UTI Symptoms In Women: Simple & Complicated.

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UTI is 30 times more common in women than men. Also, about 25-40% of women in the USA have had UTI symptoms.

UTI symptoms in women typically include burning urination, frequent urge to pee, cloudy urine, and sometimes bloody urine.

However, these symptoms represent cystitis (UTI affecting the urinary bladder).

UTI symptoms in women can vary according to the site of infection:

UTI can be either:

Acute simple UTI (acute cystitis) is when the infection is confined to the urinary bladder.
Acute complicated UTI (acute pyelonephritis): Spread of the infection to the kidneys or even to the bloodstream and other body organs.
Asymptomatic UTI (Asymptomatic bacteriuria): Presence of UTI without symptoms.

Urethritis: infection confined to the urethra (without kidney or bladder infection).
Mimics of UTI: Presence of the symptoms of UTI (as dysuria) without evidence of infection.

Here are the main symptoms of UTI:

A. Simple cystitis in women:

Acute simple cystitis is the most common form of UTI in women. It was more common in women than men due to shorter and wider urethra.

The following are the most common symptoms of UTI in women:

Burning or painful urination during and after urination (dysuria).

Frequent urge to pee urine, but only a small amount comes out.
Sudden urge to pee.
Waking multiple times to pee at night.

Cloudy or turbid urine.
Vague lower abdominal pain (bladder pain).
Vague lower back pain.

Foul-smelling urine.
Bloody urine, or the presence of small blood clots in urine.

Recurrent cystitis:

Women are most commonly affected with simple acute cystitis. However, a significant proportion may suffer from recurrent UTIs.

Recurrent UTI has defined as two or more infections within six months OR three or more infections within a year (reference).

Studies estimate that 27% of women will experience recurrent UTIs (a second UTI within six months).

Common causes & risk factors of recurrent UTIs are discussed in this article.

B. Complicated UTI symptoms in women.

A complicated urinary tract infection in women refers to infections that extend beyond the urinary bladder. Either:

Infections of the kidneys (pyelonephritis), or
Bacteria or bacterial toxins reach the blood leading to sepsis and septic shock (urosepsis).

Complicated UTIs are rare (compared to simple cystitis). It mainly affects women with chronic diseases such as cancer, liver failure, etc.

Also, complicated UTIs are common among elderly women.

Symptoms of complicated UTI include (reference):

All the classic symptoms of acute cystitis (dysuria, urgency, frequency, blood in urine, etc.).
Fever >37.7°C (>99.9°F).
Chills or rigors.

Significant fatigue, muscle aches, or any other feature of systemic illness.
Flank pain.
Pelvic or perineal pain in men.

Tenderness over the kidney area when your doctor examines it (A tender costovertebral angle at the upper back just below the ribs).

C. Urethritis Symptoms in women

Urethritis is an inflammation limited to the urethra caused by microorganisms such as bacteria. It is more common in males. However, it may also occur in females (often associated with vaginitis or cervicitis).

Infectious urethritis may lead to sharp stabbing urethral pain and urethral discharge in females.

Symptoms:

Urethritis can be completely asymptomatic or with only a weird or strange sense of discomfort in the urethra.
Urethral pain (The pain is often sharp, stepping, and continuous). The pain becomes sharper when you pee.
Urethral discharge (the severity and nature of the discharge depending on the causative organism):
- Gonorrhea causes plenty of pus or pus and mucus discharge from the urethra that comes out without urination.
- Chlamydia trachomatics discharge is often scanty and watery. In females, it is often associated with vaginitis and cervicitis.
- Mycoplasma genitalium is often asymptomatic but may cause purulent (pus) discharge from the urethra.
- Herpes simplex urethritis intense dysuria (urethral pain) without significant discharge.
Dysuria (painful urination).
Associated vaginitis and cervicitis, sometimes with associated vaginal discharge, itching, vaginal bleeding, bleeding after sex, etc.

Most types of urethritis are sexually transmitted, So check with your partner if he has similar symptoms.
In females, gonorrhea may spread to the genital system causing pelvic inflammatory disease (infection of the uterus, fallopian tubes, etc.).

D. UTI symptoms in elderly women.

UTI is very common in elderly and debilitated women. UTI is one of the most common causes of unexplained fever, or deterioration of consciousness, or deterioration of general health in elderly women.

So, you should suspect UTI in older women with unexplained fever, confusion, or deterioration of health status.

Elderly women may not present with the classical symptoms (dysuria, frequency, and urgency). So, it is important to recognize the UTI symptoms in older women.

Symptoms:

Typical symptoms of cystitis may or may not present (dysuria, frequency, urgency, etc.). So, the absence of these symptoms is common in elderly women with UTI.
New onset urinary incontinence.
Unexplained fever.

Unexplained chills.
Mild to moderate confusion.
Mood changes.

Anorexia, loss of apetite.
Flank pain.
Disorientation to persons, time, or places.

Little or no urine.
Fainting or coma.
Shortness of breath.

Consider UTI if an older woman presents with one or more of the above systems.

Why do women keep getting urinary tract infections?

Frequent UTIs are common among women, even young, healthy women with normal urinary tracts.

Key statistics:

27% of women experience at least one recurrence of UTI within six months (reference).

2.7% will experience at least two recurrences within six months.
Women with E. coli-induced UTIs are more likely to have recurrent UTIs than other causes (44% recurrence within one year (reference)).

Recurrent or frequent UTIs mainly occur as simple (uncomplicated) urinary bladder infections.

Main risk factors (reference):

Behavioral risk factors.
- Being sexually active (the frequency of sexual intercourse is the strongest risk factor for recurrent cystitis (reference)).
- New sex partners.
- Diaphragm-spermicide use.
- Spermicide-coated condoms.
- Having the first UTI before or at the age of 15 years.
- Having a mother with a history of UTIs.
Abnormal Urinary tract (especially in postmenopausal women).
- Urinary incontinence.
- Cystocele (dropped or prolapsed urinary bladder into the vaginal space).
- Post-voiding residual urine (incomplete voiding of the urinary bladder).
Genetic or biological factors.
- Genetic predisposition to recurrent UTIs is obvious. For example, daughters of women with recurrent UTIs are at higher risk.

Can UTI in women have no symptoms?

Bacteria may be found & isolated from the urine of people without any symptoms or signs of UTI. This condition is called asymptomatic bacteriuria (reference).

Asymptomatic bacteria is common, especially in females. Also, the incidence of asymptomatic bacteria increases with advancing age (reference):

Asymptomatic bacteria is present in only 1% of school girls.
The prevalence gradually increases to more than 20% in women above 80.

The absence of symptoms may be explained by:

Bladder microbiome (bacteria normally live in the bladder).
Some types of bacteria can cause infection without provoking symptoms.
Host factors: Different people respond differently to bacteria inside the bladder. The immune system may not respond to infection in some people.

Current evidence doesn’t suggest initiating treatment for asymptomatic bacteriuria, Even with pus cells in urine (reference).