Do I Have a UTI? Signs, Causes, and Treatment

A urinary tract infection (UTI) can make something as ordinary as going to the bathroom suddenly take over your day. You pee, feel the burn, and 10 minutes later your bladder is telling you to go again. If you’ve dealt with these symptoms before, you may recognize the pattern right away. But if this is your first time, the symptoms may seem oddly unpleasant and even harder to differentiate from a vaginal infection, your period, or both.

UTIs are very common. More than one in two women over the age of 20 will have a UTI at some stage in their life, and nearly one out of every four of these women can develop recurrent UTIs.¹ Most uncomplicated bladder infections are treatable. But that’s not the whole point. You should understand why it happens in the first place and what you have to do about it.

On this page

1. What is a UTI?
2. Why are UTIs so common in women?
3. What does a UTI feel like?
4. Signs at a glance
5. Can sex cause a UTI?
6. Is it really a UTI or could it be something else?
7. Why do some women keep getting UTIs?
8. Are UTIs different during pregnancy?
9. How are UTIs diagnosed?
10. What if bacteria are found but you have no symptoms?
11. How are UTIs treated?
12. What actually helps prevent UTIs?
13. When to see a doctor?

What is a UTI?

A urinary tract infection (UTI) occurs when bacteria or other microorganisms infect any part of the urinary system. The urinary system consists of the kidneys, ureters, urethra and bladder.

Most of the time, UTIs in women involve the bladder, an infection known as cystitis.² If bacteria move up the urinary tract to one or both kidneys, the infection is called pyelonephritis, or a kidney infection, and is a more severe infection that needs prompt care.

Why are UTIs so common in women?

It’s because of their unique anatomy. The female urethra is short. Its opening is near the vagina and anus. This means bacteria from the bowels and the skin can easily enter the bladder.

E. coli is typically the primary culprit. It’s a bacterium that naturally lives in the gastrointestinal tract (the digestive system, including the stomach and intestines). According to the CDC, E. coli causes 80% to 90% of UTIs.³

So it’s the bacteria in your body that causes a UTI. However, developing an infection doesn’t necessarily mean you have poor hygiene. Your risk may be higher if you⁴:

• Have had a UTI before
• Are sexually active
• Use spermicides (a contraceptive product that kills or disables sperm) or a diaphragm (a reusable contraceptive device placed inside the vagina to cover the cervix)
• Are pregnant
• Have difficulty emptying your bladder
• Have kidney or urinary tract stones
• Have diabetes
• Use a urinary catheter (a thin tube inserted into the bladder to drain urine)
• Are experiencing perimenopause or menopause

What does a UTI feel like?

A bladder infection changes how you feel when you urinate and increases how often you need to go. Common symptoms include²:

• Pain or burning sensation during urination
• Feeling the need to urinate more frequently than usual
• A strong and sudden urge to urinate
• Passing only small amounts of urine
• A feeling as if you haven’t properly emptied your bladder
• Pain or discomfort in the lower abdomen
• Cloudy urine
• Blood in the urine
• An unusually strong urine odor

However, you don’t need to have all these symptoms. Additionally, cloudy or foul-smelling urine does not necessarily mean you have an infection. Dehydration, certain foods, or certain drugs can affect the appearance or smell of urine. Vaginal secretions or blood (which occurs with your period) may also affect how your urine looks or smells.

Signs at a glance

Can sex cause a UTI?

Yes. Sexual activity is a known risk factor for UTIs. Friction and movement during sex can push bacteria from the genital or anal area toward the urethral opening. That’s why many women experience a distinctive sequence of UTI: sex one day, burning and urgency the next.

But that doesn’t mean that a urinary tract infection is a sexually transmitted infection. The bacteria that cause most bladder infections are already living near your gastrointestinal or genital areas.

STIs can sometimes mimic a UTI, though. If you have symptoms such as vaginal discharge, pain in your pelvic area, open genital sores or blisters, bleeding between your periods, a new sex partner, or exposure to an STI, it is sensible to consider both possibilities.⁵

Is it really a UTI or could it be something else?

That burning sensation when you pee doesn’t always come from your bladder.

When the vulva or vaginal opening is inflamed, urination over the inflamed area can cause a burning sensation even if there is no urinary infection. Yeast infections (an overgrowth of Candida yeast that commonly causes vaginal itching, soreness, and discharge), bacterial vaginosis (a condition caused by an imbalance of the normal bacteria in the vagina), and trichomoniasis (a sexually transmitted infection caused by a parasite) can also cause itching, irritation, bad odor, or vaginal discharge.⁶ Chlamydia and gonorrhea (both are bacterial STIs) can also lead to painful urination.⁵

If your urine tests are negative but you feel like you’ve had “UTIs”, it may be time to revisit the diagnosis. There are many other reasons to have the symptoms that you feel, such as vaginal infections, STIs, bladder pain syndrome (a long-term condition that can cause bladder pain, pressure, and frequent urination without a typical bacterial infection), urinary stones, and pelvic floor problems (the group of muscles that supports the bladder, uterus, vagina, and bowel). Recurring symptoms require an explanation, not just restarting antibiotics.

Why do some women keep getting UTIs?

A recurrent UTI means two or more UTIs within 6 months or three or more within 12 months.¹⁷

Almost one-quarter of women who develop a UTI will experience recurrent infections.¹ The reason varies from woman to woman. For one woman, infections may repeatedly follow intercourse. For another, spermicide use may contribute. Therefore, if infections keep returning, it’s important to identify the pattern.

