You immediately recognize the dreaded symptoms of a urinary tract infection (UTI) — the burning when you pee, the feeling that you constantly have to go or a feeling that it’s hard to pass urine when you try. And you know what’s next: A visit to your health care provider to get an antibiotic.
But is an antibiotic really always necessary? Can’t you try chugging a few glasses of cranberry juice first?
The short answer: If you’re experiencing classic UTI symptoms, you probably need antibiotics.
“It can be risky not to seek medical care when you have a constellation of UTI symptoms,” says Dan Ilges, Pharm.D., R.Ph., an infectious diseases clinical pharmacy specialist at Mayo Clinic’s campus in Phoenix, Arizona. “Delaying could lead to a more significant, severe infection.”
UTIs typically occur when bacteria — commonly Escherichia coli (E. coli) — get around the urinary system’s natural defenses and enter the urinary tract through the urethra. The urethra is the tube through which urine exits the body. The bacteria multiply and cause inflammation in the bladder (cystitis) or the urethra (urethritis).
UTIs are frustratingly common in women, with over 50% experiencing one or more UTIs in their lifetimes. That’s because the distances from the urethra to the anus — where the bacteria generally reside — and the urethral opening to the bladder are shorter in women compared to men, so the bacteria don’t have to travel far. Sexual activity, use of birth control such as diaphragms and spermicidal agents, and menopause also increase the risk of UTI.
Don’t go it alone
If you’ve had a UTI before, you may be tempted to skip the health care provider visit and deal with symptoms on your own. That’s a bad idea for a few reasons.
- If an infection isn’t treated, it can lead to serious problems. UTIs rarely lead to complications when treated promptly and properly. But an untreated UTI can turn into a kidney infection, which can lead to permanent kidney damage. There is also the risk of sepsis, a potentially life-threatening complication. Pregnant people with a UTI are at an increased risk of delivering low birth weight or premature babies.
- Nonprescription medications address symptoms, not the infection. Dr. Ilges offers a word of caution when using over-the-counter urinary pain relievers, such as phenazopyridine (AZO Urinary Pain Relief), and other products labeled “urinary pain relief.” “What they will do is relieve some symptoms, but they won’t treat the actual infection. And then you have a situation where there’s a festering infection that can progress and cause kidney infections or bloodstream infections,” he says. So, while these medications can help provide relief, they should only be used in conjunction with antibiotics and on the advice of your health care provider.
- You might not have a UTI at all. Along with burning during urination and a persistent urge to pee, symptoms of a UTI include pelvic pressure, lower abdomen discomfort, passing small amounts of urine, cloudy urine, blood in urine, strong-smelling urine and discharge. But some of these symptoms may be caused by other conditions, so getting a formal UTI diagnosis from your health care provider is essential.
- Cranberry juice won’t cut it. Cranberry juice can’t treat an infection. It may possibly help prevent UTIs, but even that is not conclusive.
- Taking antibiotics you have at home might make things worse. Not all antibiotics are appropriate for treating UTI, so if you have some in your medicine cabinet already, fight the urge to start them right away. Taking these can reduce the effectiveness of testing for UTI and also potentially lead to antibiotic resistance, meaning the bacteria in your system become hard to treat. (While we’re talking about this, why are there antibiotics in your medicine cabinet? Make sure to take the full course of antibiotics when they are prescribed — and discard any extras if your health care team tells you to stop before you’ve taken the whole course.)
No symptoms, no antibiotics
What if you get a urine test for another reason, and the test finds bacteria in your urine — do you need antibiotics then?
Generally no, says Dr. Ilges. Some bacteria in the urine don’t trigger symptoms. This is called asymptomatic bacteriuria (ASB). It’s a normal occurrence, and it’s more common with increasing age and certain medical conditions, such as diabetes, Dr. Ilges says.
“This is especially true in postmenopausal women when there are changes to the bacteria that live in the vagina (vaginal flora) because of pH changes and estrogen level changes,” he says. “These women are much more likely to have ASB, which usually shouldn’t be treated with antibiotics.”
However, there are a few exceptions. ASB may need to be treated in pregnant people, people with a recent kidney transplant, and those who are about to undergo urologic procedures, such as an operation to remove kidney stones (uteroscopy).
When things don’t improve
UTI symptoms are often pretty clear-cut, so a health care provider may prescribe an antibiotic before getting urine test results or may not even order urine tests. Sometimes, however, the infections don’t improve with treatment or recur frequently.
“If there’s no relief from symptoms by the end of day two or the symptoms keep coming back, a health care provider will start thinking that perhaps this isn’t a UTI or is a resistant organism,” Dr. Ilges says.
That’s where urine cultures come in handy. Urine cultures can identify specific bacteria causing the symptoms. Knowing which bacteria are causing the infection can help providers find the best antibiotic to treat it.
If you have UTIs that keep coming back, there may be additional treatment options for you. For example, the medicine methenamine may work, Dr. Ilges says. This medicine turns into formaldehyde in the urine and kills the bacteria, essentially helping to keep the urine sterile. In individuals with frequent UTIs closely linked to sexual intercourse, a low-dose antibiotic taken after sex may effectively keep infections at bay.
Dr. Ilges says it’s also important to ensure there aren’t other factors contributing to recurrent infections, such as hygiene issues. This includes wiping back to front instead of front to back and not emptying the bladder after sex. In addition, your provider may refer you to a specialist to rule out other conditions that cause UTI symptoms, such as a chronic bladder pain condition (interstitial cystitis).
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