Updated: Oct 23
Do you have cystitis symptoms? Do you think you have a Urinary Tract Infection (UTI)? This blog will discuss how to get your urinary tract infection assessed and treated.
Urinary Tract Infection (UTI) is also called Cystitis, Bladder infection or water infection. UTI is common, particularly in women. UTI in men is less common but requires a longer course of antibiotic treatment.
UTI symptoms can be very uncomfortable and having a urine infection can make you very unwell. A UTI in the lower part of the urinary tract is usually relatively simple to diagnose and treat if done so at an early stage.
If urine infection spreads into the upper urinary tract it can cause high temperature, back pain and may require treatment in hospital with intravenous antibiotics.
This blog article describes the symptoms of cystitis in adults, what to do if you have UTI symptoms and how you can to get your symptoms assessed and treated using online services.
Quick bites #FACTSMATTER
If you have mild symptoms of lower UTI, you may not require any treatment. Your UTI could resolve in 1-2 days if you drink plenty of fluids, go to wee when you need to go (do not hold it in) and avoid sugary drinks. However if your symptoms get worse at any time then speak to the doctor.
If you have moderate symptoms of lower UTI, your UTI can be diagnosed by a doctor over the phone, online, by video or in person. If required, a prescription will be organised, for collection as soon as possible. It can be helpful to have urine dipstick tests at home. You can buy ready made test kit or you can buy a set of urine testing strips.
If you are pregnant, you should see or speak to a Doctor soon after your symptoms start.
If you have a fever, back pain, are vomiting, intense shivering, feel unwell, are confused or disorientated you must see a Doctor as soon as possible.
Antibiotics are usually required for treatment of UTI. If your symptoms get worse whilst you are on antibiotics or they do not improve within 48 hours of starting antibiotics, you should speak with or see the doctor as soon as possible.
Sexually transmitted infections (STI’s) can present with similar symptoms so if you develop symptoms a week or more after having unprotected sex with a new partner you should attend a clinic for a sexual health check.
If you have repeated or recurrent UTI's i.e. 2 or more UTI's in a 6 month period or 3 or more in a 12 month period, speak to your Doctor to discuss prevention management.
What is a urinary tract infection
A urinary tract infection occurs when the urinary tract becomes infected by bacteria. The urinary tract includes your urethra, bladder and kidney.
A lower UTI affects your urethra and/or bladder. The urethra is the tube where urine flows from your bladder to leave the body from your genital area. When your bladder is infected it’s called Cystitis. When your urethra is infected it’s called urethritis. If untreated a lower UTI can progress into the upper urinary tract because the bacteria spread up the urinary tract. When the kidney is infected it's known as Pyelonephritis.
Causes of UTI
A UTI is caused by bacteria entering your urinary tract. Most commonly, bacteria enter your bladder and urethra from the outside of your body e.g. the urethra.
Picture of external genitalia in a male and female showing the opening to the urethra
The most common bacteria that causes UTI is E.coli which lives naturally in your gut and in your poo.
In females, the anus (where poo comes out) and the urethra (where urine comes out) are reasonably close together and therefore small amounts of poo can be introduced into the urethral opening in the vulval area when wiping after going to the toilet, during sex (very common) or even when wearing tight clothes
This is why many females get UTI's after having sex, why UTI’s are more common in females and also why females are advised to wipe from front (where the urethra is) to the back (where the anus is); not back and forwards and not back to front. This wiping advice is with a view to reduce risk of contamination of the vulva. It is also advised that females go to wee shortly after sex as this may help clear out and debris that has been introduced into the urethra. Passing urine often can help clear the urethra and reduce risk of UTI.
Reduced oestogen levels in females during the perimenopause, menopause and older adult life also leads to increased incidence of UTIs.
In males, bacteria can enter the urethra but males have a lower incidence of UTI because the urethral opening is at the tip of the penis which isn't close to the anus at all. Additionally men experience urethritis rather than cystitis because the urethra is longer so bacteria are more likely to remain in the urethra rather than ascend to the bladder. However anal sex or introducing an object into the urethra can also increase the chance of any UTI in males.
Cystitis (Bladder infection) symptoms aka lower UTI
The symptoms of a lower UTI are caused by inflammation and irritation and include:
1. Noticeable changes when you go to the toilet to wee such as
Needing to wee more often than usual during the daytime and night.
Getting the urgent sensation that you need to go to wee and can’t hold it in. This can result in a small leak of urine into your underwear.
Discomfort, burning or pain when you wee and after you wee
2. Blood in your wee
3. Pain in your lower part of your tummy
4. You may or may not feel unwell or tired
Older adults and people with long-term medical conditions
Adults who are 65 years or older, may present ONLY with confusion and agitation (which is called Delirium). They may not have the symptoms 1-4.
See the link at the end of the article for advice for older adults.
If you have diabetes, are taking certain medications e.g. steroids or have certain medical conditions you also may not have the classic symptoms described above e.g. you have diabetes your blood sugar may suddenly become uncontrolled instead.
People who have uncontrolled diabetes, where there is more sugar in the wee, are at increased risk of having UTI.
Contact your registered GP or NHS 111 as soon as possible, if you have or are caring for someone with a long-term condition and/or has a urinary catheter and has any of the symptoms above or if you notice any changes in usual behaviour or health measurements e.g. blood sugars.
