Is It a Urinary Tract Infection (UTI)? What Women Should Know

People usually feel relief when they empty their bladders—unless they have a urinary tract infection (UTI). Instead of comfort, they may experience a burning sensation or other symptoms when they urinate, prompting them to visit the doctor.

A UTI is a bacterial infection that affects the urinary tract. Most are caused by Escherichia coli (E. coli), although other bacteria are sometimes responsible.

UTIs occur when bacteria enter the urinary tract through the urethra, the thin tube that runs from your bladder to the opening where urine exits your body. UTIs may affect the urethra, bladder, kidneys, or ureters, which are thin tubes that connect the kidneys to the bladder.

Urinary tract infections are much more common among women than men. “UTIs tend to increase in frequency when women enter the postmenopausal stage, but it certainly can happen across the lifespan,” says Yale Medicine urogynecologist Leslie Rickey, MD, MPH. “UTIs are impactful on people’s quality of life. They are more than just an annoyance; they can really affect people’s ability to participate in social, work, and travel activities.”

Below, Dr. Rickey shares information on how to know if you have a UTI.

People with UTIs often experience one or more of the following symptoms:

• Pain or burning during urination
• More frequent urination than usual
• Increased feelings of urinary urgency
• Releasing only a small amount of urine, despite a strong urgency
• Discomfort in the lower abdomen
• Sensation of an inability to completely empty the bladder
• Blood in the urine (if you have visible blood in your urine, you should let your doctor know as soon as possible)

It’s important to note that just having bacteria in your urine doesn’t mean you have a UTI. With a few exceptions (noted below), the presence of bacteria doesn’t automatically mean that you need antibiotics.

“If someone has bacteria in their urine and no urinary symptoms, that’s called asymptomatic bacteriuria, and it does not need to be treated in most people,” Dr. Rickey says. “In special circumstances, women may be screened for bacteriuria, such as during pregnancy and prior to undergoing certain urologic procedures.”

Women likely experience UTIs significantly more often than men because of the anatomical differences between males and females.

A female has a short urethra, which starts at the bladder and ends near the vaginal opening, where urine exits the body, so the bacteria don’t have as far to travel to reach the bladder. Also, in women, the opening to the urethra is closer to the rectum, where fecal matter (stool) leaves the body. Bacteria in the anorectal area may enter the urethra, causing infection.

“It’s thought that the rectum—and the stool—is a reservoir for uropathogens, which are bacteria that can cause infections in the urinary tract,” Dr. Rickey says.

Males have a much longer urethra than females. The male urethra runs from the bladder through the length of the penis. For males, the opening to the urethra is at the end of the penis, which isn’t as close to the rectum. This makes it less likely for bacterial contamination from the anorectal area to occur. Men, however, are more likely to get UTIs if they have enlarged prostates. (When a man has an enlarged prostate and has trouble emptying his bladder, bacteria are more likely to build up in the urine. That urine remains for longer periods within the bladder, leading to a urinary tract infection.)

Certain conditions increase the risk of UTIs in females, such as being sexually active (bacteria may be introduced to the vaginal area during sexual activity), using spermicides (which can affect the vaginal biome), or being postmenopausal. “Getting UTIs during menopause probably has to do with changes in the vaginal microbiome associated with changes in estrogen levels,” Dr. Rickey says. “There may be some changes in the bladder lining as well.”

Many people who experience UTI-like symptoms go to their primary care physician or an urgent care facility for care. At the appointment, your doctor should ask you to leave a urine sample.

“Having a urinary tract infection diagnosis requires both symptoms and a positive urine test,” Dr. Rickey says. “Therefore, it’s helpful to have the urine test to determine whether urinary bacteria are causing the symptoms.”

A urine sample is analyzed in a laboratory to determine whether or not you have a urinary tract infection and, if you do, which bacteria are causing it.

Sometimes, doctors will treat a UTI before getting the patient’s urinalysis results back.

