Urinary Tract Infection (UTI)
A urinary tract infection (UTI) is characterised by burning on passing urine, the urge to pass urine frequently and pain. Such infections occur when the normally sterile urine becomes infected with bacteria or other microorganisms. The most common bacteria causing a UTI is called E.coli, though other conditions such as Staphylococcus and Chlamydia can also cause infection.
Such bacteria or organisms enter the urethra – the tiny tube that links from the vulva to the bladder – and cause irritation (urethritis). The infection can then spread back to the bladder causing cystitis (inflammation of the bladder).
If a UTI is left untreated the infection can track even further back to the kidneys, via two small tubes called the ureters (one connects between each kidney and the bladder). This kidney infection is called pyelonephritis and can be a serious health problem.
With correct treatment, a urinary tract infection can be cleared quickly – in just one or two days. Even if symptoms are quickly alleviated, always finish any antibiotic course ordered by the doctor to ensure bacteria do not recur in a stronger or different form.
UTIs are much more common in women, than men because their urethra is very close to the vagina and anus so bacteria can spread easily. Women also have a shorter urethra than men which means bacteria can travel to the bladder quicker. Sexual intercourse can also irritate the urethra in a woman and increase the incidence of a UTI, and after the menopause UTIs can also become more common in women because of changes in the urethra, bladder and vagina due to hormonal fluctuations.
In men, UTIs can be indicative of prostrate problems, kidney stones or a sexually transmitted disease (STD), and in the elderly UTIs can cause confusion and falls.
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Signs and symptoms of a UTI
- burning and pain on urination
- an urge to pass urine regularly
- even when you have just passed urine, a feeling you need to urinate again
- passing only small amounts of urine
- tiredness
- the urine may be cloudy and strong smelling, and can have blood in it or
Suppose the infection ascends higher up the urinary tract towards the kidneys (known as pyelonephritis). In that case, you may get pain in one side of your lower back or loin, depending on which ureter or kidney is affected. You will likely feel quite unwell, with fever, chills and possibly vomiting.
Risk Factors for UTIs
Understanding the risk factors for UTIs can help in prevention and early intervention. Common risk factors include:
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Diabetes - High blood sugar can make it easier for bacteria to grow in the urine.
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Immune system disorders - Conditions or medications that suppress the immune system increase the risk of infection.
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Urinary tract abnormalities - Structural issues in the urinary tract can predispose individuals to recurrent infections.
Preventing UTIs
In addition to drinking plenty of water, there are other strategies to help prevent UTIs:
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Proper hygiene. Wipe from front to back to prevent bacteria from spreading from the anus to the urethra.
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Urinate after sex. Helps flush out bacteria that may have entered the urethra during intercourse.
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Avoid irritants. Stay away from products that can irritate the urethra, such as scented soaps or douches.
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Cranberry products. Some people suggest that cranberry juice or supplements might help prevent UTIs by preventing bacteria from adhering to the bladder wall. While there is little evidence that cranberry products can treat a UTI, there are some limited studies that suggest it may better in preventing a UTI.
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Drink plenty of water. Hydration and going to the toilet help flush the urethra and other canals, which can help clear a buildup of bad bacteria that leads to UTIs.
Healthwords pharmacists' top tips
A UTI and its associated symptoms can clear just by drinking plenty of water to help dilute the acidic urine, and also flush out infection from the bladder and urinary tract. Aim to drink about one pint of water (or half a litre) every two hours, taking regular and frequent sips. You can use painkillers if you need to, they may help.
Pharmacist recommended products
UTI Treatment as part of NHS Pharmacy First
Pharmacy First is an initiative in some regions that allows pharmacists to assess and treat certain health conditions, including uncomplicated urinary tract infections (UTIs), directly without needing a prior appointment with a GP. This approach can provide a quicker and more accessible treatment pathway for patients experiencing symptoms of a UTI.
How Pharmacy First Works
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Assessment - When you visit a pharmacy participating in the Pharmacy First scheme with symptoms of a UTI, the pharmacist will conduct an assessment. This typically includes:
- Discussing your symptoms, duration, and any other relevant health information.
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Diagnosis - Based on the assessment and test results, the pharmacist will determine whether you have an uncomplicated UTI. They will also assess if antibiotic treatment is appropriate or if a referral to a GP or other healthcare provider is necessary.
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Treatment - If appropriate, the pharmacist will prescribe antibiotics. Common antibiotics for uncomplicated UTIs include:
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Nitrofurantoin is effective against many strains of E. coli, often used for its efficacy and minimal side effects.
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Trimethoprim is another common choice, particularly for patients who are not pregnant and do not have complicated UTIs.
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Other antibiotics may be used in case of local resistance as well as guildance.
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Advice and Follow-Up - The pharmacist will provide guidance on how to take the medication, potential side effects, and any other self-care measures to manage symptoms. They will also advise you on when to seek further medical help, such as if symptoms persist or worsen.
Benefits and Limitations of Pharmacy First
Quick access to treatment. Reduces wait times compared to seeing a GP, enabling faster relief from symptoms.
Convenience. Offers an easily accessible alternative for individuals who may have difficulty getting a GP appointment.
Expert Guidance. Pharmacists are trained to identify UTIs and recommend appropriate treatment, ensuring quality care.
Pharmacy First services may only be available for uncomplicated UTIs. More severe or complex cases, including those with recurrent infections or symptoms indicating a possible kidney infection, may require a GP consultation or referral to a specialist.
UTI - When should I see my doctor?
If you think you have symptoms of a UTI, you should speak with your doctor or pharmacist. Depending on the severity of the symptoms, you may feel well enough to try some self-treatment, but your doctor may also consider a course of antibiotic tablets are appropriate.
There are certain situations that require a more urgent discussion with your doctor. If you are pregnant, you will need to see your doctor or midwife and any antibiotics will be considered depending on which trimester your pregnancy is in. UTIs are common in pregnancy and can be treated without harming your baby. If left untreated they can cause kidney problems, and increase the risk of preterm labour and infection of the newborn at birth.
If you have symptoms of pyelonephritis with fevers, vomiting, and pain in your loin or back, you should see your doctor urgently, as there's a risk of becoming quite unwell with this, and of damage to the kidneys.
What will my doctor do?
Your doctor will ask about your symptoms and examine you. It's likely they will want to do a urine test in the practice and they may send this off to the lab. Depending on the possible diagnosis, they may order blood tests or imaging (X-ray, ultrasound, CT, MRI scans, or you may be referred to a specialist department. The doctor may also prescribe some medication such as antibiotics to help with your symptoms.
Do I always need antibiotics?
UTIs may need to be treated with antibiotics, although these only help your immune system do its job - your immune system alone can sometimes clear a UTI. Assess how severe your symptoms are and how long they are lasting, and discuss things with your doctor as needs be.
It's rare to clear a pyelonephritis without antibiotics, so if you have symptoms of this, contact your doctor urgently.
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