Symptoms of upper UTI
Symptoms of upper urinary tract infection include back pain, vomiting, intense shivering, high temperature/fever, feeling unwell and may also include the urinary symptoms described above. If you have any of these symptoms call NHS 111 or see a doctor as soon as possible.
Testing for cystitis at home or at a pharmacy
In most cases of cystitis your doctor will be able to diagnose and prescribe treatment without having to test your urine.
There are two types of test for UTI's
Urine Test Strips aka urine dipstick test
Urine culture test
Urine test strips
You may have seen your nurse or doctor use these at the clinic. They are plastic strips with little coloured squares on them. The strips are dipped into the urine and the squares detect substances in your urine such as blood, glucose, white blood cells, protein. The squares change colour if any of these substances are in your urine.
For UTI the main substances we look for are
Red blood cells (they will detect visible blood- where you can see your urine is red but also the strips can detect tiny amounts of blood in your urine that you can not see )
White blood cells (Leucocytes)
UTI is likely if you have the symptoms described earlier in this article and if the urine strip is
Positive for NITRITE + RED BLOOD CELLS
If NITRITE is NEGATIVE but there are WHITE BLOOD CELLS then then you may have a UTI or other cause of symptoms.
UTI is unlikely, if the urine dipstick is NEGATIVE for red blood cells, nitrite and white blood cells.
Urine test strips are not reliable in women aged 65 or older
NICE guidelines: Urinary Tract Infections
Urine test strips
You can buy urine test strips online at Amazon and other pharmacies and suppliers.
The cost is between £5-20 (GBP) depending on the number of strips
You will need to understand how to use them properly and interpret the findings so follow the instructions carefully. I will do a video on this in the future as I couldn't find a good one online.
The testing strips, pictured below, are reasonable cost at £4.80 for 6 strips and come with good instructions.
Ready made test kit
You can also buy self testing kits for around £10
The benefit of these tests are that they come with specific instructions and do the interpretation for you.
Velieve, available in UK and Ireland, can be bought online. After completing a short questionnaire, the kit can be sent to your home within 4 hours. The kit contains a cup, urine test strips and a colour board. You download an app, follow the instructions and your results are interpreted. If you test positive for UTI, they will arrange a prescription for treatment which you can collect from a local pharmacy.
You can also buy a similar kit from Boots online or pharmacy stores. The kit is called DipUTI (by Velieve).
The kit is £10.
If your test is positive you can use the Boots Pharmacist service to obtain a prescription. If you need a prescription the cost is £15 which includes the consultation and prescription fee.
If you take the test at home and it's positive you do not have to use the Boots service, you can contact your GP (by phone or video), or contact NHS111 visit on of the stores below to see a Pharmacist to get a prescription.
Keep your urine sample if you fall into any of the criteria in the section below "Urine Culture Microbiology test'
Urine culture microbiology test
Your Doctor will require a urine sample from you which they will send to the microbiology lab for urine culture if
You are pregnant
You are over 65 +
Your UTI does not respond to antibiotic treatment.
Your symptoms get worse on antibiotics.
You have blood in the urine.
You have repeat infections of UTI (called recurrent UTI). Recurrent UTI is 2 episodes of UTI in 6 months of 3 episodes of UTI in 12 months).
Wee into a jar or urine sample bottle, place it in a bag and put it in the fridge. Inform your GP (by phone or video) that you there is blood in the urine and wait for their advice. They may want to send the sample to the lab for urine culture (see below).
You will also need follow-up with the Doctor if any of the above applies.
A morning urine sample is the most reliable. It will take a few days for the result of this test to be reported from the lab. The sample should usually be taken before you start your antibiotics.
Getting treatment of your urine infection
1. Mild symptoms
If you are female, are not pregnant, do not have any blood in your urine AND your symptoms are mild your symptoms may resolve within 1-2 days without taking any antibiotic treatment. Take paracetamol, drink water, avoid sugary drinks and food and go to wee when you as soon as you feel the need to go.
NICE guidance states there isn't sufficient evidence to show that Cranberry products and Sodium citrate sachets are effective.
If your symptoms do not resolve within 2 days or get worse within that time, contact your doctor or NHS111 for assessment.
2. Moderate symptoms
If your symptoms of UTI are causing discomfort, get assessed and treated by a healthcare professional.
1. By phone
Contact your registered GP directly or call 111 .
The prescription will be sent electronically to your nearest pharmacy for collection.
Many independent doctors will offer a phone service.
2. By online assessment or eConsult
Check to see if your GP or Family Doctor offers eConsult service
Other Independent companies using Doctors or Pharmacist Independent Prescribers :
EU - Zava
US - Lemonaid Health
Most of these services offer same day prescription for collection
3. By video
Your registered GP or Family Doctor may offer this service
There are numerous independent video doctor services. In the UK some are available onsite, within the Pharmacy, some can be accessed anywhere because they are available on web browser or by app
Check my first ever blog article which provides 10 tips for speaking to your doctor by Video.
4. In person- walk in
UK - Boots has in-house treatment services with Pharmacist Independent Prescribers.
For a fee, you can attend, have a consultation with the Pharmacist and collect the prescription.
There are a number of NHS and Private walk-in clinics which won't be discussed in this article.
Get Better Soon xx
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The third image is by 'myself (silhouette365)'. Made available under the Creative Commons Universal Public Domain Dedication.