Question 1

What causes a urinary tract infection?

Accepted Answer

Bacteria that get into the urinary tract — kidneys, ureters, bladder or urethra — and multiply can cause an infection, experts said. Over 400 million cases and 236,790 deaths from UTIs were estimated worldwide in 2019, according to one study published by Frontiers in Public Health in 2022. While both men and women get UTIs, women are 3.6 times more likely to get the infection, the study showed. UTIs are more common in women, partly because the urethra, which carries urine out of the body, is shorter “so bacteria from the outside world may be able to get into the bladder more easily,” said Petar Bajic, center director for men’s health at the Glickman Urological and Kidney Institute in Cleveland. UTIs in women are more common after menopause or in women who had their uterus and ovaries removed because the lack of estrogen in surrounding tissues can change the types of bacteria that may live in that area of the body, he said. UTIs are less common in men but typically are more complicated. “The urethra tube is much longer and it’s external,” said Marisa Clifton, the director of women’s health and an associate professor of urology for the Brady Urological Institute of the Johns Hopkins University School of Medicine. “It’s much more difficult for bacteria to work all the way up to the bladder.” When men get them, there is usually a predisposing factor — the most common being benign prostate enlargement, Bajic said. This makes them more likely to retain urine, which is a risk factor for infections, experts said. Other factors in both men and women may be kidney stones, deposits that form in the kidneys that can get trapped, cause infection and sometimes block the flow of urine, which is a serious complication. The rate of infection increases with age for adolescents and peaks at 35 for both sexes. The number of deaths from UTIs is low, but it significantly increases from 65 to 75 years for both men and women, the study published by Frontiers in Public Health reported. Hospitalization can also lead to a urinary tract infection because patients could be exposed to antibiotic-resistant bacteria. Some patients are given antibiotics that can kill normal bacteria, which allows harmful bacteria to grow, experts said. UTIs should prompt a medical evaluation either by a primary care doctor or urgent care, or a urologist for recurring cases, Bajic said. “UTIs are never something you want to take lightly,” he said.

Question 2

What are the symptoms?

Accepted Answer

The main symptoms of a UTI are painful urination, pain in the lower back or abdomen, new or worsening incontinence, and new or worsening frequency or urgency of urination, experts said. Some people have blood in their urine, which in older adults might be a sign of cancer, said Christine Kistler, an associate professor of geriatrics at the University of Pittsburgh, who has conducted research on UTIs in older adults. Fever can indicate a more systemic infection. Some men report pus coming out of the penis. “Strong or foul-smelling urine is not a symptom although sometimes it is misdiagnosed as such,” Kistler said.

Question 3

How does a UTI become serious?

Accepted Answer

A UTI becomes serious when it travels to the kidneys and the rest of the body, experts said. And if the bacteria causing the infection are resistant to most antibiotics or if it comes from a blood infection known as urosepsis, a UTI can become serious, said Marc Dall’Era, interim chair of urology at the University of California at Davis Health. “This can happen typically if there is some anatomic abnormality such as a kidney stone with some amount of urinary tract obstruction,” he said. Surgery or the insertion of a catheter can also lead to a more serious infection, Dall-Era said. If the infection progresses to urosepsis, it can become life-threatening, he said.

Question 4

Are UTIs more serious in older people?

Accepted Answer

UTIs are more serious in older people, experts said. In older adults, the bladder “can become colonized with bacteria due to changes in the anatomy and physiology over time,” Kistler said. Older adults also tend to have other health issues that could lead to UTIs, Dall’Era said. They tend to have a less robust immune response, experts said. An infection is more likely to spread and can cause sepsis, a more dangerous condition. Also, if they have had surgery or trauma, they will have a harder time fighting infections, said Mitchell R. Humphreys, chair of urology at the Mayo Clinic in Phoenix. “Infections at the time of surgery can be more serious because the body is trying to heal up from surgery and if you get an infection, the body has to split its focus,” he said. UTIs are also serious for anybody who is immune-compromised. “Those are people that might be on medications to suppress their immune systems, such as people with advanced cancers or people that have received transplants,” said Brent Hollenbeck, chair of urology at Massachusetts General Hospital.

Question 5

What are the complications of a UTI?

Accepted Answer

UTIs can spread beyond the initial area of infection leading to other health conditions, experts said. UTIs can cause sepsis, a potentially life-threatening complication. “If there’s a serious enough infection in the urinary tract, it can potentially lead to kidney failure. It can lead to failure of other organs systems,” Bajic said. “It can lead to death.” Particularly in older people, UTIs may also cause confusion or changes in mental status, Bajic said. UTIs have been linked to a risk of delirium and dementia. UTIs also affect quality of life for many people. “When people become sick they are less likely to move around, and they may need rehab. They may not be able to do other things in life that they like to do,” Kistler said. “These are some things that we don’t always address that could become serious complications.”

Question 6

Why do UTIs often happen after a hospital stay?

Accepted Answer

Many patients get urinary tract infections when they are hospitalized. “In healthcare settings, the percentage of patients diagnosed with healthcare-associated UTIs is as high as 9.4 percent,” according to one worldwide study. Many have catheters and “having something put into your bladder from the outside is a big risk factor” for infections, Hollenbeck said. In hospitals, it is harder for patients to do timed toileting. Also, many patients suffer from constipation, “which, if you have stool in your rectum, that allows bacteria to get up to the opening of the bladder,” Kistler said. Others are on medications that may slow the bladder down so it doesn’t empty in a normal way, she said. “In the hospital, patients have some sort of illness and their body reserve may be decreased,” Clifton said.

Question 7

What are the treatments for UTIs?

Accepted Answer

Antibiotics are given to treat UTIs, and they should be taken as directed by your health-care professional, experts said. If you have pain or discomfort, ask your doctor for medications, and hydrate with water or other fluids. UTIs “are generally extremely easy to treat with antibiotics since most antibiotics are concentrated in the urine,” said Robert Schooley, an infectious diseases specialist. “The key is early diagnosis and treatment — and then dealing with any structural problems that might have predisposed the patient to the infection in the first place.” Kistler cautioned, though, many people have bacteria in their bladder that are not harmful and that aren’t UTIs. “You have to be very careful about treating things that are not UTIs because then you might encourage the growth of bad bacteria,” she said. “A UTI needs to be diagnosed before being treated.”

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