Urinary tract infections (UTIs) are common, especially among women. While most uncomplicated UTIs can be easily treated with antibiotics, some UTIs can progress to complicated infections that require more aggressive treatment. Knowing the signs and symptoms of a complicated UTI can help you get the right care quickly.
What is a complicated UTI?
A complicated UTI is an infection that occurs in someone with an abnormal urinary tract or a medical condition that increases their risk of serious consequences. Factors that can make a UTI complicated include:
- An anatomical abnormality in the urinary tract like a kidney stone, enlarged prostate, or neuropathic bladder
- A urinary catheter or other medical device present in the urinary tract
- A weakened immune system due to illness, medication, or age
- Diabetes mellitus
- Pregnancy
Complicated UTIs have a higher risk of spreading to the kidneys or bloodstream. They also tend to be more difficult to treat and often require intravenous antibiotics or a longer course of oral antibiotics.
Symptoms of a complicated UTI
The most common symptoms of a UTI, complicated or uncomplicated, include:
- A frequent and intense urge to urinate
- A burning sensation when urinating
- Cloudy, strong-smelling, or bloody urine
- Pelvic pain or pressure
However, people with a complicated UTI may experience additional symptoms indicating the infection has spread or become severe. Watch for:
- Fever above 101°F (38°C)
- Chills and shaking
- Flank pain (pain in your back or side)
- Nausea and vomiting
- Confusion, dizziness, or fainting
- Fatigue and muscle aches
These signs can indicate the infection has reached the kidneys or entered the bloodstream. kidney infection, also called pyelonephritis, can permanently damage the kidneys and lead to sepsis, a life-threatening reaction to infection.
Who is at risk for a complicated UTI?
While anyone can develop a complicated UTI, some people are at increased risk. You may be more likely to get a serious kidney infection if you:
- Are female as women have a shorter urethra than men
- Are pregnant which changes the urinary tract’s structure and function
- Have diabetes which impairs the immune system
- Are over 50 years old as the urinary tract changes with age
- Have a history of frequent UTIs
- Have kidney stones or an enlarged prostate which can block urine flow
- Have a urinary catheter
- Have a health condition that weakens the immune system
Talk to your doctor if you are in one of these high-risk groups. Preventing UTIs through steps like hydration and urinating after sex can help avoid complications.
When to seek emergency care
Most UTIs can be treated with a doctor’s appointment and antibiotics. However, if you experience symptoms of a kidney infection like high fever, chills, vomiting, or confusion, seek emergency medical care. A kidney infection can rapidly progress to a life-threatening emergency.
Go to an emergency room or call 911 if you have:
- A fever above 103°F (39.4°C)
- Uncontrolled shivering and shaking
- Signs of shock like rapid heart rate, lightheadedness, or fainting
- Sudden inability to urinate
- Uncontrolled nausea and vomiting
- Severe new onset flank or abdominal pain
- A weakened immune system and signs of infection
Do not wait to see if symptoms improve on their own. Kidney infections and sepsis require prompt medical treatment.
Diagnosing a complicated UTI
To diagnose a complicated UTI, your doctor will start by asking about your symptoms and medical history. Be sure to mention any relevant factors like recent urinary catheter use, diabetes, or kidney stones.
Your doctor will likely order tests including:
- Urinalysis: Checks for bacteria, white blood cells, and traces of blood in the urine.
- Urine culture: Identifies the type of bacteria causing the infection.
- Blood tests: A complete blood count can reveal an elevated white blood cell level indicating infection. Kidney and liver function blood tests help assess how the infection is impacting your body.
- Imaging tests: Ultrasounds or CT scans of the urinary tract check for obstructions or anatomical abnormalities.
Based on your test results, your doctor can diagnose a kidney infection, urosepsis, or other complications and determine the best treatment.
Treating a complicated UTI
Uncomplicated UTIs can often be treated at home with oral antibiotics for 3-5 days. Complicated UTIs usually require more aggressive treatment such as:
- Intravenous (IV) antibiotics: You may need to be hospitalized for IV antibiotics that can more directly and thoroughly treat the infection.
- Prolonged antibiotics: Oral antibiotic courses for complicated UTIs are usually 10-14 days or longer.
- Hospital care: If you have a high fever, dehydration, or kidney failure, you may need care including IV fluids and close monitoring of vital signs.
- Removal of obstructions: An obstructing kidney stone or urinary catheter may need to be removed to allow the urinary tract to fully heal.
Make sure to take all prescribed antibiotics to completion, even if you start feeling better, to prevent the infection from recurring.
Preventing complicated UTIs
If you are prone to complicated UTIs, work with your doctor to reduce your risks. Steps you can take include:
- Drinking 6-8 glasses of fluids like water each day
- Urinating before and after sexual activity
- Taking showers instead of baths
- Avoiding feminine products that can irritate the urethra
- Properly caring for urinary catheters if needed
- Treating vaginal infections promptly
- Practicing good hygiene by wiping front to back
- Getting up to urinate every 2-3 hours during the day
Your doctor may also recommend taking preventive antibiotics after activities that frequently cause UTIs, like sexual activity. Be vigilant about symptoms and seek treatment quickly at the first signs of infection.
When should I follow up with my doctor?
Schedule a follow up appointment with your physician:
- After finishing your antibiotics to confirm the infection has resolved.
- If symptoms do not improve within 2-3 days of starting antibiotics.
- If symptoms return within 2 weeks of finishing treatment.
- To evaluate any structural problems in your urinary tract that may need additional treatment.
- To discuss prevention if you experience frequent complicated UTIs.
Proper follow up helps confirm the complicated UTI has been cured and prevent the infection from recurring or worsening.
Key points about complicated UTIs
- Complicated UTIs occur due to factors like urinary tract abnormalities or weakened immune systems.
- Symptoms include fever, chills, flank pain, nausea, and confusion.
- People with medical conditions like diabetes or kidney stones are at increased risk.
- Diagnose involves a urine test and sometimes imaging scans.
- Treatment requires intravenous or prolonged course antibiotics.
- Prevent by staying hydrated, urinating frequently, and managing risk factors.
- Follow up with a doctor to confirm cure and prevent recurrence.
The bottom line
Complicated UTIs can be serious infections that need prompt treatment with prescription antibiotics. Seek emergency care if you have fever, chills, flank pain, or confusion. Work with your doctor to get the right diagnosis, treatment, and preventive care if you are prone to complicated UTIs.