If you have pain in the bladder area, 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).
Your GP should work through a recommended scheme of assessment for suspected urinary infection. This will normally include one or all of the following:
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.
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.
The usual tests performed are:
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.
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).
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:
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.
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.
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.