Urinary Tract Infections

Who is at risk of a urinary tract infection?

Urinary tract infections can occur at any age, but they are more common in certain groups.

Urinary Tract Infections in Women

Urinary tract infections (UTIs) are more common in women than in men due to anatomical and hormonal factors. The main reason for this is that the urethra—the tube through which urine passes from the bladder—is shorter in women. This can make it easier for bacteria from the external environment to reach the bladder. Furthermore, the fact that the urethra is anatomically closer to the anus increases the risk of bacteria from the gut entering the urinary tract.

Risk Factors for Urinary Tract Infections in Women

1. Sexual Activity

During sexual intercourse, mechanical contact in the genital area can cause bacteria to be transferred to the urethra. Consequently, infections may be more common, particularly in sexually active women. A new sexual partner, increased frequency of intercourse, or certain methods of contraception (particularly the use of spermicides) can increase the risk.

To protect yourself:

• Urinate after intercourse
• Drinking enough fluids
• Paying attention to genital hygiene
• Avoiding irritating products may be helpful

2. Pregnancy

During pregnancy, urinary flow may slow down due to hormonal changes and pressure on the urinary tract from the growing uterus. An increase in the amount of urine remaining in the bladder can facilitate the growth of bacteria.

UTIs are considered significant during pregnancy because:

• It can progress to a kidney infection
• It may increase the risk of premature birth
• It can cause fever and systemic infection in the expectant mother

For this reason, urine analysis and, where necessary, culture testing are important during antenatal care.

3. Menopause

Following the decline in oestrogen levels after the menopause, the vaginal flora may change and the number of protective bacteria may decrease. As a result, harmful bacteria may multiply more easily.

During the menopausal period, the following may also occur:

• Vaginal dryness
• Urinary incontinence
• Incomplete emptying of the bladder
• Changes in the pelvic floor

Situations such as these can also increase the risk of infection.

4. Inadequate Fluid Intake

If you do not drink enough water during the day, urine output decreases and it becomes more difficult to flush bacteria out of the urinary tract. Frequent urination is a natural protective mechanism that reduces the likelihood of bacteria adhering to the bladder.

In particular:

• Low water intake throughout the day
• The habit of holding in urine for long periods
• Consuming large amounts of coffee or caffeine whilst neglecting to drink water
• Failure to replace fluid loss in hot weather

may facilitate the development of an infection.

5. Additional Risk Factors

In addition to these, the following conditions may also increase the risk of urinary tract infections in women:

• Diabetes
• A habit of holding in urine for long periods
• A history of recurrent UTIs
• Kidney stones or urinary tract obstructions
• Inability to fully empty the bladder
• Constipation
• Diseases affecting the immune system
• Use of a urinary catheter

In women with recurrent urinary tract infections, it is important not only to treat with antibiotics but also to assess the underlying causes, make lifestyle adjustments and, where necessary, plan further urological investigations.

Urinary Tract Infections in Men

Urinary tract infections (UTIs) are less common in men than in women. One of the main reasons for this is that the urethra is longer in men, making it more difficult for bacteria to reach the bladder. However, when a urinary tract infection develops in men—particularly in older men—it should be assessed more carefully as it may be a sign of an underlying urological problem.

Infections in men are not always confined to the bladder; they can also affect the prostate (prostatitis), the bladder or the kidneys. It is particularly important to investigate the cause in cases of recurrent infections.

Risk Factors for Urinary Tract Infections in Men

1. Enlarged Prostate (BPH)

One of the most common causes in older men is benign prostatic hyperplasia (BPH). When the prostate enlarges, it can press on the urethra, preventing the bladder from emptying completely.

Urine remaining in the bladder:

• Creates a suitable environment for bacteria to multiply
• Increases the risk of infection
• May lead to recurrent urinary tract infections

The risk of infection may be particularly heightened if accompanied by the following symptoms:

• Weak urine flow
• Intermittent urination
• Frequent urination at night
• A feeling of incomplete emptying after urination

2. Bladder Emptying Problems

Incomplete bladder emptying is a significant factor in the development of infections in men.

