What should I do if I think I have a urinary infection?
If you have pain in the bladder area (pictured below), pain when passing urine, a need to urinate frequently or urine that is dark or strong-smelling, especially if you have a fever of 38ºC or more, you should contact your GP for further advice.
These symptoms are all non-specific. They can be caused by many other conditions such as sexually-transmitted infection, vaginal thrush (in women), chemical irritants (soap & deodorants), stones (in the kidney, ureter or bladder), interstitial cystitis, bladder cancer or inflammation in the prostate gland (prostatitis).
It is, therefore, important that you see your GP to arrange appropriate investigations to establish the exact cause of your symptoms. Failure to treat a bladder infection promptly can cause infection to spread to the kidneys. In severe cases, this may result in blood poisoning (septicaemia).
What are the facts about urinary infection?
- Most urine infections are caused by bacteria (such as E coli, pictured above the right-hand links column) which come from your bowel
- In women, the urethra (water pipe) is very close to the anus making it easy for bacteria to reach the bladder and cause infection
- Most women have at least one attack of urinary infection during their lifetime and 20% of women suffer repeated attacks. This is more likely in women who are pregnant, sexually-active or postmenopausal
- Cystitis in men and children is more serious because it is often caused by underlying problems such as an enlarged prostate, prostatitis or inherited abnormalities
- Mild urinary infections usually clear within a few days and may not always require treatment with antibiotics
- Untreated, more severe infections can involve the kidneys and may even spread into the bloodstream
- Recurrent urinary infections in women can often be managed by simple, “self-help” measures
What should I expect when I visit my GP?
Your GP should work through a recommended scheme of assessment for suspected urinary infection. This will normally include one or all of the following:
1. A full history
Your GP will take a full urological history with special attention to previous urinary infections, periods of dehydration, your sexual activity, any intake of acidic or spicy foods and any relevant past medical problems.
2. A physical examination
A general physical examination, including rectal examination (in men) and vaginal examination (in women) will normally be performed. Your blood pressure will be measured as part of this assessment.
3. Additional tests
The usual tests performed are:
a. General blood tests
The actual tests performed will be left to your GP’s discretion. It is usual to measure kidney function and to check the blood cells for anaemia or other problems.
b. Urine Tests
A simple dipstick test of the urine may confirm that an infection. It is likely that urine will also be sent to the laboratory for culture to confirm any infection and to find out which antibiotics need to be used (culture & sensitivity assessment).
c. Other specific tests
If you have any discharge (from the penis or vagina), swabs may be taken for culture.
Your GP may also arrange an ultrasound scan of your kidneys and bladder. This is not needed for a first infection in a woman but is usually performed for:
- recurrent infections in women (more than 3 attacks per year)
- all infections in men
- infections which have spread to the kidneys
- pregnant women
- patients with known neurological problems
- patients with known abnormalities of the urinary tract
- patients taking drugs which suppress the immune syste
If you fall into any of these groups, your GP will then arrange a formal referral to a urologist for further investigation. This may involve examination of the bladder as well as the investigations mentioned above.
What treatments are available for this problem?
Mild urinary infections can sometimes be cured by drinking plenty (6-8 glasses) of water daily and relieving any discomfort with simple painkillers (aspirin, paracetamol). It is, however, best to see your GP for advice especially if this is your first urinary infection.
If your symptoms are clearly caused by sexual intercourse (so-called “honeymoon cystitis”), you should refrain from sex until your infection has cleared completely.
If your symptoms worsen despite these measures, you should contact your GP immediately.
More severe infections usually require treatment with antibiotics. Your GP will normally prescribe an antibiotic (pictured) on a “best guess” policy, taking into account any allergies you may have. The drug given initially may need to be changed. This will depend on the results of laboratory culture and on the sensitivity of any bacteria to the antibiotic already prescribed. Even if no bacteria are grown from your urine sample, there is good evidence that antibiotics can be helpful in curing your symptoms. You will normally be asked to provide a further urine specimen 7-14 days after you have completed your course of antibiotics. This is important to ensure that there is no infection remaining and that any abnormal white cells or red cells in the urine have been eliminated. If they have not, further investigations may be needed to exclude problems such as stones, bladder cancer or tuberculosis.
Surgery is rarely indicated for urinary infection unless there is an underlying causative condition which requires surgical relief.
- In patients (especially children) shown to have reflux of infected urine back from the bladder to the kidneys, surgery may be recommended to stop the reflux.
- In some women after the menopause, ultrasound shows poor bladder emptying with a large residual urine and inspection of the bladder with stretching of the neck of the bladder under a brief general anaesthetic may be helpful. Hormone replacement therapy (HRT) using tablets, creams or pessaries may be prescribed after the procedure, to prevent the problem from recurring.
How can I prevent further attacks of infection?
If you suffer from repeated attacks of urinary infection, especially in women, your GP or urologist may recommend that you take low-dose antibiotics for 3-6 months
As an alternative to long-term antibiotics, you may find it helpful to take cranberry juice or tablets. Cranberry preparations have been shown, scientifically, to reduce recurrent infections. Some patients find tablets more palatable than juice. There are also a number of measures you can do for yourself to prevent further infections.
What causes a urinary infection?
Urinary infection occurs when bacteria enter the the urinary tract via the bladder and multiply to cause an infection. In children, bacteria may move from the bladder to the kidney(s), as a result of ureterovesical reflux.
Is a urinary infection important or serious in children?
