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Urinary tract infection

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of urinary tract infections.

Alternative Names

Cystitis; UTI

Symptoms

Symptoms of lower urinary tract infections usually begin suddenly and may include one or more of the following signs:

• The urge to urinate frequently, which may recur immediately after the bladder is emptied.
• A painful burning sensation. (If this is the only symptom, then the infection is most likely urethritis.)
• Discomfort or pressure in the lower abdomen. The abdomen can feel bloated.
• Cramping in the pelvic area or back.
• The urine often has a strong smell, looks cloudy, or contains blood. This is a sign of pyuria , or a high white blood cell count in the urine, and is a very reliable indicator of urinary tract infections.
• Occasionally, fever develops.

Symptoms of Severe Infection in the Kidney (Pyelonephritis)

Symptoms of kidney infections tend to affect the whole body and be more severe than those of cystitis. They may include:

• Symptoms of lower UTIs that persist longer than a week. (Sometimes lower UTI symptoms may be the only signs of kidney infection. People at highest risk for such "silent" upper urinary tract infections include patients with diabetes, impaired immune systems, or a history of relapsing or recurring UTIs.)
• An increased need to urinate at night.
• Chills and persistent fever (typically lasting more than 2 days).
• Pain in the flank (pain that runs along the back at about waist level).
• Vomiting and nausea.

Symptoms of UTIs in Infants and Toddlers

UTIs in infants and preschool children tend to be more serious than those that occur in young women, in part because they are more likely to occur in the kidneys and upper urinary tract. (Older children are more likely to have lower urinary tract infections and standard symptoms.) Infants and young children should always be checked for UTIs if the following symptoms are present:

• A persistent high fever of otherwise unknown cause, particularly if it is accompanied by signs of feeding problems and debility, such as listlessness and fatigue. (Studies have reported that up to 5% of infants and toddlers who are brought to the emergency room with fevers have UTIs. Scarring is a risk so very young children with UTIs need to be screened.)
• Painful, frequent, and foul smelling urine. (Parents are generally unable to identify a UTI just by the smell of their child's urine. Medical tests are needed.)
• Cloudy urine. (If the urine is clear, the child most likely has some other ailment, although it is not absolute proof that the child is UTI-free.)
• Abdominal and low back pain may be present.
• Vomiting and abdominal pain (usually in infants).
• Jaundice (yellowing of the skin and the whites of the eyes) in infants, particularly if it develops after 8 days of age.

Symptoms of UTIs in Elderly Patients

The classic lower UTI symptoms of pain, frequency, or urgency and upper tract symptoms of flank pain, chills, and tenderness may be absent or altered in elderly patients with UTIs. In one study, only 20% of older patients had new urinary complaints, and many have no symptoms at all.

Symptoms of UTIs that may occur in seniors but not in younger adults may include mental changes or confusion, nausea or vomiting, abdominal pain, or cough and shortness of breath. Concomitant illness may further confuse the picture and make diagnosis difficult.

• Review Date: 6/16/2006
• Reviewed By: Harvey Simon, M.D., Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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