Urinary Tract Health

What is urinary tract health?

The urinary tract―made up of the kidneys, the bladder, and the tubes leading to and from these organs (the ureters and the urethra)―produces urine and eliminates it from the body.

First, the kidneys produce urine while filtering waste products from the blood. Urine travels from the kidneys to the bladder for storage through two tubes called ureters. The balloon-like bladder empties by pushing the urine through a tube at the bladder’s bottom called the urethra. The opening for the urethra is in front of the vagina in females, and at the tip of the penis in males.

Urinary tract health refers to how well the system works at removing wastes and producing and controlling urine, as well as any disorders or problems that might occur within the tract. These problems can affect the tract as a whole, or just certain parts of the urinary tract, such as the bladder.

This section focuses on two of the more common disorders related to the urinary tract health of women: Urinary Tract Infections (UTIs) and Urinary Incontinence (UI).

For information on a range of urinary tract health issues for women, men, and children, visit the National Kidney and Urologic Diseases Information Clearinghouse.

UTIs are common infections, usually caused by bacteria, in the bladder or urethra.

There are several kinds of UTI. The type of a UTI depends on where the infection occurs. For example:

• Urethritis is an infection in the urethra.
• A bladder infection is called cystitis.

If left untreated, a UTI could travel up one or both ureters to the kidney(s), causing pyelonephritis or a kidney infection. Kidney infections can become serious and may require hospitalization as part of treatment. UTIs are not the only cause of kidney infections.

UTIs are more common among women than among men. They also can affect children. For information about UTIs in children, https://www.niddk.nih.gov/health-information/urologic-diseases/urinary-tract-infections-in-children.

UI is the loss of bladder control, or being unable to control urination.

UI can affect men, women, and children, but women are twice as likely as men to experience UI.¹ This is due to the structure of the female urinary tract as well as the effects of pregnancy, childbirth, and menopause. UI is also more common among older women, although it is not a normal part of the aging process.

Adults may experience one of several types of UI^1,2

• Stress incontinence is usually related to a structural issue, such as when the bladder is out of its normal position. Urine leaks can occur during physical movement such as laughing, coughing, exercising, or lifting, or when no movement is occurring.
• Urge incontinence or overactive bladder is usually related to the muscles around the bladder. It occurs when urine leaks at unexpected times, including during sleep. Urge incontinence is most common in older people and may or may not be a sign of a UTI. It is also associated with certain neurological conditions, such as multiple sclerosis.
• Overflow incontinence happens when an overfilled bladder causes uncontrollable leaking of urine. A person with overflow incontinence may feel unable to completely empty the bladder. Causes include tumors, kidney stones, diabetes, and medications. Overflow incontinence is most common in men.
• Functional incontinence is the inability to get to the bathroom in time because of a physical or other type of disability.
• Mixed incontinence occurs when a person experiences more than one type of incontinence. Generally, mixed incontinence refers to a combination of stress and urge incontinence.
• Transient incontinence occurs when urine leakage is caused by a temporary situation such as an infection or new medication. Once the cause is removed, the incontinence goes away.

For information about UI in men, visit https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems.

For information about UI in children, visit https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems-bedwetting-children.

UTIs in Women

A UTI develops when microbes enter the urinary tract and cause infection. Bacteria are the most common cause of UTIs, although fungi rarely can also infect the urinary tract. E. coli bacteria, which live in the bowel, cause most UTIs.

The female anatomy contributes to women's increased likelihood of contracting a UTI.¹ A woman's urethra is shorter than a man's, allowing bacteria better access to the bladder. A woman's urethral opening is also close to sources of bacteria from the anus and vagina. Sexual activity can move bacteria to the urethral opening.

Having bacteria in the bladder does not always mean there is an infection. Like the bowel, the bladder has bacteria and other microorganisms that help to keep it healthy and functioning properly.

Some forms of birth control also increase the risk of UTIs. Spermicides can cause skin irritations that allow bacteria to invade. Diaphragms may slow urinary flow, encouraging bacteria to multiply. Unlubricated condoms or spermicidal condoms may cause irritation, which can help bacteria grow.¹

The following factors also may encourage bacteria to grow:¹

• Not drinking enough fluids
• Purposely holding in urine for long periods of time
• Spinal cord injuries or other nerve damage that makes the bladder difficult to empty regularly and completely
• Conditions or situations that block the flow of urine, such as a tumor, kidney stone, enlarged prostate, or sexual intercourse
• Diabetes and other conditions that reduce the ability of the body's immune system to fight off infection
• Catheters (tubes placed in the urethra and bladder to drain urine)
• Hormonal changes in the urinary tract of pregnant women that make it easier for bacteria to spread through the ureters and to the kidneys

For information about UTIs in children, visit https://www.niddk.nih.gov/health-information/urologic-diseases/urinary-tract-infections-in-children.

