If Your UTI Is Getting Worse, You Might Be Dealing With A More Severe Kidney Infection
Urinary tract infections (UTIs) can be a pesky and painful experience down below. No one wants to be running out of their Zoom call every five minutes to hit the bathroom in discomfort. UTIs can also get even more complicated when some infections end up getting worse instead of better, even with proper treatment. What gives?
UTIs can be persistent and tough to get rid of. And some women are more likely to get them on a recurring basis (thanks, hormones!). (FWIW, one in five women gets a UTI at least once in her life, according to the National Kidney Foundation.)
The key to getting rid of your pee pain comes down to developing a treatment plan of action. And no, self-treating at home isn’t a good idea. The best way to tackle a UTI is through prescribed antibiotics from your doctor, along with a few best at-home practices for relief.
“It’s important to avoid certain activities, to give the area time to heal, flush out bacteria, and not worsen symptoms or cause irritation to the vaginal area,” says Bilal Chugtai, MD, urologist at Weill Cornell Medicine and New York Presbyterian.
If your UTI doesn’t clear up with a standard course of treatment and lifestyle changes (getting to those), it's possible you're not dealing with a UTI, and the infection is something worse. Don’t freak out, WH tapped doctors to help you navigate the painful (and sometimes confusing) issue of urinary tract infections. Here’s *everything* you need to know.
First: What is a UTI exactly—and how do you usually treat one?
Essentially a UTI is a bacterial infection that can form in your urethra, bladder, or kidneys, causing unpleasant symptoms like frequent urination, a burning sensation while you pee, pelvic pain, and more.
When UTI symptoms rear their ugly head, trying to treat them yourself will only give the infection more time to spread. The longer you wait to get medical attention, the more you're putting yourself at risk for more serious health complications.
“Waiting too long to start treatment can allow the infection to progress from a simple bladder infection treated with three days of oral antibiotics to a complex kidney infection requiring intravenous antibiotics,” says Ekene Enemchukwu, MD, assistant professor of urology at Stanford University School of Medicine.
Dr. Enemchukwu also points out that there's also the chance you're actually not dealing with a UTI at all—another reason to always check in with your health care provider about any concerning symptoms. "UTI-like symptoms, in the absence of bacteria, can be caused by other conditions, such as vaginal infections, STDs, kidney stones, severe constipation, and vaginal atrophy," says Dr. Enemchukwu.
It’s always better to err on the side of caution. Rather than trying the wait-and-see method, make an appointment with your doctor as soon as you notice any telltale signs of a UTI. And even if you’ve had a UTI before and have medication leftover from your last treatment, “there should be no giving of antibiotics without a new assessment,” emphasizes Margaret Mueller, MD, assistant professor of obstetrics and gynecology at Northwestern Feinberg School of Medicine. Instead you should call your provider, come into the office, discuss your symptoms, have a urine culture done, and then be given treatment.
If it’s a typical, mild UTI, here’s what your treatment will look like. These interventions can also make it easier for you to go about your day and sleep with a UTI.
Taking a prescribed oral antibiotic. Being on an antibiotic for three, seven, or 10 days is generally going to be your first line of defense. It’s likely that you’ll start to feel better after one or two days of taking your meds, that doesn’t mean the antibiotics have finished their job. If you stop your treatment too soon, the bacteria can build defenses against the meds, rendering the meds useless.
Drinking tons of water. Those dreadful bathroom visits may make you think twice about chugging a glass of water, but "water is essential for all bodily functions,” says Carolyn DeLucia, MD, of VSPOT Medi SPA. “If we are dehydrated, then the bacteria can fester in the bladder. When we are well-hydrated, we urinate regularly, and the water cleans the walls [of the urinary tract] easily.” Not drinking enough water can also prevent your medication from getting where it needs to go: “Antibiotics have to have good penetration into the kidneys and bladder,” adds Vandana Bhide, MD, board-certified internist and pediatrician at the Mayo Clinic. “Drinking a lot of water will help deliver the antibiotic to the urinary tract. It also flushes the kidneys and bladder, and it prevents dehydration and kidney stones.” Aim to drink half of your weight in ounces each day.
