Urinary Tract Infection

Symptoms

• Burning with urination: A stinging or burning feeling when you pass urine (dysuria).
• Frequent, urgent urination: A strong, persistent need to urinate, often passing only small amounts.
• Cloudy or strong-smelling urine: Urine may look murky or have an unusually strong odor.
• Pelvic or lower abdominal pressure: Discomfort or aching low in the belly or pelvis.
• Blood in the urine: Urine may appear pink, red, or cola-colored (hematuria).
• Flank or back pain: Pain in the side or lower back can signal the infection has reached a kidney.
• Fever, chills, or nausea: Higher fever with shaking chills, nausea, or vomiting suggests a more serious or kidney infection.

When it's an emergency

Come to Bellaire ER or come in now if a suspected UTI comes with a high fever (about 101°F or higher), shaking chills, or pain in your side, flank, or lower back. These are warning signs of a kidney infection (pyelonephritis), which can become serious quickly.

Seek emergency care if you have nausea or vomiting that keeps you from holding down fluids or oral antibiotics, confusion or new disorientation (especially in older adults), or if you feel very unwell, dizzy, or have a racing heart. These can be signs of a bloodstream infection (sepsis).

Go to the ER if you are pregnant, have diabetes, have kidney stones or a urinary catheter, take medicines that weaken your immune system, or if symptoms are severe or rapidly worsening. Men with UTI symptoms should also be evaluated promptly, as infections are less common and may need further workup.

Also come in promptly if you have visible blood in your urine, are unable to urinate, or if your symptoms do not improve within a couple of days of starting antibiotics.

When it's not an emergency

If you are an otherwise healthy adult with mild, classic symptoms: burning with urination, urgency, and frequency, without fever, back pain, or vomiting, an emergency visit usually is not required. These uncomplicated UTIs are commonly treated with a short course of antibiotics.

Bellaire ER offers telemedicine and online urgent care visits that can be a convenient option for uncomplicated UTIs. A clinician can review your symptoms, and when appropriate, prescribe antibiotics without an in-person visit. Your primary care physician is also a reasonable choice for mild cases.

Drinking plenty of water and taking over-the-counter urinary pain relievers may ease discomfort while you arrange care, but they do not cure the infection, a UTI still needs antibiotics. If your symptoms worsen, a fever or back pain develops, or you do not improve, seek in-person care promptly.

What else could be causing this

Bladder infection (cystitis)

Bacteria, most often E. coli from the bowel, travelling up the urethra into the bladder. This is what most people mean by a UTI: burning, urgency and frequency without fever or back pain. It is the common cause and the least dangerous one.

Kidney infection (pyelonephritis)

The same infection having moved up a ureter into a kidney. The distinguishing features are fever, shaking chills, pain in the flank or lower back, and often nausea or vomiting. This is the cause that turns a UTI into an emergency.

Urethritis, including sexually transmitted infection

Inflammation of the urethra alone. Burning with urination and discharge, often without the bladder urgency and frequency of cystitis. Chlamydia and gonorrhoea cause this and are treated differently from a bladder infection, so the distinction matters.

Kidney stones

A stone passing down the ureter. The pain is usually severe, comes in waves, starts in the flank and moves toward the groin, and there is often blood in the urine. Stones and infection can occur together, and a stone blocking an infected kidney is a surgical emergency.

Vaginitis

A yeast or bacterial infection of the vagina. Itching, irritation and discharge predominate, and the burning is often felt on the outside as urine passes rather than deep in the bladder. It is a frequent reason a presumed UTI does not respond to antibiotics.

Prostatitis

Infection or inflammation of the prostate in men. Urinary burning and frequency with pelvic, perineal or low back pain, sometimes fever. Urinary infection in men is less common than in women and is more often associated with an underlying cause, so it is worked up rather than simply treated.

Interstitial cystitis and bladder irritation

Chronic bladder pain, urgency and frequency with no infection to find. Urine tests are repeatedly negative or borderline. It is a diagnosis of ongoing care rather than of the emergency room, but it explains recurring symptoms that antibiotics never fix.

Catheter-associated infection

Infection in someone with an indwelling urinary catheter. Symptoms are often blunted, fever, confusion or simply feeling unwell rather than burning, because the catheter bypasses the sensations a bladder infection usually produces.

Asymptomatic bacteriuria

Bacteria present in the urine without symptoms. Common in older adults and usually not treated, because treating it does not help and encourages resistance. The exception is pregnancy, where it is treated. This is why a positive urine dip alone is not a diagnosis.

What happens when you arrive

When you arrive at Bellaire ER with UTI symptoms, you are seen by a board-certified emergency physician. Your evaluation typically starts with a urine test (urinalysis), and a urine culture may be sent to identify the exact bacteria and guide antibiotic choice.

If your physician is concerned about a kidney infection, kidney stones, or another cause, we can perform on-site CT, ultrasound, and full lab work right away. Blood tests can check for signs of a more serious or spreading infection.

We diagnose and treat in a single visit, most patients do not need a hospital transfer. Depending on your results, treatment may include antibiotics (oral or IV), fluids, and medication for pain or nausea. Before you leave, your physician explains your results and gives you a clear follow-up plan.

For mild, uncomplicated cases, our telemedicine service may let you start treatment without coming in at all.

