Urinary tract infection – more commonly abbreviated as UTI – is an umbrella term for bacterial infections that occur in the lower and/or upper genitourinary tract. This includes the kidneys (where urine is made), the ureters (which carry urine from the kidneys to the bladder), the bladder, and the urethra (where urine exits the bladder). Cystitis refers to inflammation of the bladder, which is most frequently caused by a bacterial infection. You might hear your physician or provider use the term UTI when talking about bacterial cystitis, as these terms are often used interchangeably.
Symptoms of a UTI correlate with where in the urinary tract the infection is located. In a bladder infection (i.e., bacterial cystitis), the most common symptom is pain and/or burning with urination. Women may also experience persistent or frequent urge to urinate, as well as pain and/or pressure in behind or just above the pubic bone. Whereas in a kidney infection i.e, pyelonephritis), common symptoms are lower back and/or flank pain, nausea, vomiting, chills and fevers.
UTIs are usually diagnosed based on a combination of symptoms and urine tests, such as a urinalysis (which gives general results and can be performed quickly) or a urine culture (which gives specific results about the presence and type of bacteria, but takes a few days). However, not all UTIs have accompanying symptoms; these infections are called asymptomatic bacteriuria.
A recurrent UTI is diagnosed by having at least two UTI episodes in six months or three UTI episodes in a year. These UTIs need to be proven with a positive urine culture. A UTI relapse occurs when the same bacteria causes another UTI within two weeks of completing appropriate antibiotic therapy. A UTI recurrence is when another UTI is diagnosed beyond two weeks after the first or with a different type of bacteria.
A bacteria called Escherichia coli, which lives in the intestines and spreads from the rectum to the urinary tract, is responsible for the vast majority community-acquired UTIs. Other culprits include Staphylococcus saprophyticus, Enterococcus, Klebsiella, Enterobacter, and Proteus species are less common causes.7In older women, E. coli accounts for about two-thirds of UTIs. Recurrent UTIs can be caused by the usual UTI culprits, but are more associated with antibiotic-resistant forms of E. coli and non-E. coli organisms.
We know that women who have a history of UTI (especially before the age of 15), women whose mothers’ had a history of UTI, sexually active women (especially premenopausal women), and women with pelvic floor disorders (e.g., urinary incontinence) are all at higher risk of UTI. The age group with the highest rates of UTI are women 18 to 34 years old; these infections are most commonly associated with recent sexual activity. The age group with the second highest rates of UTI are 55 to 66 year olds; these infections are most commonly associated with vaginal atrophy from decreased estrogen. Other risk factors for postmenopausal women include poor bladder emptying, poor perineal hygiene, type 1 diabetes, and pelvic floor disorders (rectocele, cystocele, urethrocele, and uterovaginal prolapse).
The strongest risk factors for recurrent UTI in young women is frequency of sexual intercourse. In postmenopausal women, the strongest factors for recurrent UTI are associated with incontinence, cystocele, and poor bladder emptying.
While there is no research evidence that urinating before/after intercourse, wiping technique, or frequent urination decreases recurrent UTI, these are easy lifestyle changes that may decrease your risk.
When experiencing recurrent dysuria (pain with urination) and/or UTIs, it is important to visit your physician. This is because a urinary sample is needed for a urine culture to determine if and which bacteria type is causing infection, which will guide antibiotic choice for treatment. It is also important that your physician performs a physical exam, which may reveal an underlying cause or potential contributor to your recurrent problem that needs to be fixed to prevent future infections.
ACOG Practice Bulletin #91, Treatment of Urinary Tract Infections in Nonpregnant Women
Publish Date: March 2008
AAFP: Recurrent Urinary Tract Infections in Women: Diagnosis and Management
Publish Date: September 15, 2010