Patients often come into the urgent care after trying to treat themselves at home for a urinary tract infection (UTI).  Determining if you are having the symptoms of a UTI yourself at home can be confusing and quite challenging.  If the wrong decision is made, and you are not treated appropriately and within the correct time period, complications can result such as progression of the UTI to kidney infection (pyelonephritis) and even to urosepsis which is when bacteria can enter your bloodstream and cause you to become very sick. Bladder infection (also known as cystitis, or UTI) is inflammation of the bladder.  They are common in women, but are very rare in men.  About 20% of all women get at least one bladder infection at some point in their lives.  A man’s chances of getting a UTI increases as he ages due to an increase in prostate size. In elderly patients, bladder infections can be particularly difficult to diagnose.  The symptoms are less specific (such as urinary incontinence or fatigue) and are frequently blamed on aging. Symptoms of bladder infection:  For some patients some or all of these symptoms may be present, and for others, none of these symptoms are present and they still have a UTI.  Symptoms can include urgent need to urinate on a frequent basis, painful urination, burning sensation with urinating, urinary incontinence (uncontrollable loss of urine), low back pain, pain above pubic bone, cloudy colored urine, bloody urine. Causes of bladder infection:  Most are caused by a bacteria called E. coli which usually lives in the intestines.  Women sometimes get bladder infections after sex.  Vaginal intercourse makes it easier for bacteria to reach the bladder through the urethra.  Some women contract the infection – dubbed “honeymoon cystitis” almost always after having sex.  Pregnant women are also more prone to infection due to the bladder being compressed by the growing fetus.  Children who get urinary tract infections should be evaluated for urinary reflux (vesicoureteral reflux or VUR). The bacteria then multiply in the bladder and cause inflammation in the walls of the bladder that may lead to the symptoms described above.  In men, a UTI may be a sign of an obstruction in the urinary tract  which may need investigation. Symptoms of kidney infection (aka pyelonephritis):  Fever, flank pain, nausea, along with the symptoms of UTI. Vesicoureteral reflux (VUR):  In normal kidney-bladder function, urine flows from the kidneys to the bladder.  In children with VUR, the urine also flows backwards, from the bladder up toward the kidneys.  As a result, children with CUR are at risk for kidney infections and may develop kidney damage.  VUR affects about 1 percent of children.  Many children will grow out of their VUR as they get older.  To determine whether your child has VUR, you should ask your doctor.  Testing such as kidney ultrasound other radiological tests may be ordered to evaluate for VUR. Common questions that I get asked: What’s the difference between over the counter AZO and Pyridium that is prescribed by your doctor?  Both contain phenazopyridine, however the prescription comes in a higher strength that is more than double the concentration of the active ingredient. Can taking cranberry juice or extract cure my UTI?  No.  Cranberry has not been shown effective as a treatment for a documented UTI.   There is some human evidence supporting the use of cranberry juice and supplements to PREVENT a UTI, although most available studies are of such poor quality that no clear dosing guidelines are available. Can I get pregnant while taking antibiotics for a UTI?  Yes, many antibiotics interfere with hormone birth control pills or medication.  You should use a backup form of birth control if you are taking antibiotics.   I hope that you have found this information useful.  Wishing you the best of health,

When a UTI needs to be seen in person

Most uncomplicated bladder infections in an otherwise healthy woman can be handled without a culture. Some cannot, and those are worth naming, because this is where I draw the line in my own practice.

If you were treated for a UTI within the last 30 days and the same symptoms are back, you need to be seen in person and you need a urine culture. Another round of the same antibiotic is the wrong move. Recurrence that fast suggests either that the original organism was resistant to what you were given, or that it was never fully cleared. A culture tells you which antibiotic will actually work. Guessing a second time costs another week and gives the infection more room to move upward.

If you are 60 or older, get seen in person for urine testing and a culture rather than treated over video. Complicated urinary infection is more common in that group, the presentation is less typical, and the cost of getting it wrong is higher.

If you are male and having urinary symptoms, I will not treat you for a UTI over video. Two reasons. Bladder infection is genuinely uncommon in men, so when it does happen the organism is more often one that first-line antibiotics miss. The larger reason is that the symptoms overlap almost entirely with things that are not bladder infections at all. Prostatitis presents this way. So do several sexually transmitted infections. Treating that blind with a UTI antibiotic leaves the real problem untreated, and in the case of an STI, still transmissible.

A first-ever episode gets seen in person too. If you have never had a UTI before, nobody has yet confirmed that this is what it is. The first one is the one worth getting right.

And any girl under 14 goes in person rather than being treated remotely. Urinary infection in a child is not a smaller version of the adult problem. As noted above, it raises the question of vesicoureteral reflux, and that needs an examination and usually further testing.

I practice entirely by video, and those are the situations where I stop and send someone out instead of prescribing. It is not caution for its own sake. A culture is the only thing that tells you what you are actually treating, and no camera produces one.

Related Reading

Kidney Stones: Pain That Can Rival Childbirth, Explained Erectile Dysfunction and Other Sexual Problems in Men Low T Explained: What Is Testosterone Deficiency Exactly? Vaginal Dryness After Menopause: Why It Doesn’t Go Away

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.