Urinary tract infections (UTI) in women – how to treat them

‘The symptoms of a UTI can be tiring, make sex uncomfortable and generally get you down,’ says doctor and Healthily expert, Dr Adiele Hoffman. ‘If you’ve never had one before it can be surprising how bad you might feel, and if you’re one of the 20% of women who get another UTI within weeks or months, even after antibiotics, you may feel frustrated and drained.’

Read on to find out the causes of UTIs, how to lower your risk and how to treat a UTI.

What is a UTI?

In most cases, a UTI is caused by bacteria from your poop getting into your urinary tract. E. coli bacteria are the main cause, accounting for up to 90% of cases.

Your urinary tract system is made up of different parts that can be infected by a UTI. These are:

• urethra: the tube that takes pee out of your body
• bladder: stores pee before it leaves your body
• ureters: 2 thin tubes that take urine from your kidneys to your bladder
• kidneys: small organs at the back of your body above your hips that make urine

The most common forms of UTI happen in your lower urinary tract and they are:

• cystitis: when your bladder is infected
• urethritis: when your urethra is infected by bacteria. But the other main cause can be a sexually transmitted infection (STI)

An upper urinary tract infection is when the bacteria has infected your kidneys – the medical name for this is pyelonephritis. You have a higher risk of a kidney infection if you have frequent bladder infections, or a structural problem in your urinary tract. Only around 1 in 100 cases of a UTI leads to a complication, such as a kidney infection, in women who are not pregnant.

What causes a UTI?

Your body has 2 exits where waste comes out – your urethra where your pee comes out, and your anus where your poop comes out. These 2 exits are close together so it’s easy for bacteria to move from your bottom into your urethra. These bacteria can cause an infection in your urethra and travel up to your bladder and your kidneys to cause infections there. Women have a shorter urethra than men and that’s why women are more likely to get UTIs.

But are there any other factors that can make bacteria more likely to transfer to your urethra? ‘When I see patients about UTIs, women are often concerned it’s because of something they’re doing wrong around toilet hygiene, or they’re worried it’s down to their sex life or choice of contraception. These are actually the most common reasons why 50–60% of women have a UTI at some point in their life,’ says Dr Adiele.

Here’s why:

• regular sex: having sex can be a trigger in some women and some research has found the more frequently you have sex, the higher your risk for a UTI. It’s thought that sex can introduce bacteria into your urethra and cause an infection

• choice of birth control: having a diaphragm fitted or using spermicides (chemicals that kill sperm which are used with some contraceptives) that change the bacteria in your vagina, can lead to growth of bacteria that can cause UTIs. Your vagina and urethra are very close together so there is a risk these bacteria can make it into your urethra and cause a UTI

Other risk factors for UTIs include:

• you’re pregnant (see below)

• your age: after the menopause your oestrogen levels drop and, like your vagina walls, your urethra becomes thinner and more prone to infections

• you have diabetes: this can lower your immunity to protect yourself against infections and also cause nerve damage that makes it hard to fully empty your bladder

• you have a kidney stone or blockage: this can block the flow of urine between your kidneys and bladder

• you’ve recently had a urinary procedure: either an examination or surgery of your urinary tract can increase your risk of an infection

What are UTI symptoms?

The main symptoms of a UTI in your urethra and bladder can include:

• burning or pain when you pee
• needing to pee urgently and often, but not much comes out when you go
• needing to go to the loo in the night
• pee that looks cloudy
• pressure in your lower belly
• feeling tired, shaky, confused or weak. This is more common in older women

Symptoms of a kidney infection usually include those mentioned above, and you may also have:

• a very high or low temperature, or feel hot and shivery
• pain in your lower stomach or in your back, just under your ribs
• a feeling that you need to be sick or vomit
• blood in your pee. This is more common in younger women

Kidney infections may lead to a severe reaction to an infection, called sepsis. This is a medical emergency. Signs of sepsis can include a combination of:

• feeling confused, drowsy or finding it hard to speak
• not going for a pee all day
• a very high or very low temperature
• having a fast heart rate

How long does a UTI last?