UI in Women

UI is caused by problems with the muscles and nerves that hold or release urine. These muscles include bladder muscles, which contract to force urine into the urethra, and sphincter muscles that surround the urethra, which relax to allow urine to pass from the body. Incontinence occurs if bladder muscles suddenly contract or sphincter muscles are not strong enough to hold back urine.

These muscles also help to hold the urinary tract in place, so if the muscles are weakened, they may not be able to keep the bladder or other structures in the right position in the body. These types of structural problems, such as when the bladder is out of position, can also cause UI.

UTIs, vaginal infections or irritation, and medications can temporarily cause or aggravate UI. Constipation and being overweight or obese put pressure on the bladder and its controlling muscles and can also cause or aggravate UI.

Other problems that can contribute to UI in women include:²

• Weakened and stretched pelvic muscles after childbirth, with aging, or from genetic causes
• Thinning and drying of the skin in the vagina or urethra after menopause
• Weak bladder muscles or muscle spasms
• Damage to nerves that control the bladder because of Parkinson's disease, multiple sclerosis, or physical injury
• Age-related or behavioral changes
• Diabetes
• Obesity
• Any injury, disability, or disease that makes it difficult to get to the bathroom promptly

For information about UI in men, visit https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems.

For information about UI in children, visit https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems-bedwetting-children.

UTIs in Women

Not every woman with a UTI has symptoms, but most people notice at least one or more of the following signs:¹

• Pain or stinging while urinating
• A frequent or strong urge to urinate, while often producing only a small amount of urine
• Milky, cloudy, dark, bloody, or foul-smelling urine
• Lower stomach or back pain

Pregnant women are more likely to get UTIs because of changes in the position of the uterus during pregnancy. In addition, pregnant women are more likely to have a UTI become a kidney infection, so they should see a healthcare provider as soon as possible after they notice symptoms. A woman's obstetrician may or may not regularly test for urinary tract infections during prenatal visits.²

Certain groups may have slightly different UTI symptoms:

• Women with catheters, tubes inserted into the urethra to drain urine, may experience a fever with a UTI, which could indicate that infection has reached the kidney. These women are at higher risk for kidney infections, so they should see their healthcare provider as soon as possible is they have a fever¹
• Older women with UTIs are more likely to feel tired, shaky, and weak and have muscle aches and abdominal pain.¹ In some older women, a UTI can quickly lead to a serious whole-body infection called sepsis. Sometimes the progression to sepsis can occur without a fever, so it is important that older women with UTI receive timely initial and followup care.

Some women may have UTI-like symptoms when they don't have a UTI. These types of symptoms may occur because of an irritant, such as a soap or a food or drink. In these cases, once the irritant is removed or goes away, the symptoms will go away too.

For information about UTIs in children, visit https://www.niddk.nih.gov/health-information/urologic-diseases/urinary-tract-infections-in-children.

UI in Women

The following are some signs of UI:³

• Leaking urine because of sudden pressure on the lower stomach from physical activity such as laughing, coughing, running, or lifting
• Sudden, strong, and frequent urges to urinate
• Unexpected and uncontrollable leaking of urine

For information about UI in men, visit https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems.

For information about UI in children, visit https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems-bedwetting-children.

UTIs in Women

To diagnose UTI, a healthcare provider will start by asking about symptoms and taking the patient's medical history. Sometimes, a woman may feel like she has a UTI, but may instead be experiencing irritation from some other cause, such as a soap or medication.

A healthcare provider may take one or more of the following steps to help confirm the presence of a UTI:¹

• Test the urine for the presence of bacteria and white blood cells, which fight infection. The patient may need to provide a "clean catch" urine sample. To do this, patients wash their genital areas to prevent bacteria from getting into the sample and then catch the urine midstream in a sterile cup.
• Culture the urine sample, especially if the patient has recurring infections or is a hospital patient. Culturing makes bacteria easier to identify by combining the urine with a substance that encourages bacteria to grow.
• Order a sensitivity test on any bacteria detected, which can help decide which antibiotic will be most effective for treating the infection.