Tests we can run on site

Urinalysis

A sample of urine examined for white blood cells, nitrites, leukocyte esterase, blood and protein. It is the first test, and it establishes whether there is an infection at all rather than another cause of the same symptoms.

Urine culture

Growing the bacteria to identify the organism and which antibiotics it responds to. Results take a day or two, so treatment is usually started before the culture returns and adjusted if the culture disagrees. It matters most in recurrent infections, men, pregnancy and treatment failure.

Blood work

A white cell count, kidney function and electrolytes, and markers of inflammation. These indicate whether the infection has gone beyond the bladder, how the kidneys are coping, and whether you are dehydrated.

Blood cultures

Drawn when there is fever, shaking chills or signs of a spreading infection, to see whether bacteria have entered the bloodstream. They identify the organism when a urine sample alone does not explain how unwell someone is.

Ultrasound

Sound-wave imaging of the kidneys and bladder, with no radiation. It shows a blocked or swollen kidney, retained urine in the bladder, and some stones. It is often the first imaging used in pregnancy and in children.

CT scan

Cross-sectional imaging, used when a stone, an obstructed kidney or an abscess is a possibility. It is the test that finds a stone blocking an infected kidney, the combination that cannot be managed with antibiotics alone.

Pregnancy test

Done for anyone who could be pregnant, because pregnancy changes both the urgency of treating a urinary infection and which antibiotics are safe to use.

Treated here, or transferred

Bellaire ER is a licensed freestanding emergency room: board-certified emergency physicians and nurse practitioners, on-site CT, X-ray, ultrasound and laboratory, medication administered on site, open 24 hours a day, 365 days a year for adults and children. It is equipped for emergency evaluation, stabilization and treatment, and it is not a hospital.

Most urinary infections are fully handled here. A bladder infection is diagnosed on a urine test and treated with antibiotics, with a prescription written for you to fill at your pharmacy. Many kidney infections are also treated here: IV fluids, IV antibiotics, and medication for pain and nausea, in people who are otherwise well enough to go home on oral antibiotics afterwards.

Some need a hospital. A kidney infection in someone who is pregnant, who cannot keep fluids or medication down, whose blood pressure is dropping, who has signs of sepsis, or who has a stone obstructing an infected kidney needs admission, and an obstructed infected kidney needs a urologist to drain it. In those cases treatment begins here: fluids, antibiotics, monitoring, imaging to find the obstruction, and continues without interruption during transfer to the hospital service that can take over. Transfer is not a failed visit; identifying who needs it is one of the things the visit is for.

If your urine test is negative, that is useful information rather than a dead end. Your physician looks for what else produces the same symptoms, and explains what to do next.

Children

Urinary infection in children often does not look like it does in adults. Infants and toddlers cannot describe burning, so the presentation is a fever with no obvious source, irritability, poor feeding, vomiting, foul-smelling urine, or in babies, jaundice or poor weight gain. A fever without a source in a young child is one of the standard reasons to test the urine.

Getting a reliable sample is part of the evaluation. In a child who is not toilet trained, a bag sample is unreliable for diagnosis, and a catheter specimen is the standard way to obtain urine that can be interpreted. School-age children can usually give a clean mid-stream sample and may describe burning, urgency, daytime wetting after being dry, or belly pain.

Bring a child in promptly for fever with urinary symptoms, flank or back pain, vomiting, or a child who is drinking poorly or looks unwell. Any fever in an infant under three months is an emergency evaluation in its own right regardless of the suspected cause. Bellaire ER treats adults and children, with on-site laboratory and ultrasound, ultrasound rather than CT is usually the first imaging in children.

Urinary infection in a young child is followed up rather than closed out. A first confirmed infection in an infant or a recurrence in any child is a reason for imaging and specialist follow-up to look for reflux or a structural cause, so keep the follow-up that is arranged.

After you leave

Antibiotics usually begin to ease burning and urgency within a day or two for a bladder infection, and over two or three days for a kidney infection. Finish the whole course even once you feel well; stopping early is a common reason an infection returns. Drink fluids steadily, and expect urine to look and smell normal again as the infection clears.

Come back, or seek care the same day, if a fever develops or climbs, if you get shaking chills, if pain appears in your flank or lower back, or if you start vomiting and cannot keep the antibiotic down. Those changes mean the infection is behaving like a kidney infection rather than a bladder one, even if it did not start that way.

Return too if your symptoms have not improved at all after two to three days of antibiotics, if they improve and then come back within a couple of weeks, if you cannot pass urine, or if you see frank blood in the urine that is new. Not improving often means the organism does not match the antibiotic, and the urine culture sent while you were here is what answers that.

If a culture was sent, make sure you can be reached for the result, and keep the follow-up appointment you were given. Men, pregnant patients, children, and anyone with a second infection within six months should be followed up rather than simply treated again, because a repeat infection is a reason to look for a cause.

Lowering your risk

You can lower your risk of UTIs by drinking plenty of fluids, especially water, and not holding urine for long periods. Urinate when you feel the need rather than waiting.

For women, wiping from front to back after using the toilet helps keep bacteria away from the urethra, and urinating shortly after sexual activity may reduce risk. Avoid douches and scented feminine products, which can irritate the urinary tract.

If you get frequent UTIs, talk with a clinician. They can look for underlying causes and discuss options such as preventive strategies or, in some cases, low-dose preventive antibiotics.