Urinary Tract Infections

Urinary tract infections (UTIs) are bacterial infections of the bladder, urethra, or kidneys. They are very common — especially in women — and usually straightforward to treat. Two India-specific points matter: untreated or under-treated UTIs can spread to the kidneys, and antibiotic resistance is rising rapidly, partly from over-the-counter antibiotic sales.

Typical symptoms

• Lower UTI (bladder/urethra): burning while passing urine, urgency, frequency, feeling of incomplete emptying, bad-smelling or cloudy urine, sometimes blood in urine, low abdominal discomfort.
• Upper UTI (kidney — pyelonephritis): high fever, chills, flank/loin pain, nausea/vomiting, often with lower UTI symptoms.
• Older adults and diabetics may present atypically — only with confusion, tiredness, or worsening sugars.
• Infants: fever, poor feeding, irritability, foul-smelling urine.

Common risk factors

• Female anatomy (short urethra) — women > men.
• Sexual activity, menopause, pregnancy.
• Urinary catheters, diabetes, pelvic organ prolapse.
• Kidney stones, enlarged prostate.
• Dehydration, holding urine for long periods.

Diagnosis

• Urine routine + microscopy shows pus cells and sometimes bacteria.
• Urine culture + sensitivity — guides antibiotic choice, especially for recurrent UTIs, men, pregnancy, pyelonephritis, or resistant infection. *Ideally get the culture before starting antibiotics*.
• Imaging (ultrasound) for recurrent UTIs, pyelonephritis, children, men — look for stones, obstruction, or structural issues.

Treatment

• Lower UTI in a healthy non-pregnant woman: a short course of oral antibiotics — typical 3–5 days, choice guided by local resistance patterns.
• Upper UTI: longer course, sometimes IV, sometimes hospital.
• Drink plenty of water; paracetamol-class for pain/fever; urinary alkalinisers help the burning.
• Don't self-start leftover antibiotics — wrong drug or too short a course contributes to resistance and masks relapse.
• Cranberry juice/extracts have limited evidence and are not a substitute for antibiotics.
• Recurrent UTIs (3+ a year): low-dose prophylactic antibiotic, post-coital prophylaxis, vaginal estrogen in postmenopausal women, urology assessment.

Red flags — see a doctor urgently

• High fever, chills, vomiting, flank pain (kidney involvement).
• Blood in urine.
• UTI in a man, in pregnancy, in a child, or after catheterisation.
• No improvement after 48 hours of antibiotics — culture sensitivity may be needed.
• Confusion or delirium in an older adult.

Prevention

• Drink adequate water; don't hold urine for long periods.
• Wipe front to back; urinate after sexual intercourse.
• Avoid harsh douches and bath oils.
• Good control of diabetes.
• Check that vaginal dryness is treated in post-menopausal women.