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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Michael Maynard

My husband had several UTIs in a short time amount of time. (Sepsis and Urinary Tract Infections) At his last urgent care, the doctor told him he has feces in his urine and to make an appointment with a urologist, so we did. But on 1/02/23 my husband woke up shaking uncontrollably and had a fever of 103.3. I took him back to the urgent care where they took his BP, which was 85/60. The nurse told me to take him to the ER immediately. When we arrived at the ER, they took him back right away. They did all ... Read Full Story

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Jennifer I

I gave birth on 3/17/20. I was released after 4 days. The next day of being home, I started to feel ill. (Sepsis and Pregnancy & Childbirth) Heart racing, dizzy, chills. My OB recommended I wait it out due to the Covid situation in the hospitals. The next day, I was much worse. Couldn’t speak or barely breathe. Felt like I had pins and needles all over my body. My husband called 911. I was rushed to the hospital and diagnosed with severe sepsis from a UTI. (Sepsis and Urinary Tract Infections) I was on infusion antibiotics for 14 days ... Read Full Story

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Donna Swain

Unfortunately, I am all too familiar with sepsis. I am very prone to UTIs, but it is rare that I recognize that I have one because I get no symptoms, until it’s too late! (Sepsis and Urinary Tract Infections) Without the usual symptoms of a UTI, the infection gets out of control and I quickly becomes septic. I must be very careful with this because in 2015, I had a liver transplant (unrelated to my UTIs or sepsis). (Sepsis and Organ Transplants, Sepsis and Impaired Immune System) Unfortunately, when I become septic, I get very confused, disoriented, and unable to ... Read Full Story

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Sarah S.

At 37 1/2 weeks pregnant, I had my 2nd son by C-Section. It was unplanned, but necessary as I had low fluid levels and baby was “not in distress, but not thriving”. I had my 1st via C-sec also, so I knew what to expect. Everything was uneventful, and we both went home healthy 2 days later. (Sepsis and Pregnancy & Childbirth) Two days after being home, I developed a slight fever. I wasn’t very concerned and thought maybe I had overdone it that day and it was my body’s way of telling me to take it easy. In the ... Read Full Story

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Carol Mulkern

I had been feeling a bit “run down” as my Mom had just died. Two weeks later I went to an urgent care facility as I had pain when I urinated. I was prescribed antibiotics but they didn’t seem to work after 7 days. I reluctantly agreed to go to the local ED as my daughter thought I seemed “off”. The previous evening I had had the cold sweats as I was literally shivering out loud. (Sepsis and Urinary Tract Infections) Upon my arrival to the ED, vitals, medical history, urine spec, and chest X-ray were done. While waiting for ... Read Full Story

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Other Topics

Urinary Tract Infections (UTI)