For recurring UTIs, healthcare providers may order one or more of the following tests to find out if the urinary tract is normal:¹

• Kidney and bladder ultrasound. This test bounces sound waves off the pelvic organs to create an image of their structure and reveal abnormalities.
• Voiding cystourethrogram. The test creates an X-ray image of the bladder and urethra while the bladder is full and during urination. It can show abnormalities inside the organs and whether urine flow is normal.
• Computerized tomography (CT) scan. X-rays and computers are used in this test to create clear, detailed three-dimensional images.
• Magnetic resonance imaging (MRI). This test uses radio waves and magnets rather than X-rays to produce clear, detailed images of the body's organs and soft tissues.
• Radionuclide scan. During this test, special cameras and computers are used to create images as a small amount of a radioactive chemical passes through the kidneys.
• Urodynamics. This test determines how well the bladder, sphincter muscles, and urethra are storing and releasing urine.
• Cystoscopy. During this test, the healthcare provider inserts a tube-like instrument inside the urethra and bladder to look for a cause of infection, such as a structural anomaly.

For information about UTIs in children, visit https://www.niddk.nih.gov/health-information/urologic-diseases/urinary-tract-infections-in-children.

UI in Women

To diagnose UI, healthcare providers begin by taking a medical history and asking about symptoms. They often ask patients to keep a bladder diary to track patterns of voiding (urinating) and leaking episodes. The diary can help a healthcare provider understand the cause of the problem and how best to treat it.

Information collected in a bladder diary typically includes times and amounts a patient urinates, straining or discomfort, fluid intake, and when and about how much urine leaks. Healthcare providers may give patients a special pan that fits over the toilet rim to measure how much they urinate. If the diary, symptoms, and medical history are not enough to diagnose UI, healthcare providers may recommend other tests. In addition to urodynamics and cystoscopy tests and an ultrasound of the urinary tract, the tests may include:²

• A bladder stress test. This test requires a patient to cough vigorously while the healthcare provider watches for leakage from the urethra opening.
• Urinalysis and urine culture. A laboratory test of urine is conducted to detect infection, urinary stones, and other possible UI causes.

For information about UI in men, visit https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems.

For information about UI in children, visit https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems-bedwetting-children.

UTIs in Women

Because bacteria cause most UTIs, the usual treatment for the condition is bacteria-fighting antibiotics.¹

The choice of medication and length of treatment depend on the woman's medical history, the type of bacteria causing the infection, and whether the woman is allergic to any antibiotics.¹ Healthcare providers may order a sensitivity test to identify which type of bacteria are causing the infection and to help select the most effective antibiotic.

Antibiotic medication is most effective when patients take the full recommended amount. It is important not to stop taking antibiotics at the first sign of improvement. The infection may remain in the body even after symptoms disappear.

For more information on treatments for UTIs in women, visit https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-infection-uti-in-adults/treatment.

For information about UTIs in children, visit https://www.niddk.nih.gov/health-information/urologic-diseases/urinary-tract-infections-in-children.

UI in Women

Healthcare providers select treatments for UI based on the woman's age, the specific type of bladder control problem, and lifestyle.2 Several options are described below:

Bladder Control Training

This method may involve the following strategies:

• "Timed voiding," or using the bathroom at planned times; healthcare providers may use a bladder diary to help set a schedule
• Kegel exercises to strengthen the pelvic muscles that help hold in urine
• Lifestyle changes, including losing weight, quitting smoking, avoiding alcohol and caffeine, avoiding lifting heavy objects, and preventing constipation

Medications

Medications can be used to:

• Block nerve signals that cause urinary frequency and urgency
• Help prevent bladder spasms by relaxing bladder muscles
• Shrink the prostate and improve urine flow

Medications that prevent swelling and high blood pressure may increase urine output and aggravate UI. Switching to an alternative medication may solve the UI problem.

Biofeedback

Tracking the contractions of the bladder and urethra muscles with an electronic device or diary may help patients gain control over these muscles.

Neuromodulation

Implanting a device to stimulate the nerves leading from the spine to the bladder can be effective when urge incontinence does not respond to bladder training or medication.

Absorbent Underclothing

Absorbent products worn under clothes may help patients feel more assured and confident.

Vaginal Devices, Injections, and Surgery for Stress Incontinence

Options include:

• A stiff ring inserted into the vagina to reposition the urethra
• Collagen injected into the bladder neck and urethra tissues to thicken them
• Surgery to support the bladder in its normal position, which may be done with a sling that is attached to the pubic bone. (Learn more in Pelvic Floor Disorders.)

Catheterization

Inserting a catheter tube through the urethra into the bladder can assist people whose bladders do not empty completely because of overflow incontinence, poor muscle tone, surgery, or spinal cord injury.

For information about UI in men, visit https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems.

For information about UI in children, visit https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems-bedwetting-children.