A urinary tract infection, or UTI, is an infection that can happen anywhere along the urinary tract. The urinary tract includes the:

• Bladder
• Kidneys
• Ureters -- the tubes that take urine from each kidney to the bladder
• Urethra -- the tube that empties urine from the bladder to the outside

Cystitis, a common condition, is usually caused by bacteria entering the urethra and then the bladder. This leads to inflammation and infection in the lower urinary tract.

Certain people are more likely to get UTIs. Women tend to get them more often because their urethra is shorter and closer to the anus. Elderly people (especially those in nursing homes) and people with diabetes also get more UTIs.

Some children develop UTIs. In boys, they are most common before the first birthday. In young girls, UTIs are most common around age 3, overlapping with the toilet training period.

Cystitis in children can be promoted by abnormalities in the urinary tract. Therefore, children with cystitis, especially those under age 5, deserve special follow-up to prevent later kidney damage.

The following risk factors increase your chances of getting a UTI:

• Bowel incontinence
• Catheterization
• Kidney stones
• Immobility (for example, during recovery from a hip fracture)
• Menopause
• Narrowed urethra
• Not drinking enough fluids
• Pregnancy
• Prostate inflammation or enlargement
• Sexual intercourse, especially if you have multiple partners
• Using a diaphragm for birth control

The symptoms of a UTI include:

• Cloudy urine
• Blood in the urine
• Foul or strong urine odor
• Frequent or urgent need to urinate
• Need to urinate at night
• Pain or burning with urination
• Pressure in the lower pelvis

Young children with UTIs may only have a fever, or no symptoms at all.

• Mental changes or confusion (in the elderly, mental changes or confusion often are the only signs of a urinary tract infection; possible spread to the blood should be considered)
• Flank (side) pain, vomiting, fever, and chills (may be a sign of kidney involvement)
• Painful sexual intercourse
• Penis pain

Tests generally include taking a urine sample.

Urinalysis commonly reveals nitrates, white blood cells, and red blood cells. See also: RBC - urine

A urine culture (clean catch) or catheterized urine specimen may be done to determine the type of bacteria in the urine and the appropriate antibiotic for treatment.

TESTING IN CHILDREN

Many children with cystitis need special imaging studies to determine why they got a urinary tract infection. Many of them have something abnormal about their anatomy that predispose them to infections. The long-term consequences of repeated urinary tract infections in children can be quite serious. However, these infections can usually be prevented.

Special studies usually include an ultrasound of the kidneys and an x-ray taken during urination (called a voiding cystourethrogram or VCUG).

Most experts recommend this evaluation for:

• Girls over age 5 who have had two or more urinary tract infections
• All boys with their first urinary tract infection
• All children who have a fever along with their urinary tract infection
• All children under age 5 with their first urinary tract infection