“If someone has very clear symptoms of a UTI, and it’s maybe their first one or they get a UTI infrequently, there’s a decent chance their health care provider might just treat them,” Dr. Rickey says. “But if a woman is having frequent or repeated UTI episodes, then a urine specimen should be obtained for testing.” Recurrent UTIs are defined as having more than two infections in six months or more than three infections in a year.

Some people check to see if they have a UTI from the privacy of their own homes, since there are over-the-counter tests to screen for UTIs. At-home tests are used by some patients as a screening tool, but sometimes the results provide false positives or negatives.

“Additional lab testing may be necessary before a provider will prescribe antibiotics,” Dr. Rickey says.

Because UTIs are bacterial infections, they are most often treated with antibiotics.

“Macrobid, bactrim, and fosfomycin are the first-line antibiotics recommended,” Dr. Rickey says. “We’re usually going to start with these, unless a patient has an allergy to the medication or has had a recent UTI that was resistant to these antibiotics.”

Resistant bacteria can create a problem as there are fewer antibiotic options for treatment. “This is one of the reasons why we try to avoid the unnecessary use of antibiotics, because you can create resistant bacteria that have less available treatment options in terms of effective antibiotics,” Dr. Rickey says.

For women getting frequent infections, there are various options for trying to prevent UTIs.

“There are some common nonantibiotic prevention strategies. There is very good evidence of the effectiveness of vaginal estrogen therapy in preventing UTIs and also increasing evidence of how cranberry supplements can help. Another popular option is an over-the-counter [OTC] supplement called D-mannose,” Dr. Rickey says.

Vaginal estrogen therapy includes creams or tablets that are used in the vagina a few times a week, says Dr. Rickey. The vaginal estrogen cream requires a prescription from a medical provider.

Vaginal estrogen likely works by restoring the vaginal pH and microbiome, Dr. Rickey says, while cranberry and D-mannose help prevent certain bacteria, including E. coli bacteria, from attaching to surfaces within the urinary tract. Because most UTIs are caused by E. coli, these supplements may be helpful for controlling UTIs. However, more research is needed to determine the mechanism of action and effectiveness. Because D-mannose is a type of sugar, people with diabetes should not take this supplement unless they talk to their doctor.

If women continue to have recurrent UTIs despite these treatments, they may be prescribed a low-dose antibiotic to take daily in order to reduce the number of UTIs that occur.

Certain habits may help to decrease the risk of getting UTIs. These suggestions may help:

• Stay hydrated. Drink enough water throughout the day; six to eight glasses daily may be effective. “The increased fluid intake recommendation is evidence-based—it has been shown in a study to help reduce UTIs in women getting frequent UTIs,” Dr. Rickey says.
• Go to the bathroom at appropriate intervals. “The act of voiding flushes out the bladder and helps to decrease the risk of bacterial numbers building up,” Dr. Rickey says. A healthy voiding interval is not well defined, but is probably at least every three to four hours, depending on your fluid intake. Holding urine in your bladder for a very long time may increase the risk of a UTI.
• Urinate after having sex. Women who are sexually active are at an increased risk of UTIs, but using the bathroom before and after sex may decrease that risk.
• Take cranberry tablets. This OTC product works by preventing bacteria from sticking to the bladder wall. OTC tablets are better than cranberry-based beverages. “We’ve tried to get people away from drinking the cranberry juice cocktail, which can have a lot of sugar or artificial sweetener and probably doesn’t have the concentration of the active cranberry metabolite,” Dr. Rickey says. Look for a dietary supplement with 36 mg of proanthocyanidins (PACs).
• Practice good hygiene. When using the bathroom, women getting frequent UTIs may want to practice wiping front to back instead of back to front. “I’m not sure there’s a lot of evidence behind that, but I think it may help, and it certainly doesn’t hurt,” Dr. Rickey says.
• See a bladder specialist. If you’re a woman who gets frequent UTIs, your doctor may refer you to a urologist or urogynecologist. It’s uncommon for women to have an anatomic cause for recurrent UTIs, but sometimes additional tests may be helpful. Most importantly, they can work with you to reduce your risk of future UTIs.