Lower urinary tract infections (UTI)
A lower UTI is an infection of your bladder or urethra. Find out about the symptoms, causes and treatment options, including for older people.
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Book an appointment onlineWhat is a lower urinary tract infection?
A lower urinary tract infection (UTI) is an infection of your bladder (cystitis) or urethra (urethritis), the tube that carries urine out of your body. It's usually caused by bacteria and is one of the most common bacterial infections, especially in women.
What are the symptoms of a lower UTI?
Common symptoms of a lower UTI include:
- pain or a burning sensation when you pee
- needing to pee more often than usual, during the day and night
- a sudden or urgent need to pee
- pain in your lower tummy
- urine that looks cloudy, or smells strong.
Older people are more likely to get lower UTIs than upper UTIs, and confusion, agitation or restlessness are often the first sign, rather than the more typical symptoms above. A UTI can also disrupt your sleep, making the following day harder to cope with.
What causes a lower UTI, and who is at risk?
Most UTIs happen when bacteria, often from your bowel, get into your urinary tract through the urethra. Around 1 in 2 women will have a UTI at some point in their life, compared with around 1 in 8 men (12%), since a woman's shorter urethra makes it easier for bacteria to reach the bladder.
Things that increase your risk of a UTI include:
- having sex
- being pregnant
- being peri- or post-menopausal
- a blockage in your urinary tract, such as a kidney stone
- conditions that make it hard to fully empty your bladder, such as an enlarged prostate in men, or fibroids in women
- having diabetes
- using a catheter.
UTIs are very uncommon in healthy young and middle-aged men, and rarely develop in men under 50. Around 1 in 10 girls and 1 in 30 boys will have had a UTI by the age of 16.
Are there different types of UTI?
Yes. UTIs can be classified by where they occur:
- Lower UTIs: These affect your bladder or urethra and are the most common type
- Upper UTIs: These affect your kidneys or the tubes connecting them to your bladder (ureters), can affect people of all ages and are more serious.
Doctors also describe UTIs as:
- Simple: These just affect the bladder
- Complicated: These are infections that are resistant to treatment, or that involve the kidneys.
How is a lower UTI diagnosed?
A UTI is usually diagnosed from your symptoms and a urine sample, which is tested for white blood cells (leukocytes), red blood cells and bacteria.
If you keep getting UTIs, your doctor may want to identify the specific bacteria involved, or investigate whether a structural or functional problem in your urinary tract is contributing.
Further tests, if needed, may include:
- an ultrasound, CT or MRI scan
- a test to see how well your bladder stores and releases urine (urodynamics)
- a cystoscopy, where a thin camera is used to look inside your bladder and urethra.
How is a lower UTI treated?
Most lower UTIs are treated with a short course of antibiotics, alongside things you can do yourself to help you feel better.
Non-surgical treatment
Most women are given a three-day course of antibiotics. Men, pregnant women, and people with more serious symptoms may need a slightly longer course. If you're prescribed antibiotics, it's important to finish the full course, even if you feel better quickly, to fully clear the infection and reduce the risk of it becoming resistant to treatment.
If an infection is severe, particularly if it has reached your kidneys, you may need to be admitted to hospital for fluids and medicine given through a drip.
Self-care
Here are some things you can do to help ease the symptoms:
- rest
- drink enough fluid so your urine is pale and you're peeing regularly
- avoid sex until you feel better
- take a suitable painkiller, such as paracetamol
- see a pharmacist who can advise on over-the-counter treatments, such as potassium citrate, to help ease symptoms, and can tell you if you need to see a doctor.
There is no evidence that cranberry products or urine alkalinising agents treat a lower UTI.
When should I see a doctor?
Seek medical advice if:
- your symptoms are severe or getting worse
- you don't improve after a couple of days
- it's the first time you've had these symptoms
- you're pregnant, or you're male
- you're worried for any reason.
Get medical advice straight away if you or someone you're caring for develops sudden confusion, a fever, shivering, pain in the back or sides, or nausea or vomiting, as these can be signs of a more serious kidney infection.
FAQs
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Can a UTI cause confusion in older people?
Yes. In older people, especially those with dementia, sudden confusion or a change in behaviour can be an early sign of a UTI, sometimes appearing before, or instead of, the more typical symptoms like pain when peeing. However, confusion alone doesn't confirm a UTI, since dehydration, medication changes or other infections can cause similar signs, so a urine test and clinical assessment are needed to check.
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Can I get treatment for a UTI without seeing a GP?
Often, yes. In many parts of the UK, pharmacists can assess and treat uncomplicated UTIs, including prescribing antibiotics where appropriate, without a GP appointment. This can mean faster access to treatment, though you may still need to see a GP if your symptoms are more complex or don't improve.
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Are there things I can do to help prevent UTIs?
Yes. Drinking plenty of water, peeing regularly rather than holding it in, keeping the genital area clean, wiping from front to back, and peeing before and after sex can all help. Avoiding scented soaps and tight synthetic underwear may also help. If you're past menopause, ask your GP about vaginal oestrogen cream, which can reduce your risk.
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Is a UTI the same as a sexually transmitted infection?
No. While sexual activity can increase your risk of a UTI, a UTI itself is not a sexually transmitted infection.
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Why do I keep getting UTIs?
Recurrent UTIs, usually meaning two or more in six months, are more likely if you've had a UTI before, especially one before the age of 16, if a close family member has recurrent UTIs, if you use spermicide, or if you don't fully empty your bladder when you pee. Your doctor can discuss preventive treatment options with you if this affects you.
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How can I tell if a UTI has spread to my kidneys?
A kidney infection tends to cause the same symptoms as a lower UTI, plus a fever, chills or shivering, pain in your back or sides, and nausea or vomiting. This is more serious and needs urgent medical attention, so contact a doctor straight away if you notice these symptoms.