Conditions that may lead to this:

• Prostate-related obstruction
• Weak bladder muscle function
• Neurological disorders (e.g. spinal cord injury or neurogenic bladder)
• Diabetes-related bladder dysfunction
• Previous pelvic surgery

Urine remaining in the bladder for a long time facilitates the colonisation of bacteria and may lead to the infection becoming chronic.

3. Stone Disease

Kidney, ureter or bladder stones can disrupt the flow of urine, thereby increasing the risk of infection. Some stones create a suitable environment for bacteria to adhere to the surface and may cause the infection to recur despite antibiotic treatment.

The following symptoms may be present in the presence of stones:

• Burning sensation when passing urine
• Frequent urination
• Blood in the urine
• Pain in the lower back or groin
• Recurrent episodes of infection

In particular, repeated growth of the same bacterium may warrant assessment for the presence of stones.

4. Use of a catheter

The use of a urinary catheter is one of the strongest risk factors for infection in men. A catheter can facilitate the direct entry of bacteria into the bladder.

The risk is particularly increased in the following situations:

• Long-term catheter use
• Frequent catheter changes
• Hospital admissions
• Inability to empty the bladder regularly

For this reason, a catheter should only be used when necessary and appropriate care must be provided.

5. Other Risk Factors

The following conditions may also increase the likelihood of developing a urinary tract infection in men:

• Advanced age
• Diabetes
• Previous urological procedures
• Urethral stricture
• Conditions in which the immune system is suppressed
• Low fluid intake
• Unprotected sexual contact and certain sexually transmitted infections

In men, particularly in the presence of fever, chills, lower back pain, blood in the urine or recurrent infections, it is important to investigate the underlying cause and carry out a urological assessment rather than simply prescribing antibiotics.

Urinary Tract Infections in Children

Urinary tract infections (UTIs) are one of the most common infections in childhood, and symptoms can differ from those in adults, particularly in younger children. Early diagnosis and appropriate treatment are important because, in some children, recurrent infections can lead to damage to kidney tissue and long-term problems that may affect kidney function.

Symptoms in children may vary depending on age.

Symptoms in Infants and Young Children

In infants in particular, symptoms of infection may not always be related to urination.

The following signs may be observed:

• Unexplained fever
• Irritability and crying spells
• Reduced feeding or loss of appetite
• Vomiting
• Slower weight gain
• Disturbances in sleep patterns
• Foul-smelling urine
• Change in nappy count

In particular, urinary tract infection must always be considered in infants with a fever where no other source of infection can be identified.

Symptoms in Older Children

As children get older, the symptoms become more similar to those seen in adults.

Common complaints:

• A burning sensation or pain when passing urine
• Frequent urination
• Sudden urge to urinate
• Abdominal pain
• Discomfort in the lower abdomen
• Bedwetting or recurrent urinary incontinence
• Unpleasant odour or cloudiness in the urine
• Fever and fatigue

The onset of recurrent urinary incontinence, particularly in a child who had previously gained toilet control, may be an important finding that warrants investigation.

Why the Cause Should Be Investigated in Recurrent Urinary Tract Infections

In children who have had multiple infections, it is important not only to treat the condition but also to investigate the underlying cause.

Conditions to be assessed:

• Congenital structural abnormalities of the urinary tract
• Bladder emptying disorders
• Backflow of urine into the kidney (vesicoureteral reflux)
• Constipation
• Toilet training difficulties
• Inadequate fluid intake
• Bladder and bowel dysfunction

Where deemed necessary:

• Urine analysis
• Urine culture
• Ultrasound scan of the urinary system
• Advanced imaging techniques

may be scheduled.

In children, particularly if they have a high temperature, vomiting, general malaise or a history of recurrent infections, it is important to carry out an assessment without delay to safeguard kidney health.