Urinary Tract Infections

Urinary tract infections, or UTIs, are common infections that more frequently affect people with short urethras, cisgender women and transgender women who have had vaginoplasty, surgery to create a vagina. Most often, UTIs are 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.

Sometimes incorrectly called blood poisoning, sepsis is the body’s life-threatening response to infection or injury. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment. People shouldn’t die from a UTI, but if sepsis begins to take over and develops to severe sepsis and then to septic shock, this is exactly what can happen. UTIs cause more than half the cases of urosepsis among older adults.

Sepsis and septic shock can result from an infection anywhere in the body, such as pneumonia, influenza, or urinary tract infections. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment. Worldwide, one-third of people who develop sepsis die. Many who do survive are left with life-changing effects, such as post-traumatic stress disorder (PTSD), chronic pain and fatigue, organ dysfunction (organs don’t work properly) and/or amputations.

What is a urinary tract infection?

A urinary tract infection is an infection in the urinary tract, which runs from your kidneys, through the ureters, the urinary bladder and out through the urethra. UTIs 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.

How do you get urinary tract infections?

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 because wiping after going to the bathroom, sexual activity, or unsanitary conditions. Once the bacteria have entered the urethra, the body tries 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.

Treatment

When caught early, it is usually quite easy to treat a bacterial UTI effectively. After confirming that you do have an infection (usually through a simple examination of a urine sample), 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.

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

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.
  • 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.

The information here is also available as a Sepsis Information Guide, which is a downloadable format for easier printing.

Would you like to share your story about sepsis or read about others who have had sepsis? Please visit Faces of Sepsis, where you will find hundreds of stories from survivors and tributes to those who died from sepsis.

If you suspect sepsis, call 9-1-1 or go to a hospital and tell your medical professional, “I AM CONCERNED ABOUT SEPSIS.” 

Suggested Citation: Sepsis Alliance. Sepsis and Urinary Tract Infections. 2022. https://www.sepsis.org/sepsisand/urinary-tract-infections/

Updated June 6, 2022.

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Urinary Tract Infections

Urinary tract infections, or UTIs, are common infections that more frequently affect people with short urethras, cisgender women and transgender women who have had vaginoplasty, surgery to create a vagina. Most often, UTIs are 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.