Urinary Tract Infection (UTI)

What is a Urinary Tract Infection (UTI)?

A urinary tract infection (UTI) is a bacterial infection most commonly occurring in the bladder or urethra. However, they can also be found in the other parts of the urinary system the kidneys and ureters. UTIs are much more likely to affect women than men, and are typically treated with antibiotics. Fortunately, there are also a number of preventive steps that women can take to reduce their risk of getting a UTI.

What are the types of Urinary Tract Infections (UTI) in Singapore?

UTIs can be categorised according to the location of the infection. The three types of UTIs are: 

  • Urethritis
    This involves the urethra and usually presents with painful urination.
  • Cystitis
    This involves the bladder and can present with lower abdominal pain, fever and blood in the urine.
  • Pyelonephritis
    This is the most serious type of UTI involving an infection of the kidneys. The patient may feel ill with fever, backache and nausea/vomiting. If severe, this may lead to pus forming in the kidney.

UTIs can also be either acute(resolves after treatment) or recurrent.

Recurrent Urinary Tract Infections

A recurrent UTI is widely defined as more than two episodes of uncomplicated or complicated UTI in the last six months or more than three episodes in the last 12 months, documented by urine culture.

UTI can manifest as either cystitis (involving the bladder) or pyelonephritis (involving the kidneys) and may also be classified as complicated or uncomplicated. 

Uncomplicated UTIs are sporadic, community-acquired episodes of cystitis and pyelonephritis in otherwise healthy individuals.

A complicated UTI indicates structural or functional urinary tract abnormalities or an underlying pathology that makes UTIs more common for that patient. This also means that the patient may have increased risks of infection or failure of therapy.

Please seek advice from your family doctor or specialist if you have recurrent UTIs. We are here to help you.

What are the common causes of Urinary Tract Infection (UTI) in Singapore?

UTIs are caused by bacteria and other microorganisms entering the urethra and bladder. If the bacteria multiply sufficiently and overwhelm our natural immune defence mechanisms, this will cause an infection. In some instances, the bacteria are able to travel to the kidneys via the ureters, resulting in pyelonephritis. Some common types of bacteria that cause UTIs are Escherichia Coli (E. Coli) and Enterococcus faecalis, commonly found in the gastrointestinal tract.

In addition, there are certain triggers that may increase a woman’s likelihood of developing a UTI, including:

  • Sexual intercourse
  • Dehydration
  • Infrequent urination
  • Poor toileting hygiene
  • Immunocompromised states or chronic conditions (eg; diabetes)
  • Genital syndrome of menopause
  • Elderly with voiding issues
  • Poor mobility and constipation in the elderly
  • Presence of urinary catheters

What are the risk factors for Urinary Tract Infections?

The risk factors for developing a UTI are: 

  • Female anatomy
  • Menopause
  • Sexually transmitted diseases
  • Kidney stones
  • Bladder stones
  • Catheter usage
  • Abnormalities in the urinary tract
  • Immune disorders
  • Recent urinary procedures

What are the symptoms of a Urinary Tract Infection?

Some common symptoms to look out for when it comes to UTIs are: 

  • A burning sensation during urination
  • Blood in the urine
  • Cloudy urine
  • Abnormal discharge
  • Incomplete voiding of the bladder
  • Frequent, painful urination
  • Incontinence
  • Pelvic or abdominal pain

In addition, acute pyelonephritis is known to result in high fever, pain in the back or flank, chills, as well as nausea or vomiting.

When should I visit a doctor?

You should see a urologist if you are experiencing any of the symptoms of a UTI. If you have a high fever, flank or back pain, or nausea, it is important that you seek medical treatment as soon as possible, as these are signs of a more serious kidney infection.

How different are Recurrent UTIs for males?

Male UTIs are considered complicated, and you should be investigated by a urologist because there may be an obstruction to your urination or there may be a bladder condition.

 

We need to assess for common conditions such as stones, benign prostatic enlargement and prostatitis (inflammation of the prostate). You may present with lower urinary tract symptoms, such as pain at the tip of the penis during urination. Other symptoms include:

 

  • Pain in the abdomen
  • Blood in the urine 
  • An inability to urinate
  • Infection of the kidneys or in the testes

What can I expect during my first consultation?

During your first consultation, you will be asked questions about your symptoms and medical history. Some of these are:

 

  • Describe the current symptoms
  • Duration of symptoms 
  • List of the medications you are taking (e.g. previous antibiotics prescribed)
  • Previous surgical procedures, if any
  • Other diseases or conditions (e.g. diabetes) 
  • Lifestyle (exercising, smoking, alcohol, and diet)
  • Amount of fluids taken each day
  • Sexual history, menopausal history for females

A urine sample will also be taken and sent to the laboratory. The results of this urine test may take a few days, during which you may be empirically prescribed various medications. 

In order to better understand your condition, a general physical examination of your abdomen and genitals may be conducted.

How are Urinary Tract Infections (UTI) diagnosed in Singapore?

