Urine Infections (UTIs): Symptoms, Treatment and When to Worry

Urinary tract infections, usually called UTIs or urine infections, are among the most common bacterial infections in the UK. Around half of women will have at least one in their lifetime. Many have repeat infections. They are less common in men but can be more complicated. In England, many uncomplicated UTIs in women can now be assessed and treated by a pharmacist, making it quicker to get help without waiting for a GP appointment.

What a UTI is

A UTI happens when bacteria, most often from the bowel, enter the urinary tract. An infection of the bladder is called cystitis. An infection that travels up to the kidneys is called pyelonephritis, or a kidney infection. It is more serious. Women are more prone to UTIs because the urethra is shorter and closer to the anus.

Symptoms of a bladder infection

Common symptoms include pain, burning or stinging when passing urine, needing to pass urine more often or urgently, needing to go during the night, pain in the lower tummy, cloudy urine, blood in the urine and urine that smells unusual. Symptoms in older adults can be less typical. A sudden change in behaviour or confusion may be the first sign, although confusion has many possible causes and should always be assessed. Babies and young children may simply have a fever, vomiting, poor feeding, tummy pain, irritability or wetting accidents.

Signs of a kidney infection

A kidney infection may cause a high temperature, shivering, pain in the side or back just below the ribs, nausea or vomiting and feeling generally unwell. It needs prompt medical treatment. A kidney infection can occasionally lead to sepsis, so call 999 or go to A&E for confusion, severe breathlessness, very fast breathing, mottled skin, extreme shivering or passing no urine for a day.

Pharmacy First for UTIs

In England, pharmacists can assess uncomplicated UTIs in women aged 16 to 64 who are not pregnant under Pharmacy First. If criteria are met, they can supply antibiotics without a GP appointment. They will refer onwards if there are signs of kidney infection, symptoms are unusual, you have recurrent infections, you have had a catheter or there are other factors that need a clinician's assessment. Our guide to NHS 111, Pharmacy First and A&E explains the scheme.

Men, pregnant women, children, people over 65 and anyone with a catheter or a significant kidney condition should usually speak to a GP or NHS 111 rather than using the Pharmacy First UTI pathway.

Treatment

Antibiotics are often used to treat bacterial UTIs, though some mild bladder infections in women improve on their own within a few days. A clinician may suggest waiting briefly or provide a prescription to use if symptoms do not improve. Take antibiotics exactly as prescribed. Paracetamol or ibuprofen can help with pain. Drinking enough fluid so you pass pale urine may help you feel more comfortable.

A urine test may be used in some groups, although dipstick testing is not recommended for adults over 65 because harmless bacteria in the urine are common and can lead to unnecessary antibiotics.

Prevention

Some practical steps may reduce the risk. Drink enough fluids to stay well hydrated, do not delay passing urine when you need to go, wipe from front to back after using the toilet, pass urine soon after sex and avoid perfumed products around the genital area. Treating constipation can also help, particularly in children and older adults.

The evidence for cranberry products is mixed. They may slightly reduce recurrent infections in some women, but they do not treat an active UTI and can interact with some medicines. D-mannose is sold as a supplement for recurrent UTIs, but evidence remains limited. For recurrent UTIs, a GP may discuss other options, including vaginal oestrogen after the menopause or preventive antibiotics in selected cases.

UTIs in men

UTIs are less common in men and may indicate an underlying issue such as prostate enlargement or incomplete bladder emptying. Men with urinary symptoms should see a GP. Fever, pelvic pain or pain around the base of the penis or back passage can suggest prostate infection.

UTIs in children

UTIs in babies and children are less common but important to identify, because repeated infections can occasionally affect the kidneys. A child with an unexplained fever, particularly a baby, may have a urine sample tested even without obvious urinary symptoms. Children with suspected UTIs should be assessed by a GP or through NHS 111 rather than a pharmacy. Constipation and holding in urine are common contributing factors worth addressing.

UTIs in pregnancy

UTIs in pregnancy need prompt assessment because untreated infections can lead to kidney infection and pregnancy complications. Pregnant women are routinely offered urine testing during antenatal care. Contact your GP, midwife or NHS 111 if you have symptoms.

When to get help

Speak to a pharmacist if you are a woman aged 16 to 64 with typical UTI symptoms and are not pregnant. See a GP or call NHS 111 if you are a man, pregnant, have symptoms in a child, are over 65, have blood in your urine without other symptoms, symptoms do not improve within 48 hours of antibiotics or infections keep returning. Get urgent help for fever with back or side pain, vomiting or feeling very unwell. Call 999 for signs of sepsis.

A quick recap

UTIs cause burning when passing urine, frequency, urgency, lower tummy pain and sometimes blood in the urine. Kidney infection causes fever, shivering and back or side pain and needs prompt treatment. In England pharmacists can assess uncomplicated UTIs in non-pregnant women aged 16 to 64. Men, pregnant women, children, people over 65 and anyone with kidney infection symptoms should see a GP or use NHS 111. Cranberry does not treat an active infection.

Frequently asked questions

Can a UTI go away without antibiotics?

Some mild bladder infections in women improve without antibiotics, but kidney infections and UTIs in higher-risk groups need prompt treatment.

Can a pharmacist give me antibiotics for a UTI?

In England, pharmacists can supply antibiotics for uncomplicated UTIs in non-pregnant women aged 16 to 64 when criteria are met under Pharmacy First.

Does cranberry juice cure a UTI?

No. Cranberry products may help prevent some recurrent infections, but they do not treat an active UTI.

Are UTIs sexually transmitted?

No, although sex can increase the chance of bacteria entering the urethra. Some sexually transmitted infections can cause similar symptoms.

How long does a UTI take to clear with antibiotics?

Symptoms often begin improving within one to two days. Contact a clinician if you are not improving after 48 hours.

Why do older people become confused with infections?

Any infection can sometimes cause confusion in older adults, but confusion also has many other causes. It should be assessed rather than assumed to be a UTI.

What are the signs a UTI has spread to the kidneys?

Fever, shivering, back or side pain below the ribs, nausea or vomiting and feeling generally unwell.