Are UTIs different during pregnancy?

Yes. You do need to be a bit more cautious about UTIs during pregnancy. UTIs occur in about 8% of pregnancies.⁸ Pregnancy-related hormonal and physical changes can make it easier for bacteria to travel toward the kidneys. UTIs in pregnancy are associated with pyelonephritis, preterm delivery, and low birth weight.⁸

Pregnancy is also one of the few situations in which bacteria in the urine may need treatment even when there are no symptoms. This is called asymptomatic bacteriuria, and it affects an estimated 2% to 10% of pregnant patients.⁸

Therefore, ACOG recommends a urine culture early in prenatal care.⁸ If you are pregnant and notice burning or urgency, blood in the urine, or other symptoms of UTI, call your OB-GYN. Do NOT self-treat with antibiotics, as the selection of antibiotics is important in pregnancy.

How are UTIs diagnosed?

Often the first step in diagnosis is your symptoms. Urinalysis can identify findings that are consistent with infection, such as blood and white blood cells. For culture, the bacteria are allowed to grow in the laboratory so the organism may be identified and antibiotic sensitivity determined.⁹

Home UTI dipstick tests check urine for markers such as nitrites and leukocyte esterase (an enzyme associated with white blood cells). They can provide a clue, but a positive result does not confirm a UTI on its own. A negative result can make infection less likely, but it should not replace medical advice when symptoms persist, recur, are severe, or occur during pregnancy. A culture is particularly useful if:

• You are pregnant
• UTIs keep returning
• Your symptoms are unusual
• Initial treatment has failed
• A kidney infection is suspected
• Antibiotic resistance is a concern

What if bacteria are found but you have no symptoms?

Not all bacteria found in urine require medication. Asymptomatic bacteriuria involves bacteria without UTI symptoms. Antibiotics are generally not used in healthy nonpregnant adults because treatment offers minimal benefit and can lead to antibiotic resistance.¹⁰

As mentioned before, pregnancy is an important exception.⁸¹⁰

How are UTIs treated?

Most cases of bacterial UTIs are treated with antibiotics. No single antibiotic is best for everyone. Your health care professional can choose the most appropriate antibiotic based on your previous urine culture results, other health conditions, allergies, pregnancy, kidney function, recent antibiotic use, and local resistance patterns.¹¹

Follow your healthcare provider’s instructions precisely, and don’t take any medication from a previous infection. While recovering, you can also:

• Drink enough fluid to remain hydrated unless you have been advised to restrict fluids.
• Use a heating pad over your lower abdomen if it helps.
• Ask which pain medication is appropriate for you.

Phenazopyridine (a urinary pain reliever) may temporarily ease burning and urgency, but it does not treat the infection and can turn urine red-orange.¹²

If symptoms become worse, do not get better, or if they return quickly following treatment, seek advice from your medical practitioner instead of using the same medicines again and again.⁷

What actually helps prevent UTIs?

You can find lots of advice on UTIs online, but some of it is more evidence-based than others.

Drink enough water

If you usually drink very little water, increasing your intake can help.

In a randomized trial of 140 premenopausal women with recurrent UTIs, adding 1.5 liters of water a day was associated with an average of 1.7 episodes of cystitis over 12 months.¹³ Women who did not change their daily fluid intake averaged 3.2 episodes.¹³

That doesn’t mean everyone should try to chug a few more liters, but if your fluid intake has been consistently low, enhancing your hydration could be a good step.

Observe for any trend involving sex or contraception

If you notice a pattern of UTIs occurring after sex, inform your doctor. Some women may be offered prevention antibiotics around the time of sex.⁴⁷

Spermicides and diaphragms can also raise the risk of UTIs. So, consider changing your method if UTIs occur frequently.

Consider menopause-related changes

Declining estrogen levels during perimenopause and menopause can cause the tissue of the vagina and urinary tract to change. These changes are part of genitourinary syndrome of menopause (GSM) and may lead to recurrent urinary tract infections (UTIs).

For suitable women, low-dose vaginal estrogen may help lower the recurrence rate and should be considered with a doctor.⁴⁷

Does cranberry work?

Cranberry may help prevent recurrent UTIs, but it does not treat an infection.

A 2023 Cochrane review of 8,857 patients showed that cranberry reduced the risk of symptomatic, culture-proven UTIs in women with recurrent infections.¹⁴ The major problem is the wide variation in cranberry products and doses. There isn’t enough evidence to recommend cranberry for prevention during pregnancy.¹⁴

What about D-mannose?

That’s not so convincing. A study of 598 women with recurrent UTIs demonstrated that there was no difference in the number of recurrent medically attended UTIs with daily use of D-mannose versus placebo.¹⁵

Therefore, we would not recommend D-mannose as your primary preventive measure.

When to see a doctor?

Contact a healthcare professional if:

• This is your first suspected UTI
• Symptoms are persistent or worsening
• Symptoms do not improve after treatment
• The infection returns soon after antibiotics
• You are experiencing recurrent UTIs
• Blood in the urine continues after the infection clears
• You also have vaginal discharge, genital sores, significant itching, bleeding between periods, or possible STI exposure
• You have kidney stones, difficulty emptying your bladder, or another urinary condition
• You are pregnant or could be pregnant and have urinary symptoms

Frequently asked questions