Sepsis and Urinary Tract Infections

Urinary tract infections, or UTIs, are common infections. They more frequently affect people with short urethras, including cisgender women, transgender women who have had vaginoplasty (surgery to create a vagina), and transgender men who have not had phalloplasty (surgery to create a penis). Most often, a UTI is treated quickly and effectively with antibiotics. Unfortunately, not all UTIs are treated quickly and some aren’t even identified, particularly among people who have limited or no sensation below the waist or who are unable to speak for themselves.

Untreated urinary tract infections may spread to the kidney, causing more pain and illness. It can also cause sepsis. The term urosepsis describes sepsis caused by a UTI.

Sepsis, which was often called blood poisoning, is the body’s life-threatening response to infection. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment.

Suggested Citation:
Sepsis Alliance. Sepsis and Urinary Tract Infections. 2023. https://www.sepsis.org/sepsisand/urinary-tract-infections/

Updated November 8, 2023.

 

More About UTIs

Definition

A UTI is an infection in the urinary tract, which runs from your kidneys, through the ureters, the urinary bladder and out through the urethra. The infections are very common and, in general, easy to treat.

A lower UTI, the more common type, affects the lower part of the urinary tract, the urethra and urinary bladder. Infection of the urethra is called urethritis and of the bladder is called cystitis. If the kidney is infected, called pyelonephritis, this is an upper UTI, as the kidney is the highest part of the urinary tract.

A UTI can be caused by bacteria (the most common type of infection) or a fungus.

Causes

The design of the human body makes it so it isn’t hard to get a bacterial UTI, because the infection comes from outside, through the urethra. Bacteria in the genital area can enter the urethra and the urinary tract, either through wiping after going to the bathroom, sexual activity, or unsanitary conditions. Once the bacteria have entered the urethra, the body tries to fight them off, but sometimes the bacteria multiply and cause an infection.

In the case of a fungal infection, usually the fungus gets to the urinary tract through the blood stream. Those who develop this type of infection are usually ill with a disease that has compromised their immune system, such as AIDS.

In general, people with shorter urethras get more UTIs than do cisgender men and transgender men who have had a phalloplasty, surgery to create a penis and lengthen the urethra. This increases with age. Statistics show that those with shorter urethras often get more than one over their life time. Almost 20% who have had one UTI will go on to have a second.

Symptoms

In the early stages of a lower UTI, you may feel:

  • Sudden and extreme urges to void (pass urine)
  • Frequent urges to void
  • Burning, irritation or pain as you void
  • A feeling of not emptying your bladder completely
  • A feeling of pressure in your abdomen or lower back
  • Thick or cloudy urine – it may contain blood

As the infection progresses, you may experience:

  • Fever
  • Pain in the lower flank, part of the back where your kidneys are located
  • Nausea and vomiting
  • Fatigue

Seniors may not show any of these signs or they may be too subtle for someone else to notice. An added symptom among this age group is confusion. Often, if a senior’s behavior changes suddenly, they may have an undiagnosed UTI.

Diagnosis

Most UTIs can be identified by symptoms and confirmed through a urine test.

If your doctor suspects that the infection has spread, you may need additional tests. These could include blood tests, scans of your kidneys, or a pelvic ultrasound.

Treatment

When caught early, it is usually easy to treat a bacterial UTI effectively. After confirming that you do have an infection, you will likely get antibiotics to fight the particular bacteria causing the infection. You also should drink a lot of water, to help flush out the infection.

It is essential that you complete your full prescription, taking all the antibiotics you receive, even if you feel 100% again. Even with the symptoms gone, the bacteria will still be present for a while and you need those antibiotics to finish getting rid of them. If you do not finish your prescription, there is a very good chance that the bacteria left behind will grow again, causing another infection. And, they may become resistant to the antibiotics that you originally used.

To treat a fungal UTI, your doctor would prescribe anti-fungal medications.

Prevention

In many cases, we can prevent urinary tract infections.

  • When cisgender women and transgender women wipe themselves after having a bowel movement, they should wipe from front to back, reducing the chances of stool touching the entrance of the urethra. Caregivers must do the same thing when providing intimate care.
  • After having sex, clean your genital area as the act of sex could push bacteria into the urethra.
  • If someone has a catheter, a tube that drains urine from the bladder, inserting the catheter must be in as sterile or clean an environment as is possible. As well, the urethral area must be kept clean, particularly of stool. Urinary catheters should not stay inserted for longer than necessary.

If you have frequent urinary tract infections, there are some steps you can take to try to reduce the number of infections you get. They include:

  • Drinking plenty of water every day, to help flush out your urinary tract.
  • Eat a healthy diet. Malnutrition, not consuming enough nutrients for your needs, can lower your body’s ability to fight infection.
  • Don’t hold your urine. Empty your bladder as frequently as is realistic and possible.
  • For cisgender women and transgender women, continue the wiping from front to back and cleaning well after sex.
  • Also some cisgender women find that diaphragms increase their number of UTIs, so if you are using a diaphragm, you may want to discuss an alternate method of birth control with your healthcare provider.

Related Resources

Information Guide

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Amy L.

My name is Amy and I’m a survivor of sepsis. In April of 2020 I wasn’t feeling so great. I have frequent UTIs so I chalked the symptoms up to that, got an antibiotic and expected to feel normal within a few days. I didn’t. (Sepsis and Urinary Tract Infections) My symptoms progressively became worse but I muscled through it and lived most days normally. The morning of May 10 ,2020- I awoke with an unquenchable thirst and was totally lethargic. I went to the ED, with a 104 fever and my BP was off of the charts. It was ... Read Full Story

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Karla Peters

My story begins with a UTI in May of 2019. (Sepsis and Urinary Tract Infections) I went to urgent care and was diagnosed with a UTI. I was given antibiotics. On Thursday I felt worse. I wanted to sleep. My youngest son made me go back to urgent care. Urgent care had received results from urine culture. They were trying to get ahold of me with no success. I got to urgent care and I was in septic shock. (Sepsis and Septic Shock) I really think I would have died if I stayed home. I’ll always be grateful for my ... Read Full Story

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Yolanda H.

Back in 2022 I was experiencing pain all over my body I was so sick that I thought I had the flu or even Covid. I went to the doctor. They couldn’t tell me what was wrong went back home and still felt worse. I was feverish hot and cold. My hands were clammy, my speech was slurred, my skin was mottled, my lips were blue. I also had nausea and vomiting and was in a delusional state. I also couldn’t urinate for 24 hrs. I went to the ER and was diagnosed with UTI and sepsis, was given antibiotics ... Read Full Story

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Amanda Nelson

In 2019, I got sepsis through a UTI. I am also diabetic and when I got the UTI, instead of going to the doctor, I decided to wait and see if I could fight the infection myself. (Sepsis and Urinary Tract Infections, Sepsis and Diabetes) I never thought that I could get sepsis. I did not even know what sepsis was until I got it and did not think that I could get it from something as simple as UTI. However I am diabetic and it changes the map of things of things for me. Since having sepsis I have ... Read Full Story

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Barnaby Flower

I developed sepsis and then septic shock in April 2022. I was unaware I had it and been in a bad way for 60 hours without realising I had it. Symptoms included not being able to eat without being sick and not being able to stand up without falling over and slurring. On the 3rd day I decided to have a bath. I then proceed to fall though a bath glass window upon trying to get out the bath and I fell to the floor through the window, suffering 200 cuts. I lost over a pint of blood on my ... Read Full Story

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Other Topics

Urinary Tract Infections (UTI)