UTIs are primarily diagnosed with a urinalysis and urine culture. The urinalysis will show the presence of white blood cells and red blood cells in the urine, both of which are signs of a UTI. A urine culture allows the growth of urinary tract bacteria in a laboratory, which will let your doctor identify the type of bacteria causing the infection and assess which antibiotics will be most effective in treating the UTI.

In cases of recurrent UTI, an ultrasound or other diagnostic imaging tests may be carried out to examine your urinary tract for any abnormalities. You may also be asked to undergo a cystoscopy.

  • Urine test You will need to provide a urine sample for tests to exclude any current urinary tract infection and traces of blood in the urine.
  • Uroflowmetry This is a simple test that electronically records urine flow rate. You will urinate into a container called a uroflowmeter. This test helps your doctor check whether there is any obstruction to the flow of urine.
  • Imaging of the bladder/kidneys You may get an ultrasound of the bladder and kidneys, which uses high-frequency sounds to create an image of your bladder/kidneys. You may also need an x-ray/CT scan at the Diagnostic Imaging Centre to exclude any causes for persistent/recurrent infections (e.g., stones in the urinary tract).
  • Cystoscopy If you have blood in the urine or an abnormal ultrasound/x-ray/CT finding of the bladder, you may be asked to undergo a flexible cystoscopy in the clinic. This day procedure allows us to look into your bladder using a telescope to assess if you have any other conditions.

How are Urinary Tract Infections treated?

Oral antibiotics

Oral antibiotics are the first line of treatment when it comes to UTIs. Some commonly used antibiotics include amoxicillin, nitrofurantoin, fosfomycin, and quinolones. Given the possibility of bacteria developing a resistance to any given antibiotic, it is important to follow your doctor’s instructions for taking your prescribed medications and fully complete any courses of antibiotics you are prescribed. 

Intravenous antibiotic treatment

In cases of recurrent UTI or multi-drug resistant UTI, you may require intravenous antibiotic treatment, possibly involving a short stay in the hospital. Following this intravenous treatment, you may still be prescribed a prolonged use of oral antibiotics to clear the infection fully.

Procedures

For UTIs caused by obstructions in the bladder or kidneys, a procedure to remove these obstructions will be arranged if needed.

Lifestyle changes

 In cases of frequent UTIs, your doctor may prescribe certain lifestyle changes, including: 

  • Avoid dehydration
  • Urinate regularly
  • Urinate after sex
  • Use lubrication during sex
  • Take a single dose of oral antibiotics following sexual intercourse
  • Longer term antibiotics (about 6 months)
  • Maintain proper toileting hygiene
  • Avoid vaginal douching
  • Females using spermicides or vaginal diaphragms should try alternative forms of contraception
  • Get screenings for conditions such as diabetes mellitus if suspected. If diabetic, proper glucose control is essential for preventing recurrent infections

Drug treatment for females

Medications may be required if self-management or lifestyle changes are inadequate to control the infections. Common medications are antibiotics, probiotics, cranberry extracts, topical estrogen cream/pessary for postmenopausal females. 

  • Post-coital prophylaxis — This is recommended if UTI is brought on by sexual intercourse
  • Probiotics or cranberry extracts — These are health supplements that may be useful in preventing UTIs in otherwise healthy individuals
  • Topical oestrogen cream — For postmenopausal females, we may recommend topical oestrogen cream/ pessary if you have dry or thin genitals. Topical oestrogen therapy improves the tissue quality of the genitalia region, prevents UTIs and relieves some symptoms such as pain when urinating. 
  • Intravesical therapy — For patients with severe, recurrent infections with failed treatments, I may suggest intravesical therapy using hyaluronic acid. This usually requires a few treatments performed weekly.
  • UTI vaccines — This group of medications help prevent UTI in females. It uses inactivated bacteria, usually taken orally or sublingually (under the tongue) over a period of 3 months.

Summary

While we can easily treat most UTIs, more severe cases of recurrent UTIs are more challenging to manage. If you are experiencing any symptoms of a UTI, please consult us for a proper diagnosis and medical treatment to prevent any further complications. 

Some over-the-counter supplements that help with UTI prevention are also available. However, you should speak to your doctor before taking any supplements to ensure that they are the right choice for you.

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Dr. Fiona Wu 2

Dr Fiona Wu
Consultant Urologist

MBBS (S'pore), MRCS (Edin), MMED (Surg),
MMED (Clinical Investigation),
FRCS (Urol) (RCPSG), FAMS (Urology)

Dr Fiona Wu is an experienced Consultant Urologist and is the Medical Director of Aare Urocare.

Prior to her private practice, she spent 15 years in public service. She was a Consultant in the Department of Urology at National University Hospital (NUH), Alexandra Hospital and Ng Teng Fong General Hospital.

She believes in treating urinary incontinence in a holistic way using minimally invasive methods – this ranges from laser treatment, neurotoxin injections, electromagnetic nerve stimulation to minimally invasive surgeries, etc. She worked closely with the gynaecology and colorectal departments to treat complex pelvic floor conditions and continues to do so in her own practice.

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