By Dr. Jamin Brahmbhatt
“Wait … can men really get urinary infections? Is this fake news?”
This was one of the messages I received over the past 24 hours.
Yes, men can get urinary tract infections. Not fake news.
All of this interest was sparked by news this week that President Bill Clinton has been hospitalized for treatment for a urinary tract infection that spread to his bloodstream.
I first heard the news when I was in a room with a new male patient who recently had two back-to-back urinary tract infections. This patient is one of hundreds I may see in a year as a urologist. They’re sent to me to help figure out why these infections are occurring and how to prevent the next one.
To quench the curiosity driven by the recent news, here’s what I’d like you to know about UTIs.
1. So what exactly is a UTI?
UTI is short for urinary tract infection. It’s an infection of the organs in your body — I call them pipes — that are meant to funnel your urine out of your system and into the urinal. Most UTIs are caused by bacteria that work their way into the urethra, prostate, bladder or kidneys.
2. How are UTIs in men different from those in women?
Way more women than men are diagnosed with UTIs. Anatomically, we feel this happens because women have a shorter urethra — the tube that connects the bladder to the outside world. The shorter length makes it easier for bacteria to travel to the urinary system. Men have longer urethras and therefore can be protected against urinary infections.
But the length of the urethra alone cannot protect men against UTIs — over their lifetimes, 12% of men will get urinary symptoms linked to a UTI. This by no means implies a urethra or penis are short or small. In men, there is usually a more clear pathologic cause to the infection beyond just the length of the urethra.
3. What puts certain men at a higher risk for UTIs?
There are many reasons why a guy may get a UTI — all of them we take seriously and should not be ignored.
Men older than 50 tend to get more infections than younger men. As a urologist, I see men get recurrent infections when they do not properly empty their bladder because of an enlarged prostate. Beyond the prostate, men may not empty their bladder if they have nerve damage from stroke, uncontrolled diabetes or injury to the spine. Men can also get infections that start from the prostate or testicles that seed up into the bladder, or the opposite can happen where the infection goes from the bladder to the other organs. Kidney stones can also be a cause of infection. (I know this from personal experience — I’ve had a kidney stone myself!)
Younger men may also present with urinary infections because of sexually transmitted diseases. Men can also get an infection if they have a recent procedure done in the urinary system.
4. What are the signs and symptoms of a UTI?
Burning with urination (dysuria), increased urinary frequency, urgency, incontinence, foul smell, blood in the urine, fevers, chills, pain in the abdomen near the bladder. Believe it or not, some men may have zero symptoms and still get diagnosed with a UTI based on urine cultures done for other purposes.
5. How are UTIs diagnosed?
UTI is diagnosed by sending your urine off for a culture. This is when a sample of your urine is processed and evaluated for various strains of bacteria. The most common bacteria identified in urinary tract infections is E.coli. Once the culture is done, the results can guide treatment, which is usually oral antibiotics. There is a test called a urine analysis which can be done quickly in our office which can suggest an infection. However, the best test is an actual culture.
Doctors do not wait for the culture results — which can take one to three days — to start treatment. If an infection is suspected, an antibiotic will be started immediately and then adjusted based on the culture results.
6. How is a UTI treated?
UTIs generally are treated with oral or IV antibiotics. Most infections can be treated with oral antibiotics. However there are superbugs that may be resistant to what we can give you by mouth that may require the use of stronger antibiotics through an IV. Most treatments last seven to 10 days, but can be longer.
In severe cases of infection that has spread to the bloodstream, strong IV antibiotics are started immediately to control the infection. Patients are placed in the hospital to start these strong treatments. You do not have to stay in the hospital for weeks if you have infection in your bloodstream. As long as you are doing well — no fever, normal labs, heart and pulse OK — then you may continue these IV treatments from home. Each treatment is tailored to your condition.
7. Can UTIs be treated with home remedies?
As a doctor, my answer is: No. Men should not try to treat infections on their own. If you have symptoms, get yourself to a doctor or emergency room.
8. How can UTIs be prevented?
The best prevention is making sure first there is nothing anatomical that needs to be corrected, such as an enlarged prostate, kidney stone or blockage.
Proper hygiene can help prevent infections. Men with uncircumcised penises should make sure they can retract the foreskin and clean under the foreskin and the glans properly. Cranberry supplements have been shown to help prevent infections. Staying hydrated by drinking enough fluids/water during the day can also help. Making sure you don’t hold your urine can help, too. Staying in good health to avoid chronic medical conditions such as diabetes and heart disease will also protect against infections.
9. My infection is gone. Are there any long-term effects on my body?
Recurrent, untreated infections could cause strictures, or tight scars, in your urethra that would slow your stream and make it difficult to empty your bladder. Infections could also cause the bladder to lose its ability to fill and empty properly. In the long run, if you are getting constantly treated with antibiotics, we may run out of antibiotics to give you due to resistance.
10. After I get treated for my first infection, what’s next?
The first priority is to clear the infection with antibiotics.
From there, we do a full workup with a detailed history, evaluation of chronic medical problems and exam of the genitals to look for anatomic issues such as a foreskin that won’t retract back. Imaging may include a CT scan of the abdomen and pelvis to look for kidney stones, blocked tubes and other abnormalities.
If you see a urologist, you will likely get a cystoscopy, where we place a camera inside of a small tube into the urethra to look at the inside of your urine channel. The cystoscopy helps look for strictures, large obstructing prostates and changes to the bladder walls. Once a cause is found, it’s aggressively treated with either medication or surgery.
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