Signs Can Vary In Women, Men, Children, And The Elderly
By Jerry Kennard | Reviewed by Richard N. Fogoros, MD
Anyone who has ever had a urinary tract infection (UTI) knows full well how frustrating and uncomfortable they can be. Even a mild case can cause pain when urinating, an increased urge to urinate, and blood or pus in the urine. If the infection moves from the bladder to the kidneys, the condition can get worse, triggering severe back pain, nausea, vomiting, and, in rare cases, kidney damage.
And, it’s not just adults who can be affected. Newborns and children can also get UTIs, and those occurring in the elderly can sometimes be life-threatening. By knowing the signs and symptoms of a UTI, you can seek treatment and avoid many of complications of this all-too-common infection.
The symptoms of a urinary tract infection are largely defined by their location in the urinary system. Broadly speaking, there are two types of UTI:
A lower urinary tract infection is one that occurs in the bladder or urethra (the tube through which urine exits the body). It is commonly referred to as a bladder infection.
An upper urinary tract infection involves the kidneys and ureters (the duct through which urine passes from the kidneys to the bladder). An infection of the kidneys is also referred to as pyelonephritis.
Lower Urinary Tract (Bladder Infection)
A lower urinary tract infection typically occurs when bacteria enter the urethra and cause an infection in the bladder.
When symptoms appear, they often start with a dull ache or discomfort in the pelvis or urethra. Usually, within hours, the UTI will manifest with characteristic symptoms, including:
Pain or burning during urination (dysuria)
An increased urge to urinate (urinary urgency)
The need to get up at night to urinate (nocturia)
Inability to hold your urine (urinary incontinence)
Passing frequent, small amounts of urine
Cloudy urine caused by pus (pyuria)
Bloody urine (hematuria)
Pus discharge from the urethra
Lower abdominal discomfort
Pelvic pain in women
Upper Urinary Tract (Pyelonephritis)
A bladder infection that has migrated to the kidneys is usually considered serious and in need of urgent medical care. Pyelonephritis can cause systemic (all-body) symptoms that are not only more overt but frequently debilitating.
Signs of pyelonephritis may include:
A high fever (over 100.4 degrees)
Rigors (shivering and sweating accompanied by a rise in temperature)
Nausea or vomiting
Flank pain (pain that’s usually deep and high in the back or sides, though it can be present in the upper abdomen)
Babies, young children, and the elderly are also commonly affected by UTIs and often in vastly different ways. The main challenge in the very young and very old is that the classic signs are frequently either missing or misattributed to other causes.
With new-borns especially, the only clues you may have are a persistent fussiness or crying accompanied by odd-smelling urine and the refusal to eat.
This is why it is important to always to discuss your baby’s bowel and urinary habits at every doctor visit, however mild or incidental the changes may seem.
In contrast, the signs of a UTIs in toddlers and younger children will be more characteristic and may include dysuria, urinary urgency, daytime incontinence (enuresis), or the rubbing or grabbing of the genitals.
A UTI in the elderly will usually not have any of the traditional symptoms seen in other adults. These may include urinary incontinence and mental confusion (caused by the bacterial penetration of the blood-brain barrier). If your loved one is older, the main clues to watch out for are sudden changes in behavior and bladder control, especially if accompanied by lower abdominal pain or strong-smelling urine.
UTI complications often occur as result of an untreated or undertreated infection. The risk is also high in people with an underlying kidney disorder, diabetes, or diseases that cause immune impairment (such as HIV).
Complications of a urinary tract infection include:
Recurrent UTIs occurring at least twice in six months or four times in a year, most commonly in women
Urethral narrowing (stricture) in men with recurrent infections
Increased risk of preterm birth and low birth weight in pregnancy
Permanent kidney damage
Sepsis (a potentially life-threatening, whole-body inflammatory response caused by a severe infection)
Because a urinary tract infection in new-borns will often have few, if any, of the classic signs of a UTI, a child may only become symptomatic when sepsis (also referred to as urosepsis) develops. Sepsis is always considered a medical emergency.
Go to an emergency room or call 911 if your baby develops some or all of the following symptoms:
Yellowing of the eyes and skin (jaundice)
Decreased tone (floppiness)
Cloudy or bloody urine
Pale pallor or even a bluish skin tone (cyanosis)
A bulging of the soft spot on the back of the head triggered by the development of meningitis
In the Elderly
Since UTIs are frequently missed in the elderly, the infection may only become apparent when urosepsis starts to affect the brain and other vital organs.
Symptoms include of this dangerous complication include:
An abnormally rapid heart rate (tachycardia)
High fever or hypothermia (body temperatures below 95 degrees)
Difficulty breathing or shortness of breath (dyspnea)
Sudden extreme anxiety
Severe back, abdominal, or pelvic pain
Dementia-like symptoms triggered by the development of brain inflammation (encephalitis)
If left untreated, sepsis can lead to septic shock, organ failure, and death.
When to See a Doctor
While milder UTIs will often go away on their own without treatment, you shouldn’t avoid seeing a doctor if the symptoms persist for more than a couple of days.
With that being said, if you develop signs of a kidney infection, including flank pain, nausea, or vomiting, you need to see a doctor immediately.
If you are pregnant, you should never take a chance with UTIs, especially if you have diabetes, HIV, or have had previous infections. Even mild symptoms should be looked at, treated, and monitored to ensure that the infection is fully cleared.
Without exception, any symptoms of suggestive of sepsis should be treated as a medical emergency. This is especially true in babies or the elderly.
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Robinson, J.; Findlay, J.; Lang, M. et al. “Urinary tract infections in infants and children: Diagnosis and management.” Paediatr Child Health. 2014; 19(6):315-19.
Schwartz, B. (2014) “Urinary Tract Infections.” In: Levinson, W. eds. Review of Medical Microbiology and Immunology, 13e. New York, NY: McGraw-Hill Education.
Solomon, C. “Urinary Tract Infections in Older Men.” N Engl J Med. 2016; 374:562-571. DOI: 10.1056/NEJMcp1503950.