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

UTIs

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Betty Lott

It was six years ago in March 2018, at the age of 67, that I went into septic shock. (Sepsis and Septic Shock) I had been having multiple UTIs and going to the walk-in one time, my primary gynecologist, etc. So, I guess no one was really keeping track of the number of episodes. (Sepsis and Urinary Tract Infections) I was at at my granddaughters’ flag football game and was not feeling well. I thought maybe I had a kidney stone or infection but just did not feel well in general. I was in touch with a nurse friend and ... Read Full Story

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Diana L.

It started with a urinary tract infection I did not even know I had. (Sepsis and Urinary Tract Infections) That weekend, I lost my appetite and was extremely tired. I went to urgent care the next day, where I was given antibiotics for the UTI. The day after, I felt worse, and went to the ER, where I was given a blood transfusion, along with other medications. I was asked if I wanted to admit to the hospital, and I though the medication would work, so I went home. After 2 days, I woke up one morning and was very ... Read Full Story

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Gary Wozniak

My dad struggled with many health issues including an autoimmune disease and heart issues for most of his adult life. He had a UTI that went bad and he was rushed to the hospital. (Sepsis and Autoimmune Diseases, Sepsis and Urinary Tract Infections) He started to show signs of getting better but in the end he lost his fight with sepsis. There’s no one way to describe my dad. He was a pastor, professor and friend to just about everyone. We were able to make sure he was comfortable and not alone. I held his hand as he left this ... Read Full Story

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Sarah Cowles

Sarah started her February 16, Friday morning babysitting her youngest grandson for a few hours while my sister had to work. She noticed her stomach was upset a little bit throughout the day. She was familiar with stomach issues and took medication to help with nausea. She was living with diabetes, kidney disease, a blood clotting disorder, and more. She managed well for a 58-year-old woman and joked about her owning her own pharmacy. That afternoon, we decided  to order a pizza since there was a snow storm. By 7pm when it arrived, she suddenly started to vomit very harshly ... Read Full Story

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Monica Wirick

My beautiful mother passed away on 6/15/24 due to complications from sepsis. She fought a 5 year battle of 3 different leukemias and brain tumors. She had a really bad UTI and leg infection which led to her being septic. We need to make a change for cancer patients with sepsis. My mom was the most loving mother who would’ve done anything for her children. Unfortunately these diseases took her too soon but now I have the strength to advocate for her.  (Sepsis and Urinary Tract Infections, Sepsis and Cancer) Read Full Story

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Other Topics

Urinary Tract Infections (UTI)