who are older are at higher risk
• Restricted mobility: like after surgery or an accident
• Kidney stones
• Obstruction in the urinary tract, like a large prostate or a stone lodged in your ureter
• Usage of urinary catheters
• Diabetes Mellitus
• Pregnancy
• Urinary tract malformations
• Immune deficiency

Frequently Asked Questions

How are urinary tract infections diagnosed?

Urinary tract infections can be diagnosed by a urologist, infectious disease specialist, or a general practitioner. Your doctor will start by asking you about your symptoms. The location of pain and intensity of symptoms can help identify how severe the infection is. He or she will perform a full physical examination to try to identify the issue. This is usually enough to establish a preliminary diagnosis of urinary tract infection. Your doctor will then order one or more tests to confirm their suspicion:

• Urine analysis and culture: This is one of the most important tests in diagnosing urinary tract infections. You will be asked to pee in a cup, and the urine is sent to the lab. A urinalysis will be quickly done to see if there are blood cells, immune cells, or bacteria in your urine. Culture results will take more time, usually 2 days, before they come out. A culture identifies the exact type of bacteria that you have in your urine. This helps your doctor confirm the diagnosis and adjust your antibiotic treatment accordingly.
• Routine blood work: Your doctor might order a blood count and a C-reactive protein (CRP) level to see how your immune system is reacting to the infection. White blood cell count and CRP are usually more elevated in severe infections.
• Imaging: A CT scan or ultrasonography might be ordered if you have severe symptoms and your doctor is still unsure of the diagnosis. Imaging is helpful in diagnosing upper urinary tract infections.

How are urinary tract infections treated?

Since urinary tract infections are usually caused by bacteria, antibiotics are the cornerstone of treatment. Depending on your general health and the severity of symptoms, your doctor will choose whether you need hospital admission or can receive treatment at home.

After confirming the diagnosis, your doctor will prescribe a special class of antibiotics used to treat UTIs. If you’re admitted to the hospital, you will receive an intravenous antibiotic initially, and if you’re going home, he or she will prescribe an oral antibiotic. In both cases, once the urine culture result is confirmed, your doctor will adjust your medications to the results. Treatment can range from a single dose to up to 2 weeks of antibiotics depending on the severity of your infection.

Urinary tract infections are common and can happen to anyone, especially if they have one or more risk factors. Treatment is fairly straightforward and antibiotics are usually enough. If you are feeling a burn when urinating or have frequency, urgency, or pelvic or flank pain, you should check with your doctor and ask about the possibility of having a urinary tract infection.

How do you get a urinary tract infection?

The urinary tract is normally sterile. An infection happens when harmful bacteria get into your urinary system. One the most common types of infection seen in an out-patient environment, Urinary tract infections (UTIs) tend to affect women more than men. It is estimated that over 50% of all women experience a UTI at least once in their lifetime, with around 30% of them suffering from multiple episodes. It also accounts for 10–14% of all infections among the elderly. Among children, it is the second most common bacterial infection. A UTI is also quite commonly acquired in a hospital setting due to catheterization. Termed catheter-associated UTI (CAUTI), it represents 40% of healthcare-associated infections. The mechanism of urinary infections differs slightly between men and women since the anatomy is different between the two genders. So, we’ll split this section into two: 

How does a man get a urinary tract infection? 

Urinary tract infections are less common in men than in women. The reason for that is that the urethra is longer in men. It extends through the penis and opens at the tip. This makes it much harder for bacteria to travel backward and invade the urinary system. 

In men, urinary tract infections are usually associated with sexually transmitted infections (STIs), namely chlamydia. Otherwise, most men that develop a urinary infection usually have a urinary tract abnormality, such as: 

• Urinary tract obstruction (enlarged prostate or obstructive kidney stone)
• Urinary incontinence
• Having a urine catheter 
• Urinary or genital tract surgery 

In such cases, the bacteria can cross from the gut organs (intestines) and invade the urinary tract. A catheter or surgery can introduce the germ right into the urinary system and cause an infection.

Still, sometimes, a UTI can happen in men even if none of these factors exist. 

How does a woman get a urinary tract infection? 

Women are much more likely than men to develop urinary tract infections. The urethra is very short in women - only 2-5 centimeters. This means that germs can easily get from the urethral opening to the bladder and then climb up to invade the ureters and kidneys. 

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Sources:

• niddk.nih.gov/health-information/urologic-diseases/bladder-infection-uti-in-adults
• niddk.nih.gov/health-information/urologic-diseases/kidney-infection-pyelonephritis
• cdc.gov/getsmart/community/for-patients/common-illnesses/uti.html
• ncbi.nlm.nih.gov/pubmedhealth/PMHT0024568/
• https://www.degruyter.com/document/doi/10.1515/labmed-2021-0085/html?lang=en

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