Is it possible to get rid of a UTI in 24 hours? And can a UTI go away on its own? Some UTIs go away by themselves in 2 to 3 days. If your UTI doesn’t clear up on its own within about 48 hours, see your doctor, who can prescribe antibiotics. UTIs usually clear up in around 3 days with these, but it can take up to 5 days if the bacteria you have is resistant to the antibiotics you’ve been given.

How to prevent a UTI with self care

There are some measures you can take to lower your risk of getting a UTI, including:

• checking your toilet hygiene: Always wipe from front to back. Clean your anus and outer lips of your vagina daily with water

• peeing as soon as you get the urge: Don’t hold onto your urine and pee regularly. The longer urine is in your bladder, the more time bacteria has to grow. And don’t rush it when you’re peeing – try to fully empty your bladder

• peeing as soon as possible after sex: This flushes away bacteria that may be lingering near your urethra

• think about switching your contraception: If you use a diaphragm or spermicides, it may be a good idea to explore other contraceptive options

• staying hydrated: Drinking 6 to 8 glasses of fluid per day means you pee more frequently, which flushes out infections before they take hold. But don’t have lots of sugary food or drinks, as they may encourage bacteria to grow in your urinary tract

• avoiding tight clothing and synthetic underwear: These can trap moisture and create a breeding ground for bacteria in your urinary tract. For the same reason, it’s a good idea to change out of wet swimwear and workout pants

• avoid douching and using feminine hygiene sprays: They can disturb the healthy bacteria in your vagina and make you more prone to infections. Instead, clean your genitals with water or with unperfumed soaps

• taking showers, or limiting baths to 30 minutes or less: This is because when you’re in a bath, the water can become contaminated by the bacteria that lives on your skin. This bacteria can then reach your bladder opening

How to get rid of a UTI: home remedies and pharmacy treatments

Home treatment for UTI

If your symptoms are mild, there are self-care measures you can take which may ease your pain, including:

• resting and drinking more water so your pee is pale throughout the day, which helps flush out bacteria
• taking painkillers such as paracetamol up to 4 times a day to reduce pain and lower your temperature
• holding a hot water bottle over your stomach, back or between your thighs to ease discomfort

There are key times you need to see a doctor about a UTI (read "When to see a doctor for UTI below.

Over the counter UTI medicine

If you have mild symptoms, your pharmacist can talk to you about over the counter UTI medicine available, such as painkillers. They can also advise you about whether you need to see a doctor. If your symptoms are more severe or if they haven’t gone away after 48 hours, you should see a doctor, who will likely prescribe you antibiotics.

If you’re not sure whether to see a pharmacist or a doctor, use our Smart Symptom Checker for feedback on your symptoms. This can help you decide what your next best step is.

When to see a doctor for UTI

Your doctor can help you deal with UTIs by giving you a diagnosis, offering treatment if you need it, and helping to make sure you get urgent treatment if you have a kidney infection.

You’ll also need to see your doctor if your UTIs keep coming back as you might need different treatments to get them under control.

See a doctor if your UTI doesn’t go away on its own within 48 hours or if:

• this is the first time you’ve had a UTI
• you're pregnant and have symptoms of a UTI (see UTI in pregnancy, below)
• you have symptoms of a UTI after surgery
• your symptoms don’t improve, or get worse, within 48 hours without treatment, or within 2 days of starting antibiotics
• your symptoms have come back within 6 months after treatment for a UTI
• you’ve had 2 episodes in 6 months, or 3 episodes in 12 months
• you have blood in your pee
• you could be at risk of an STI
• you’re over 65 years old
• you have a catheter
• you have a weakened immune system

There are other conditions that can cause urinary symptoms too. If you keep needing to pee urgently or frequently, or you also notice you're losing weight, getting more bloated or have ongoing belly pain, then it’s important to see a doctor. These are potential signs of ovarian cancer, but it’s much rarer – a woman’s risk of getting ovarian cancer in her lifetime is 1 in 78.

