Urinary tract infection (UTI)

A urinary tract infection (UTI) occurs when bacteria enter the urinary system and multiply, often leading to discomfort or difficulty when urinating. Most UTIs affect the urethra or bladder in the lower urinary tract and are easily treatable, but if left unchecked, bacteria can spread to the upper tract, from the ureters to the kidneys, where infection is more serious.

At Penn Medicine, we diagnose and treat UTIs with personalized care designed to relieve your symptoms and prevent future infections. When advanced care is needed to address severe or recurring UTIs, you’ll have access to top urologic specialists and surgeons.

Common UTI symptoms in both women and men may include:

• Burning or pain when urinating
• A strong urge to urinate, even when little urine comes out
• Frequent urination
• Cloudy, dark, or strong-smelling urine
• Blood in the urine (hematuria)
• Pain or pressure in the lower abdomen or pelvis

If your symptoms have not resolved within a couple of days or are getting worse, it’s time to visit the doctor. Fever and chills, low back pain, and nausea or vomiting may be signs of more severe infection that has reached the kidneys. You should seek immediate medical care if you are experiencing these UTI symptoms. 

In some older adults, sudden changes in behavior or mental state could be triggered by a UTI. Family members or caregivers may notice confusion, increased forgetfulness, agitation, unusual sleepiness, or a sudden decline in daily functioning. There are many possible reasons for behavioral changes in older adults, so it’s important to get a medical evaluation.

Most infections start when bacteria, commonly E. coli from feces, enter the urethra, the tube that carries urine from the bladder out of the body. They then travel up to the bladder, causing symptoms. Factors that may cause UTIs or make you more vulnerable to getting them include:

• Sexual activity that introduces bacteria into the urethra
• Holding urine for long periods
• Poor hydration
• Hormonal changes, including pregnancy, menstrual cycle fluctuations, and menopause
• Blockages such as kidney stones, bladder stones, or an enlarged prostate
• Use of urinary catheters
• Conditions like type 1 diabetes and type 2 diabetes that weaken the immune system 

Anyone can get a UTI, but they occur more often in those assigned female at birth because the urethra is shorter and closer to the rectum, making it easier for E. coli to pass into the urinary tract and reach the bladder. For people assigned male at birth, UTIs occur more frequently in those aged 50 and older due to a higher incidence of prostate conditions in this age group. 

Most urinary tract infection treatments use antibiotics to eliminate the bacteria causing the infection. Your provider will choose a medication based on your symptoms and the type of bacteria identified. Common UTI treatment approaches include:

• Antibiotics taken for several days
• Pain relief medication to ease burning during urination
• Drinking plenty of fluids to help flush bacteria from the urinary tract

Many people begin to feel better within a few days of starting antibiotic treatment. However, it’s important to take the full course of medication to fully clear the infection.

For people experiencing repeated, severe UTIs because of a blockage or anatomical abnormality, surgery may ultimately be recommended. Penn Medicine is home to experts in all types of reconstructive urology. Our surgeons are leaders in these advanced procedures and use robotic and minimally invasive urology surgery whenever possible for the most precise treatments and faster healing.

There are steps you can take to help reduce your risk of developing a UTI.

• Drink plenty of water each day to stay hydrated
• Urinate when you feel the urge instead of holding it
• Wipe from front to back after using the bathroom
• Urinate after sexual activity
• Don’t use irritating products in the genital area such as douches, sprays, or harsh cleansers
• Avoid tight, constricting pants and underpants that trap moisture and encourage bacteria growth

If you have frequent UTIs, your healthcare provider may recommend additional prevention strategies or medications.