Urinary tract infections are a common problem. It is more frequently seen among females in childhood, adolescence and adulthood but by the senior years, UTIs affect men and women equally. Most of us think that we would know when we have a UTI, but not necessarily so. Sometimes UTIs are relatively silent meaning that there is almost no symptoms. Those symptoms that may be present are subtle that most people do not even notice it or understand that it is a problem in the urinary tract.
It is important to understand how urinary tract infections arise as it provides some insight to the way the symptoms develop.
Most UTIs are ascending bacterial infections. The bacteria enter through the urethra, travels up it to the bladder which it then infects. A bladder infection is known as cystitis and most UTIs affect the bladder. However, it is possible for the infection to then climb high up into the ureters. It is rare for a person with an infection of the bladder and ureters to be without symptoms. From here the infection can spread to the kidney if UTI treatment does not commence on time or if the infection does not resolve.
It is also possible for the bacteria to travel through the bloodstream to lodge and infect the urinary tract. This is known as hematogenous spread and the bacteria may have entered elsewhere in the body, not through the urinary tract. Another possibility is that an infection of a neighboring organ in the pelvis spreads directly to the urinary tract. Both hematogenous spread and direct spread from neighboring organs outside the urinary tract are not common ways that UTIs arise.
Frequent Urination With Urging
Frequent urination is one of the most common symptoms of a UTI. It does not mean that you have a full bladder in every instance but may pass even small amounts of urine repeatedly within a short period of time. Another characteristic symptom is that you do not feel that you emptied your bladder properly despite urinating so often. You may even urge to pass urine constantly. While it is normal for some people to urinate more than others, passing small amounts of urine repeatedly and usually more than 8 times in a day can be a sign of a UTI.
Burning During And After Urination
Burning urine is another characteristic symptom. It can be felt from below the umbilicus (belly button), all the way to the genitals. The burning is intense while urinating but can persist even afterwards. Sometimes it continues a while after urinating although it may not be as intense as when you pass urine. Most people feel the burning most intense at the tip of the genitals but this does not mean that the problem is isolated to this area. Burning behind the genitalia is another common complaint in a UTI.
Cloudy And Discolored Urine
Urine is normally pale yellow to clear in color. Sometimes it is a darker yellow when our water intake is not sufficient but here as well it is not a sign of any problem. Irrespective of the color, urine is always translucent meaning that you can could see through it. However, in UTIs the urine appears cloudy. There may also be other causes of cloudy urine that is not related to UTIs. Often it is discolored, varying from a pink or red color to a darker mustard yellow and even murky brown. The main reasons for these changes in color and clarity is due to pus (pyuria) and bleeding (hematuria) from the urinary tract.
Strong Urine Odor And Fishy Smell
It may not be clearly evident in every UTI case but typically the urine has a strong odor. The descriptions of the odor varies but it is usually somewhere between a strong ammonia smell, to a chemical-like odor or even an offensive fishy odor. Many people with a UTI will also find that the odor lingers after urinating, and is present on the genitalia and even soils the underwear with this persistent odor. It can sometimes be so strong that it can be smelled by others who come in close contact with a person, especially if a person does not wipe thoroughly after urinating.
Pelvic And/Or Rectal Pain
Often UTI pain is not as localized to the genitalia or urinary tract as one would expect. It is common for there to be diffuse pain in the pelvis and a person cannot isolate the pain to one exact spot. While pelvic pain is a common complaint in women with UTIs, men often complain of rectal pain as well. Sometimes the rectal pain is mistaken for a problem with the colon especially if there are little to no urinary symptoms present. It is also not uncommon for a person to experience this diffuse pelvic pain for days or even weeks before more specific urinary symptoms arise.
Abdominal Pain And Kidney Pain
The bladder is the most commonly affected part of the urinary tract and lies in the pelvis. Therefore pelvic pain is so common in urinary tract infections. However, there are instances where the pain is felt higher up the torso towards the lower part of the abdomen or even the flanks. Pain just below the umbilicus can occur despite it being due to the bladder which lies much lower down. Flank pain is usually associated with the kidneys but it must be remembered that the ureters run from the bladder up to the kidneys. If the infection gets into the ureters, a person may experience flank pain even though the kidneys are unaffected.
Malaise With No Symptoms
It is not uncommon for a person to have no urinary symptoms in the early stages of a UTI. However, this does not mean that a person is entirely asymptomatic (without any symptoms). Instead the symptoms may not be specific to the urinary tract. Malaise is a common symptom in urinary tract infections. This is a general feeling of being unwell despite no specific symptoms. Many people describe it as feeling ‘fluish’. Another symptom that may be seen is loss of appetite despite there being no urinary symptoms at the outset.
Fever, Nausea And Vomiting
A fever is not very common with urinary tract infections involving the ureters, bladder and urethra. However, it is more likely to occur when the infection involves the kidneys. Similarly a kidney infection may present with nausea and vomiting although this is not evident in infections within the lower parts of the urinary tract. These three symptoms – fever, nausea and vomiting – are often confused for a gastrointestinal infection and not a urinary tract infection. It is only when the kidney pain (flank pain) and urinary symptoms arise that a kidney infection is suspected.