UTI during pregnancy

Pregnancy hormones can make a UTI more likely and make any bacteria in your bladder more likely to spread to your kidneys. When you’re pregnant you may have trouble completely emptying your bladder because your uterus – which is home to your developing baby – sits on top of your bladder. Leftover pee with bacteria in it can then cause a UTI.

Throughout your pregnancy your pee will be tested to check for infections. If any bacteria is found this will be treated with antibiotics – even if you don’t have symptoms – that are safe to take during pregnancy.

Always see a doctor if you’re pregnant and you think you may have a UTI. If left untreated, it could lead to a kidney infection and that can result in complications, such as premature birth and low birth weight. But it’s important to know that treating any bacteria picked up on routine urine screening during pregnancy can reduce your chances of getting a kidney infection, and early treatment can help prevent the risk of complications.

If you're pregnant and you’re having unexpected contractions, severe abdominal pain or vaginal bleeding, see your doctor straight away.

When to get urgent medical help for a UTI

One in every 100 UTIs leads to a kidney infection. Get a same-day doctor’s appointment or get urgent care if you have any of the symptoms of kidney infection mentioned above. Rarely, a kidney infection can lead to sepsis if it’s not treated, which needs emergency medical attention.

How is a UTI diagnosed?

Your doctor or nurse will discuss your symptoms, and if it’s unclear whether you have a UTI, they will use a dipstick urine test to check for infection, which acts like a UTI test by looking for the bacteria that cause UTIs. In some cases, you’ll be treated without needing a sample, but in others, a sample will need to be sent to a lab for urine culture testing. This is more likely if you:

• are pregnant
• have blood in your pee
• have recurrent UTIs
• have an underlying problem with your urinary tract
• have a catheter
• are over 65 years old

Antibiotics for UTI

• your doctor may prescribe a short course of antibiotics, usually a 3-day course. If your symptoms are mild your doctor may suggest you wait for 48 hours before taking the antibiotics, just in case your symptoms clear up on their own

• you’ll most likely get a slightly longer course of treatment if you’re pregnant or if you have more serious symptoms

• it’s important you finish the course of antibiotics, even if you start to feel better in 2 days. Some bacteria are resistant to certain antibiotics, so if your infection doesn’t clear up with your first prescription, see your doctor again. They will usually take a urine sample and send this to a lab for a urine culture test. This can help identify the specific bacteria causing your infection. You’ll then be prescribed alternative antibiotics that can help fight it

3 questions about UTIs, answered

Here, we answer some of your most common questions around UTIs.

1. Can drinking cranberry juice prevent a UTI?

You’ve probably heard that drinking cranberry juice can get rid of a UTI, or reduce your chances of getting a UTI again – but the reality is there isn’t much good quality evidence that it can.

2. Why have I got UTI symptoms but no bacteria in my urine?

‘If you’ve got UTI symptoms but no bacteria has been found in your urine test, it’s still possible that you have a UTI, as the test might not pick up all UTIs,’ says doctor and Healthily expert, Dr Ann Nainan.

But there may be something else going on. ‘There are other types of infection, such as STIs, that can cause symptoms similar to those of UTIs, so it's worth getting checked for STIs if there's a possibility you could be at risk, or if you also have other symptoms like unusual vaginal discharge or a vulval rash,’ adds Dr Ann.

‘Other conditions that can cause inflammation near your urethra can also bring on symptoms similar to those of a UTI, as can conditions that press on your bladder or cause a blockage in your urinary tract. These can include skin conditions, kidney stones, interstitial cystitis (a bladder condition where you get long-term pelvic pain and problems peeing) and, more rarely, cancers including ovarian cancer. See your doctor to discuss what else it could be.’

3. Can you have sex with a UTI?

‘It’s advisable to avoid penetrative sex – including using sex toys – while you have a UTI,’ says Dr Ann. ‘This is because sex could be painful or irritate the area that's inflamed and worsen your symptoms. As sex is also a risk factor for UTIs, it could introduce another infection before this one has cleared up. If you feel comfortable enough for other kinds of intimacy, which avoid penetration, then there's no proven reason to avoid them.’