This patient education brochure was prepared in consultation with: William J. Ledger, MD Given Foundation Professor of Obstetrics and Gynecology Department of Obstetrics and Gynecology Cornell University Medical College Obstetrician and Gynecologist-in-Chief The New York Hospital-Cornell Medical Center New York, NY Lauri J. Romanzi, MD Assistant Professor of Obstetrics and Gynecology Department of Obstetrics and Gynecology Cornell University Medical College Director, Division of Uro-Gynecology The New York Hospital-Cornell Medical Center New York, NY Marianne J. Legato, MD Professor of Clinical Medicine Department of Internal Medicine Founder and Director, Partnership for Women's Health at Columbia Columbia University College of Physicians and Surgeons New York, NY

1. Do I Have a Urinary Tract Infection?
2. How Serious is a UTI?
3. Are UTIs Common?
4. What Causes a UTI?
5. Do I Have to See the Doctor?
6. What's the Treatment?
7. Which Antibiotic is Best for Me?
8. Will I Have Any Side Effects From Treatment?
9. Do I Have to Take All the Medicine?
10. What Else Can I Do?
11. Can UTIs Be Prevented?
12. What to Look For
13. Glossary

Do I Have a Urinary Tract Infection?

The most common symptoms of urinary tract infection (UTI) include:

• Sudden urge to urinate
• Need to urinate more often than usual
• An uncomfortable burning sensation, cramps, or pain when urinating or immediately afterward.

Urinary incontinence could also be a symptom, particularly in older women.The most common type of UTI affects the lower part of the urinary tract (Figure 1) and is called UTI, bladder infection, acute cystitis, or "honeymoon cystitis."

Figure 1. - Uncomplicated urinary tract infection means inflammation of the bladder.

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How Serious is a UTI?

In most cases, doctors can treat and cure UTIs quickly and easily. An untreated lower UTI, however, can become a serious condition involving the kidneys. In pregnant women, untreated UTIs can affect the pregnancy and might cause premature labor. In older women, UTIs can be more serious. They can cause kidney infection, which may lead to bacteria in the bloodstream. This is harder to treat.

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Are UTIs Common?

Some experts say that 43% of women between 14 and 61 have had at least one UTI. These infections are more common in women who are sexually active, in women aged 20 to 50, and in those who have diabetes and other conditions that weaken the immune system.

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UTIs occur more frequently in women than in men. They are caused by bacteria normally found in and around the vagina and the lower bowel. In women, the opening to the lower bowel (anus) is very close to the opening of the urethra, the tube that carries urine from the bladder to the outside of the body (Figures 2 and 3). The closeness of these openings makes it relatively easy for bacteria from the vagina and anus to enter the urethra and travel the short distance to the bladder. Bacteria can be pushed into the urethra, for example, by the movement of the penis during sexual intercourse.

Figure 2. Relationship of urethral opening, vaginal opening, and anus.

Figure 3. External genitalia (vulva) and anus.

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Do I Have to See the Doctor?

You should see a doctor to get the right diagnosis and treatment for your condition (See UTI: What to Look For). Several conditions, including sexually transmitted diseases (STDs), have similar symptoms but require different treatments. Your doctor will usually diagnose UTI after asking questions about your symptoms. The doctor may also ask for a urine sample to test for an infection. If you get a positive result on one of the home tests that are available, you should seek medical advice as soon as possible.

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What’s the Treatment?

Your doctor will usually prescribe oral antibiotics for your UTI. In older women, UTIs are more likely to cause kidney infection. Therefore, women over 50 may need to take antibiotics for a longer time, or may need to be given antibiotics by injection.

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Which Antibiotic Is Best for Me?

In general, the best antibiotic for UTI will cure the infection and have few side effects. The decision to prescribe one medication over another is usually made after considering several factors, including antibiotic effectiveness, side effects, cost, and the possibility that the bacteria will resist the medicine. Patients are often involved in their own treatment, so you should discuss the various antibiotics with your doctor and participate in treatment decisions.

Your doctor will probably ask several questions to make certain the selected medication is a good and safe choice for you. Among other things, your doctor will want to know if:

• You are taking oral contraceptives.
• You are trying to get pregnant.
• You are pregnant (or think you are) or breast feeding.
• You are (or think you are) allergic to penicillin, sulfa, or any other drugs.
• You have had side effects after taking antibiotics in the past.
• You have taken antibiotics in the past that have not worked.
• You are currently on another prescription or nonprescription medication.
• You have an existing medical condition (for example, kidney, liver, or lung problems).

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Will I Have Any Side Effects From Treatment?

Like all medications, antibiotics sometimes cause side effects. Most side effects are minor and do not last long. They include nausea, headaches, dizziness, or sensitivity to light. Some patients are also allergic to certain antibiotics and suffer from skin rashes or other allergic reactions. Antibiotics sometimes affect the levels of bacteria normally found in your body, which may result in diarrhea or yeast infections. There are also some other, possibly serious side effects, but they are rare. Ask your physician about these other side effects.

As a partner in your own health care, you should learn to recognize when antibiotics may be associated with side effects and let your doctor or pharmacist know right away. This is especially important if the side effects worry you or last more than a couple of days. Your doctor may then suggest another treatment that may be more appropriate for you. To learn more, you should always discuss your treatment with your doctor and pharmacist and ask for written information about the medicine you are prescribed.

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Do I Have to Take All the Medicine?