- Urinary infections can make children feel very ill with non-specific symptoms such as vomiting, abdominal pain and a high temperature
- Renal scarIf infection enters the kidney(s) by reflux, the infection may cause a scar to form in the kidney(s)
- Scarring of the kidney (pictured) due to infection is permanent. This can cause problems with kidney function and may cause high blood pressure in later life
- Urinary infections in children must be treated without delay to prevent scarring
- Urinary infections may be an indicator of problems (abnormalities) within the urinary tract. These abnormalities may be a risk factor for future problems, including further infections
How will I know if my child has a urinary infection?
Symptoms of urinary infection may vary considerably with age. Infection may occur without the “fishy” smell and burning pain which adults often experience. In babies and young infants, urinary infection often has very non-specific features. If your child has a temperature without any obvious reason (such as a cold or cough), you should try to collect a urine specimen so that infection can be ruled out.
Symptoms in infancy:
- High temperature (fever)
- Poor feeding
- Smelly nappies
- Abdominal pain (“tummy ache”)
Symptoms in childhood:
- High temperature (fever)
- Increased frequency of passing urine
- Vomiting and / or diarrhoea
- Being “off their food”
- Abdominal pain (“tummy ache”)
- Back pain
- Bed wetting (when previously dry)
- Smelly or bloody urine
- Pain when passing urine
How will a urinary infection be confirmed?
A sample of your child’s urine will need to be collected to look for signs of infection & dehydration. How the urine sample is collected will depend on your child’s age and how ill he/she is
The following headings describe the common ways in which urine can be collected from a child:
1. The older child who is toilet trained
a. Mid-stream urine (MSU) collection
- The child’s genitalia are cleaned with warm, soapy water
- The child begins to pass urine into the toilet
- Part way through passing urine, a specimen is collected into a sterile container
- The last part of the urine is then passed into the toilet again
2. The non-toilet trained child
a. “Clean catch collection” (preferred because of the low risk of contamination from skin or bowel motions)
- The child’s genitalia are cleaned with warm, soapy water
- Part way through passing urine, the collection is made in a container held under the child, without touching the child’s skin
b. Urine collection bagUrine collecton bag
- The child’s genitalia are cleaned with warm, soapy water and dried
- A special collection bag is stuck over the child’s urethral opening (“water passage”)
- As soon as urine enters the bag, the bag is promptly removed & the urine transferred into a sterile container
- If the collection is contaminated by bowel motions, the whole process must be started again
3. Very ill children (or those in whom it is difficult to catch a urine sample)
a. Specimen collection from a urinary catheter
- The child’s genitalia are cleaned with saline (salt solution)
- A small catheter is inserted into the bladder, through the urethra, by a doctor or nurse
- A specimen of the drained urine is collected in a sterile container
- The catheter is removed
b. Specimen collection from a suprapubic aspirateSuprapubic aspiration
- The skin in the lower part of the child’s abdomen (“tummy”) is cleaned with an antiseptic solution
- A fine needle is passed through the skin directly into the child’s bladder
- The aspirated urine is placed into a sterile container and the needle is removed
Collecting a urine sample from a child who is not toilet trained can be difficult and frustrating. Whilst using a collection bag may seem simple, this specimen is easily contaminated and the results are not as accurate as midstream or clean catch samples. Your Specialist Nurse, GP or Health Visitor can help you learn more about this.
How will my child’s urine infection be treated?
In babies and infants who are unwell, your doctor will not normally wait for the laboratory results to become available (this can take up to 48 hours) but will start treatment immediately with antibiotics. It may be necessary to change the antibiotic if your child is showing no improvement or if the laboratory results show that a different antibiotic would be better.
To clear the infection, it is very important that your child takes all the antibiotic medicine exactly as prescribed.
In most children, the fact that the child has improved is sufficient to say that the infection has cleared. In a few children (especially those with known abnormalities in the urinary tract), it is important that a further urine sample is collected and sent to the laboratory after the antibiotics have finished. This will confirm that the infection has been completely cleared. In these cases, it is best sent three days after the antibiotic course has been completed. If any traces of infection are found, the infection can come back again.
Will my child need further tests?
In a child over one year of age, additional investigations are not necessary unless the infections keep recurring or the bacteria found are unusual
It is normally recommended that children who have had a urinary infection before their first birthday should have an ultrasound scan of their kidneys, ureters and bladder. This is because a urinary infection can be the first clue to the presence of an underlying physical problem within the urinary tract. If any abnormality on the ultrasound is found, or if the infecting bacteria are unusual in any way, other tests and investigations may be needed
How can my child & I prevent further urinary infections?
- Ensure your child drinks plenty of fluids throughout the day so that he/she actually need to pass urine more frequently and the urine is lighter in colour (more dilute). Drinks should be water or water-based (e.g, squash) rather than tea/coffee/fizzy drinks
- Include a glass of cranberry juice in your child’s diet every day
- Ensure that your child goes to the toilet to empty his/her bladder regularly (e.g. on waking, mid-morning, lunch, mid-afternoon, teatime & before bed)
- Change nappies regularly
- Teach girls to wipe from front to back after passing urine so that germs from the anus do not enter the urethra
- Avoid scented soaps, bubble baths and hair washing with shampoo in the bath
- Encourage your child to wear only cotton underwear
- Ensure your child has a healthy diet
- Bio-yogurt may help by increasing “good bacteria”
- Constipation should be avoided. Ensure that your doctors are aware of any problems with constipation so that it can be treated immediately
- Follow the advice given to you about antibiotic treatment
Your doctors may decide that, to help prevent further infection, your child needs “prophylactic” antibiotics. This is a smaller dose than is used to treat an actual infection. It is intended to prevent infection from becoming established. Prophylactic antibiotics are best taken at bedtime.