Avoiding foods that could irritate your bladder. Avoid foods and drinks that are known to rub the bladder the wrong way, including coffee, alcohol, caffeinated sodas, acidic fruits, spicy foods, and artificial sweeteners. “Exposing yourself to these irritants in the midst of a UTI isn’t particularly harmful or dangerous,” says David Kaufman, MD, of Central Park Urology in New York City, “it just makes you feel worse, like putting salt in a wound.”
Taking lots of bathroom breaks. If you have the urge to go but hold it in instead, you could be setting up your urinary tract for problems. When you retain your urine, you're causing your body to hang onto all those germs that are floating around in your bladder—the opposite of what you should do if you're hoping for a quick recovery. "Emptying out the bladder flushes out the bacteria that’s been introduced there,” says Dr. Bhide.
Pausing on sex. Doing it while you have a UTI isn't exactly advised. "Most women with symptomatic UTIs avoid sexual activity because it's too uncomfortable," notes Dr. Enemchukwu. "It can also theoretically push bacteria from the vagina back into the bladder, causing a new infection." So, it's generally best to refrain from sexual activity during an active infection. Adds Dr. Kaufman, “I usually allow the patient to decide when she is ready for sex—it’s typically not a big problem once she starts antibiotic treatment.”
Sooo...what happens if a UTI gets worse?
There are a few reasons why your UTI might not improve, the first being that you stop taking your antibiotics. “Survivor bacteria that have been exposed to a short course of antibiotics will evolve to resist that antibiotic,” explains Dr. Kaufman. That means the infection will no longer respond to the medication, making it much tougher to get rid of the UTI.
UTI getting worse even with antibiotics? It’s also an unfortunate fact that some women are more prone to UTIs than others. For example, women that are postmenopausal or around the time of perimenopause will experience a decrease in estrogen, which affects the type of bacteria that exists in the vagina, Dr. Mueller says. “When those 'good' bacteria are depleted, because that estrogen is no longer circulating, that can allow for vulnerability of the vagina and the lower urinary tract to let in what we call 'bad' bacteria, like E. coli, or [other] things that cause urinary tract infections,” she explains.
If you have more than two UTIs in six months or three in one year, docs will typically recommend you get a cystoscopy or CT scan to look inside the bladder and make sure there's nothing there that shouldn't be there (think: kidney stones).
That brings us to another reason your UTI could be getting worse: It might *not* be a standard UTI and is actually a more serious kidney infection that requires emergency care. This can occur when bladder infections are left untreated, Dr. Mueller says.
Symptoms of a more severe kidney infection can include:
Blood in urine
High fever
Chills
Flank pain
Nausea
Vomiting
Sepsis
How do you know if you’re dealing with a standard UTI or severe kidney infection?
Both are technically forms of UTIs. A standard UTI, though, typically just means you're dealing with cystitis, or inflammation of the bladder. That inflammation causes those typical UTI symptoms like painful or burning urination and urgent or frequent urination, explains Dr. Mueller.
But a kidney infection, also known as pyelonephritis, is caused by the same bacteria and oftentimes results from an untreated bladder infection. These symptoms are typically much more severe.
When should you seek medical attention for a UTI?
Always, Dr. Mueller says. Self-treatment is not a great idea. And while popular over-the-counter relief products like Azo do exist, they’re not recommended as treatment on their own. “[OTC products] can help with some of the symptoms,” Dr. Mueller explains, "but they have has no antibacterial properties.” Going to your doc for a prescribed antibiotic is your best bet, along with adding in those lifestyle best practices mentioned earlier.
And if there’s any indication that you’re experiencing a kidney infection, like blood in your urine or pain around your torso, head to the emergency room ASAP for urgent care. This will likely require hospitalization and intravenous antibiotics.
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