Oral (by mouth) antibiotic therapy may be prescribed for up to 2 weeks, depending on the choice of medication. Whatever medication is selected, you must drink a lot of fluids during the time you are taking medications.

Follow the directions on your prescription bottle carefully, since some medications should be taken with food. Be sure to finish all the prescribed medication as instructed, even if you feel better in a couple of days. This is very important. If you stop taking your medicine before the prescription is finished, the bacteria causing the infection may remain, and you risk getting another infection or a more serious infection involving the kidneys.

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What Else Can I Do?

Be sure to take all the prescribed medicine, as directed, and watch for side effects. Call your doctor if you think the medicine isn’t working. Avoid sexual intercourse during treatment and return to the doctor’s office for a follow-up visit to ensure the infection is gone. Antibiotics sometimes affect the levels of bacteria normally found in your body, which may result in yeast infections, so you should ask your doctor what to do to restore this balance.

Along with the oral antibiotic treatment, your doctor may prescribe a pain reliever (analgesic) or a medication to ease the cramps (antispasmodic). Some women use hot water bottles or heating pads to relieve sore areas and the achy, crampy feeling.

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Can UTIs Be Prevented?

The following tips may help prevent UTIs:

• Drink at least 8 glasses of water a day. to flush bacteria from the urinary tract. This is particularly important for women who work outside the home, because they tend to restrict their fluid intake during the day to avoid using public toilets.
• Urinate frequently (every 2 to 3 hours) or as soon as you feel the urge. Don’t hold urine when the bladder is full. Again, this is particularly important for women who work outside the home.
• Avoid wearing tight clothing, which restricts the circulation of air, traps moisture, and promotes bacterial growth. Instead, wear loose clothing and choose underwear with a cotton crotch, which allows air to circulate.
• Practice good hygiene on a daily basis: clean the area around the vagina and anus carefully after urination or a bowel movement. Wipe from front to back to avoid contaminating the urethra with bacteria.
• Consider drinking at least 1 but not more than 2 glasses of cranberry juice cocktail per day. This is especially important for older women. Some specialists say cranberry juice prevents certain common UTI-causing bacteria from attaching to the bladder wall, which is the first step in a UTI.
• If you are menopausal or postmenopausal, you may have thinning vaginal and urethral lining, which increases the risk of bladder infection. You should ask your doctor about treatment for this condition.
• If you are sexually active, take steps to reduce your risk of infection. You and your partner should wash your hands, pubic hair, and external genitalia (Figure 3) before participating in sexual intercourse. Be sure to urinate after sexual intercourse. Women should monitor their sexual positions to see if there is an association between certain positions and the onset of a UTI. Avoid positions or activities that seem to cause UTIs. Spermicidal gels and poorly fitting diaphragms may increase the chances of UTIs. You may want to ask your doctor if another form of birth control is more appropriate for you.

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What to Look For

Women who have UTIs may have some or all of the following:

• Sudden urge to urinate (doctors call this urgency)
• Need to urinate more than usual (frequency)
• Pain, burning, or cramps during or immediately after urination (dysuria)
• Feeling that the bladder won't completely empty
• Urge to urinate during sleeping hours (nocturia)
• Cloudy urine, which may mean the presence of pus (pyuria)
• Blood in the urine (hematuria)
• Lower abdominal cramps, soreness, or pain
• Backache
• Fever
• Loss of bladder control (urinary incontinence) could also be a symptom in older women

You should call your doctor if you have any of the above signs or symptoms.

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Glossary

Acute. Brief, intense, short-term.
Analgesic. A medicine to relieve pain.
Antibiotic. A medicine that kills bacteria or stops bacterial growth.
Antispasmodic. A medicine that prevents or lessens spasms or muscle cramps.
Anus. The opening of the rectum.
Bacteria. Very tiny organisms that sometimes cause disease in humans. Singular: bacterium.
Bladder. A muscular organ that stores urine.
Cystitis. A bladder infection.
Dysuria. Difficulty or pain during urination.
External genitalia. The sex organs that can be seen (vulva in women [Figure 3], penis and scrotum in men).
Hematuria. Blood in the urine.
Hygiene. Cleanliness to promote good health.
Immune system. The mechanism by which the body protects itself against disease.
Infection. Invasion by and multiplication of disease-causing microorganisms (organisms too small to be seen with the naked eye) in body tissue.
Incontinence, urinary. Leakage of urine from the bladder.
Inflammation. A condition of body tissue that involves redness, heat, swelling, and pain.
Kidneys. Two organs that produce urine and cleanse the blood of waste products.
Menopause. The end of menstruation, occurring usually between the ages of 45 and 50.
Menstruation. Monthly flow of blood from the uterus, commonly called the "period."
Mons pubis. A small pad of fatty tissue over the pubic area (Figure 3).
Postmenopausal. Occurring after menopause.
Pus. The fluid produced during inflammation, which can include cells such as bacteria, infection-fighting white blood cells, and waste matter.
Rectum. The last part of the lower bowel.
Recurrence. Reoccurrence or repetition.
Ureter. A long tube that carries urine from a kidney to the bladder.
Urethra. A short tube that carries urine from the bladder to the outside of the body.
Urinary incontinence. See Incontinence, urinary.
Urinary tract. The organ system that eliminates urine from the body; it includes the kidneys, ureter, bladder, and urethra.
Urinate. To pass urine from the body.
Urine. Watery fluid containing waste products secreted by the kidneys.

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