Katie McCann has had more than one urinary tract infection (UTI), so when she felt a persistent urge to urinate, and felt a burning sensation when she did, she knew it was likely another UTI.
“While in the past, I might have considered at-home remedies or waited a bit longer before seeking medical intervention, the stakes felt higher,” she says, because this time she was pregnant. As a breastfeeding counselor, she was aware that untreated UTIs could raise the risk of her giving birth prematurely. Her doctor prescribed a course of antibiotics.
If you think you might have a UTI, here’s what you need to know about diagnosis, treatments, and side effects.
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What Is a UTI?
A UTI is an infection, usually caused by a bacteria, that takes hold in your bladder, kidney, ureters (the tubes that take urine from your kidneys to your bladder), and/or urethra (the tube that carries urine from the bladder out of your body.)
Symptoms of UTIs
According to the Centers for Disease Control and Prevention (CDC), a UTI is most likely to take hold in your bladder. But in rare instances, it can also travel to your kidneys and other parts of your body.
If only your bladder is infected, your symptoms are likely to be confined to your lower abdomen and pelvis and include:
- Pain or burning while urinating
- Frequent urination
- Feeling the need to urinate despite having an empty bladder
- Bloody urine
- Pressure or cramping in the groin or lower abdomen
If your kidneys are infected, your symptoms are likely spread beyond your abdomen and pelvis and can include:
- Fever
- Chills
- Lower back pain or pain in the side of your back
- Nausea or vomiting
How to Know If You Have a UTI
Your best bet is to see your healthcare provider if you have any of the symptoms listed above and suspect that you might have a UTI. He or she will analyze a sample of your urine.
However, if you’re unable to see a healthcare provider quickly, or if you were already diagnosed and want to know whether your treatment is working to clear your infection, you might consider an over-the-counter (OTC) test. However, you’ll still need to see a healthcare provider whether the test is positive (for an antibiotic prescription) or if it’s negative and your symptoms persist for healthcare analysis.
Additionally, your provider may want to check for other conditions that can cause similar symptoms, such as kidney stones. Any UTI in a man is considered “complicated,” because their anatomy makes the infection more likely to spread to other organs.
UTI Treatment and Side Effects
Since bacteria cause UTIs, if you test positive, your doctor will most likely prescribe an antibiotic drug. When deciding which antibiotic to prescribe, your provider will consider the severity of the infection, whether your infection is resistant to antibiotics, and any allergies you may have to the drugs.
Antibiotics for UTIs
The most commonly prescribed antibiotics for UTIs include:
- nitrofurantoin monohydrate/macrocrystals
- Trimethoprim-sulfamethoxazole
- Fosfomycin
- Oral beta-lactams
- Fluoroquinolones*
Most antibiotics have similar side effects. For example, antibiotics typically kill more than just the bacteria causing your infection. They often also kill many good bacteria found in your digestive system, leading to diarrhea. Eating fermented foods with probiotics such as yogurt can help reduce the risk of gastrointestinal (GI) symptoms.
Side effects of antibiotics include:
- Bad rash
- Bad sore throat
- Respiratory difficulties
- Nausea and vomiting
- Diarrhea
- Stomach pain
- Swelling of joints
Rare Side Effects
- Stevens-Johnson Syndrome (a rare skin disorder most associated with sulfonamides such as Bactrim)
- Retinal detachment
- Compromised kidney function (associated with fluoroquinolones)
- Widespread pain (with symptoms similar to fibromyalgia)
- Tendinitis
- Heart palpitations
- Muscle spasms
*You should be especially cautious about fluoroquinolones. The Food and Drug Administration (FDA) put a black-box warning on fluoroquinolones because an agency safety review found that both oral and injectable fluoroquinolones are associated with disabling side effects, such as tendon ruptures.
OTC Pain Medicine for UTIs
Antibiotics will help clear your infection, but they take a few days to work, and during that time, the antibiotics won’t help reduce the symptoms, such as pain. If you need help managing the pain, you can take over-the-counter (OTC) painkillers such as phenazopyridine (a drug made specifically for UTI symptoms), NSAIDs, or tylenol (acetaminophen).
Phenazopyridine
This is an old drug. Phenazopyridine has been on the market since 1928, a time when regulations didn’t require nearly as much testing to prove the drug’s safety and efficacy. Most of what we know about the drug is based on healthcare providers’ observations, rather than the randomized, controlled trials drugs must go through today. Mica (she chose not to share her last name), who has had many UTIs in her life, usually takes this drug to relieve some of the urgency and burning until she can see a doctor.
If you take far more than is indicated on the label, it can cause fatal overdoses.
