Urinary tract infection (UTI) in men – do you know the signs?

What is a UTI?

Your bladder is usually a sterile environment that cleans itself regularly when you pass urine. This mechanism helps to prevent bacteria from causing an infection, as does your immune system, but bugs can still get a foothold sometimes. Urinary tract infections (UTIs) occur when bacteria enter your bladder from outside, by passing up your urethra (waterpipe), and begin to multiply within the urine.

When the infection affects your bladder and urethra, it is referred to as a lower UTI or cystitis. Sometimes the infection may travel up to reach one or both of your kidneys and develop into an upper UTI, also known as pyelonephritis. Pyelonephritis is more serious as it can cause damage to your kidneys. UTIs are less common in men than in women, as men have a longer urethra that makes the passage of bacteria into the bladder more difficult. They are also rare in men under the age of 50.

 What causes a UTI?

The most common bacteria that causes UTIs is called E. coli. It is an organism that usually lives in your own bowel without causing any harm. However, these bacteria often remain present around the anus after passing stool and they can travel to your bladder. Risk factors that increase the likelihood of getting a UTI include:

• Sexual intercourse – this introduces more bacteria into the urethra
• Not passing urine often – meaning that bacteria are not flushed out regularly
• Not emptying your bladder fully – similarly, when a small amount of urine remains it provides an opportunity for bacteria to grow
• Having an enlarged prostate gland – this can obstruct urinary flow and lead to a build-up of static urine in your bladder
• Urinary catheters – bacteria can grow on the surface of catheters
• Kidney stones – these can become lodged anywhere along your waterpipes and block the flow of urine
• Misshapen kidneys – this can also lead to a build-up of urine

These all provide an opportunity for bacteria to grow and multiply. If you have a condition that disturbs the function of your immune system this will also place you at greater risk of developing an infection as your body is less able to tackle invading bugs.

What are the signs of a UTI?

It is possible that you are suffering from a lower UTI if you experience some of the following symptoms:

• Passing urine more frequently or more urgently
• A burning sensation when urinating
• Unusually smelly urine
• Blood in your urine
• Pain in your lower tummy or pelvis

An upper UTI may additionally cause a fever, shaking and chills, pain in your loin (the area over your kidney), and feeling sick or generally unwell.

I think I might have a UTI – how is it diagnosed?

If you suspect that you have a UTI, speak to your doctor immediately. They will ask you some questions about your symptoms and will likely ask for a sample of urine to test for signs of infection with a simple ‘dipstick’ test. This quick test detects the chemical signature of a bacterial infection in your urine and you will know the results straight away.

Further testing is usually recommended in men, especially if you have had recurrent UTIs or an infection that has lasted for a long time. This may involve sending a urine sample to a laboratory for a ‘culture’. In this case, any bacteria present in the urine are grown so they can be analysed, allowing the specific bacteria to be identified. This information helps to target your treatment more precisely. However, it will take a few days for the results of a urine culture to be available.

If an upper UTI is suspected, ultrasound scans or X-rays of your kidneys, bladder and the connecting tubes (ureters) may be recommended to look for kidney stones or misshapen kidneys. If a kidney abnormality is found, it may be investigated further with CT scans.

How can UTIs be treated and prevented?

The initial treatments for UTIs include simple measures such as increasing your fluid intake to help flush out bacteria, taking painkillers, and using agents that neutralise the acidity of your urine to reduce the burning sensation, such as bicarbonate of soda.²

If antibiotics are required, a short course of treatment is usually effective at clearing up the infection and your symptoms should resolve within 5 days. If you have had a urine culture performed, the antibiotics will be tailored to fight the particular type of bacteria that has been identified. Upper UTIs usually require antibiotics for a longer period of time as the infection is often more serious.

Lifestyle measures are often effective at preventing UTIs occurring in the future. These are especially important if you are found to be at greater risk of UTIs due to abnormal kidneys, an enlarged prostate, or a poorly functioning immune system. These preventative measures include:

• Drinking enough fluid to make you urinate frequently
• Passing urine soon after sexual intercourse
• Avoiding strong soaps when you have a bath
• Taking regular Vitamin C to make your urine more acidic – this helps to prevent bacteria growth
• Eating plenty of fibre and taking other steps to avoid constipation

Summary

UTIs are a common problem in women, but they can also affect men. Urinary infections are more likely if you have a poor immune system, abnormally functioning kidneys, or if you do not drink enough fluids to make you urinate frequently throughout the day. The signs include burning when passing urine, needing to pass urine frequently and urgently, and smelly urine. If you suspect a UTI, speak to your doctor for advice. They will be able to assist in diagnosis and provide antibiotic treatment if necessary. Following this, your UTI should clear up within a few days. Further investigations are usually warranted in men with UTIs, and this may involve scans of your kidneys, ureters and bladder. You can help to prevent further UTIs by managing the risk factors, and ensuring you drink plenty of fluids.