Urinary tract infections (UTIs) are very common, affecting 50-60% of women at some point in their lifetime (around 150 million people every year worldwide), and can be very unpleasant.
According to the NHS, there are approximately 9 million GP appointments per year for UTI. This suggests that up to 1 in 7 of the UK population require treatment every year. Failure to treat UTIs can lead to serious health complications - in 2019, the NHS spent £434m treating 184,000 emergency hospital admissions for UTI.
What does a UTI feel like?
There are two main areas where you can get a UTI, the lower urinary tract and the upper urinary tract. Lower urinary tract infections tend to form in the urethra and/or bladder.
Some of the most common symptoms of (lower) UTI are1:
- Urinary urgency: Feeling a constantly strong urge to pee
- Urinary frequency: Needing to pee more often than usual
- Pain or a burning feeling when urinating
- Incontinence (leaking urine)
- Blood in the urine / cloudy urine
- Lower stomach / lower back pain
Upper urinary tract infections can happen when an infection spreads from the urethra and/or bladder to the kidneys. (See: Stages of a Urinary Tract Infection)
How do you know if a UTI has spread to your kidneys?2
Symptoms of an upper UTI (kidneys) include:
- Upper back pain
- Nausea / vomiting
- Fever / chills
Infection of the kidneys can be life threatening. If you are experiencing any of these symptoms and feel that you may have a more serious infection, it is important that you seek help from a medical professional straight away.
But why are UTIs so common? And why do I keep getting them?
The main causes of a UTI
Scientific research findings from the last couple of years have suggested that hot weather, bacteria in the gut, and Vitamin D deficiency may be risk factors for UTI:
A study from the US published this year found that when the average temperature of the past week had been 25-30°C, the number of UTIs reported increased by 20-30% compared to when the temperature was 5-7.5°C.3 The reason behind this connection may be dehydration. In hotter weather, it is possible to become dehydrated, which is a major risk factor for UTI.
It is relatively well known that certain hygiene practices can lessen the risk of UTI, such as wiping front to back and peeing after sex. This is because bacteria from your gut can be transferred to your urinary tract, and a recent study confirmed a link between the bacteria present in the gut and the bacteria detected in UTI.4
Another study published in 2020 demonstrated a possible connection between Vitamin D deficiency and UTI, as participants in the study who experienced UTI had considerably lower levels.5 Vitamin D is important for immune function, so without it the body is less equipped to fight a bacterial infection like UTI. In the UK, it is estimated that around 30-40% of the population are Vitamin D deficient (owing to the lack of sunshine!)6, meaning it is especially important to find ways to increase your Vitamin D intake. Sources include oily fish, eggs, and cereals.7
The risk factors for UTI also differ depending on whether you are premenopausal, postmenopausal or pregnant8:
The most frequent causes of UTI in premenopausal women include those related to sexual activity: frequency of sexual activity, use of spermicides (which some condoms contain), and having a new sexual partner. Other common predispositions include a personal or family history of UTIs and blood groups. Genetic influences also mean that some women will have urinary tracts that are more susceptible to colonization by harmful bacteria.
As well as the premenopausal risk factors listed above, lower levels of oestrogen post-menopause mean that not as much “good” bacteria is produced in the body which would normally fight off harmful bacteria. Also, continence issues and pelvic organ prolapse are common post-menopause which can lead to problems with storing urine and emptying the bladder. If the bladder cannot fully empty, harmful bacteria is more likely to set up shop.
UTI during pregnancy
Pregnancy is also linked to issues with storing urine and emptying the bladder, and asymptomatic bacteriuria (the presence of bacteria without UTI symptoms) is very common.
However, it is important to note that (contrary to prior beliefs) urine is not sterile, meaning that healthy bladders are not completely void of bacteria but rather they contain fluctuating levels of different bacterial species.9 Some UTI testing methods (e.g., standard culture) will return a positive result, when in fact the bacteria found by the test is part of the normal microbiome (community of bacterial species) within the bladder. This is important to note because unnecessarily taking antibiotics increases the risk of antibiotic resistance, and in pregnancy increases risk to the foetus.
And there are some medical conditions which can increase the risk of UTI for different reasons10:
Pelvic organ prolapse
Pelvic organ prolapse happens when the bowel, bladder, womb or top of the vagina slip down from their normal position, and is caused by weakening of the pelvic floor muscles due to things like pregnancy, menopause and hysterectomy.10 When these organs descend, it leads to more difficulty emptying the bladder for around 40% of people, increasing the risk of UTI.
Neurogenic bladder is defined as bladder issues (e.g., issues with storing urine, emptying the bladder, bladder overactivity) caused by damage to the brain or spinal cord, or nerve damage, as this type of damage can disrupt signals from the brain to the bladder. Medical conditions which can be associated with neurogenic bladder include spina bifida, multiple sclerosis (MS), Parkinson’s disease, stroke, spinal cord injury and diabetes. With conditions like these, bladder issues are more prevalent, and so UTI is also more prevalent.
Neurogenic bladder, and other bladder conditions, can also require the use of a catheter. Catheterisation increases the risk of UTI as the catheter can carry bacteria, and so it is crucial to maintain good hygiene practices, including both hand and catheter hygiene.
How to treat a urinary tract infection: Can I get antibiotics for a UTI without seeing a doctor?
If you do suspect that you have a UTI, it is important that you do a urine test, which you can do at home with the TestCard UTI test kit (available at TestCard.com). If you test positive, you can use our treatment partner to get your antibiotics delivered to your home.
If your symptoms become more severe or you begin to experience symptoms of a kidney infection (e.g., vomiting, fever, chills), it is important that you seek help from a medical professional straight away.
3Simmering, J. E., Polgreen, L. A., Cavanaugh, J. E., Erickson, B. A., Suneja, M., & Polgreen, P. M. (2021). Warmer weather and the risk of urinary tract infections in women. The Journal of Urology, 205(2), 500-506.
44Magruder, M., Sholi, A. N., Gong, C., Zhang, L., Edusei, E., Huang, J., ... & Lee, J. R. (2019). Gut uropathogen abundance is a risk factor for development of bacteriuria and urinary tract infection. Nature communications, 10(1), 1-9.
5Ali, S. B., Perdawood, D., Abdulrahman, R., Al Farraj, D. A., & Alkubaisi, N. A. (2020). Vitamin D deficiency as a risk factor for urinary tract infection in women at reproductive age. Saudi Journal of Biological Sciences, 27(11), 2942-2947.
6Calame, W., Street, L., & Hulshof, T. (2020). Vitamin D Serum Levels in the UK Population, including a Mathematical Approach to Evaluate the Impact of Vitamin D Fortified Ready-to-Eat Breakfast Cereals: Application of the NDNS Database. Nutrients, 12(6), 1868.
8Storme, O., Tiran Saucedo, J., Garcia-Mora, A., Dehesa-Dávila, M., & Naber, K. G. (2019). Risk factors and predisposing conditions for urinary tract infection. Therapeutic advances in urology, 11, 1756287218814382.
9Hilt, E. E., McKinley, K., Pearce, M. M., Rosenfeld, A. B., Zilliox, M. J., Mueller, E. R., ... & Schreckenberger, P. C. (2014). Urine is not sterile: use of enhanced urine culture techniques to detect resident bacterial flora in the adult female bladder. Journal of clinical microbiology, 52(3), 871-876.