However, more common side effects of phenazopyridine include:
- Headaches
- Rashes
- Nausea, vomiting and diarrhea
- Kidney problems
- Anemia
Side Effects of Tylenol for UTIs
The main risk of taking Tylenol for aches and pains is liver damage, especially if you drink alcohol while taking it. There is also emerging evidence that taking it while pregnant may impact your baby’s cognitive development and raise the risk of ADHD.
While it isn’t common, one study in JAMA found that taking acetaminophen at the recommended dose for four days in a row could elevate your risk of liver damage.
Signs of liver damage include:
- Nausea, vomiting, or loss of appetite
- Fatigue or weakness
- Jaundice (yellowing of the skin or eyes)
- Pain in the upper right part of the abdomen
Read more about the risks and benefits of Tylenol in “MedShadow’s” Need to Know: Acetaminophen.
Side Effects of Aspirin, Advil (ibuprofen), or Aleve (naproxen)
All NSAIDs can cause serious side effects, including stomach ulcers, gastrointestinal bleeding, kidney failure, heart attacks, and strokes. Aspirin is the exception. It can cause GI bleeding and stomach ulcers, but not heart attacks and strokes. The risk of these side effects of NSAIDs increases if you take higher doses and/or if you take the drug for longer periods of time, but if you get treatment quickly for your UTI, you shouldn’t need to take them for more than a few days.
More common side effects of taking NSAIDs are stomach issues like irritation, pain, heartburn, gas, bloating, constipation, and diarrhea. Taking your NSAIDs with food or milk can help to reduce this effect. Dizziness, mild headaches, problems concentrating, balance issues, and lightheadedness are also common.
Read more about the side effects of NSAIDs in “MedShadow’s” The Lowdown on NSAIDs for Pain and Need to Know: NSAIDs.
Risks of UTIs
If a UTI isn’t treated, it can spread. The main risk is that the infection spreads to your kidneys or even your blood stream. Call your doctor right away if you have symptoms such as a fever, chills, pain in your sides or back.
UTIs in Pregnancy
UTIs are especially dangerous during pregnancy. If they aren’t treated, they could cause kidney infections and high blood pressure or preeclampsia. They can also raise the risk of your baby having a low birth weight or preterm birth. However, a review of 10 clinical trials showed that several antibiotics are highly effective at clearing UTIs and preventing dangerous outcomes for mom and baby.
Preventing UTIs
UTIs are very common, especially among women. Most women will have one at some point in their life, and many women experience more than one infection. The Office of Women’s Health recommends the following habits to lower your risk of infection.
- Avoid holding urine in. Use the restroom when you need to go.
- Urinate before and after sex.
- When using the restroom, wipe from front to back to avoid spreading bacteria from back to front.
- Drink six to eight glasses of fluids such as water or tea, per day to help flush out bacteria.
- Clean the anus and the outer lips of your genitals each day.
- Do not douche or use feminine hygiene sprays.
- If you get a lot of UTIs and use creams that kill sperm (spermicides), talk to your doctor or nurse about using a different form of birth control instead.
- Wear cotton underpants. Avoid tight-fitting pants, which trap moisture, and change out of wet bathing suits and workout clothes quickly.
- Choose showers over baths.
Mica, who had three UTIs in one month, was desperate to prevent more.
“I did all the things they tell you to do,” she says, describing drinking water, avoiding douches, urinating after sex, and wiping front to back. Finally though, she says that installing a bidet seems to have made the biggest difference for her. She’s been using it for about two years and calls it her “secret weapon.”
Do Cranberries Prevent UTIs?
After she gave birth, Mica got another UTI. Her midwife told her to take cranberry pills or drink cranberry juice.
“My UTI never progressed further,” she says.
A review of 50 studies found that cranberry and cranberry products (such as tablets or capsules) may reduce the risk of UTIs in children and women with recurrent infections, though the review didn’t demonstrate that the products are effective in pregnant women or the elderly.
Does Uqora Work?
You may have seen commercials for a company called Uqora, a company that says its products are able to treat and prevent UTIs. It’s important to note that Uqora is not a drug, therefore the company’s claims that the product works have not been evaluated by the FDA.
There is a small amount of evidence that D-mannose, one of the main ingredients in Uqora products, may lower your risk of developing a UTI. Researchers have noted that D-mannose can cause diarrhea. While you can take the supplements to try and prevent UTIs, it’s still important to talk to your healthcare provider about the fact that you’re taking them, and call your healthcare provider if you do develop symptoms of an infection.
Long-Term Antibiotics for Recurrent UTIs
If you keep getting UTIs over and over, some healthcare providers might recommend that you take antibiotics for two months (as opposed to the five days or less you might be prescribed for a single infection.) A review of 16 studies in children suggests that this length of medication can help prevent future infections, but in addition to a higher risk of antibiotic side effects, this type of long-term treatment can raise the possibility that future infections will be resistant to the antibiotic you received.
