It is uncommon to have a urine infection if you are a man under the age of 50. The usual treatment is a course of a medicine called an antibiotic. Tests to assess the bladder, prostate, or kidneys are sometimes advised.
Understanding the urinary tract
There are two kidneys - one on each side of the upper part of the tummy (abdomen). They make urine which drains down tubes called ureters into the bladder. Urine is stored in the bladder. It is passed out through a tube (called the urethra) from time to time when we go to the toilet.
In men the prostate gland sits just underneath the bladder. If the prostate is enlarged, this may affect how well the bladder drains.
What is a urine infection and what causes it?
Most urine infections are caused by germs (bacteria) which come from your own bowel. They cause no harm in your bowel but can cause infection if they get into other parts of your body. Some bacteria lie around your back passage (anus) after you pass a stool (faeces). These bacteria sometimes travel to the tube which passes urine from your bladder (the urethra) and into your bladder. Some bacteria thrive in urine and multiply quickly to cause infection.
A urine infection is often called a urinary tract infection (UTI) by doctors. When the infection is just in the bladder and urethra, this is called a lower UTI. If it travels up to affect one or both kidneys as well then it is called an upper UTI. This can be more serious than lower UTIs, as the kidneys can become damaged by the infection.
This leaflet only deals with urine infections in men. It does not deal with sexually transmitted infections such as chlamydia which can affect the urethra and cause similar symptoms. See separate leaflets called Cystitis (Urine Infection) in Women, Recurrent Cystitis in Women and Urine Infection in Children.
How common are urine infections?
Urine infections are rare in men aged under 50. They become more common in older men. Urine infection is much more common in women.
Why do some men develop urine infections?
In some cases an underlying problem can increase the risk of developing a urine infection. These include the following:
- An enlarged prostate may stop the bladder from emptying properly. Some urine may then pool in the bladder. Germs (bacteria) are more likely to multiply and cause infection in a stagnant pool of urine. See separate leaflet called Prostate Gland Enlargement for more details.
- Bladder or kidney problems may lead to infections being more likely. For example, kidney stones or conditions that cause urine to pool and not drain properly.
- Having a urinary catheter. A catheter is a thin, flexible, hollow tube, passing from the bladder to the outside. This may be used to help you pass urine in a number of different circumstances. Having a catheter is the most common cause of urine infections which develop whilst in hospital.
- A poor immune system increases the risk of having any infection, including urine infections. For example, if you have AIDS or are taking chemotherapy.
In other cases the infection occurs for no apparent reason. There is no problem with the bladder, kidney, prostate, or defence (immune) system that can be identified.
What are the symptoms of a urine infection?
- Infection in the bladder (cystitis) usually causes pain when you pass urine, and you pass urine more frequently. You may also have pain in your lower tummy (abdomen). Your urine may become cloudy, bloody or smelly. You may have a high temperature (fever).
- Infection in the kidneys may cause pain in a loin (the side of the abdomen over your kidney) and a high temperature (fever). It may cause you to feel sick or be sick (vomit). You may feel generally unwell.
In some elderly men, the only symptoms may be a recent onset of confusion or just feeling generally unwell, even without any actual urinary symptoms.
Are any tests needed?
A urine sample can confirm the diagnosis and identify the germ (bacterium) causing the infection. Further tests are not usually necessary if you are otherwise well and have a one-off infection. However, your doctor may advise tests of your kidney, prostate, or bladder if an underlying problem is suspected.
An underlying problem is more likely if the infection does not clear with an antibiotic medicine, or if you have:
- Symptoms that suggest a kidney is infected (and not just the bladder).
- Recurring urine infections. For example, two or more in a three-month period.
- Had problems with your kidney in the past, such as kidney stones or a damaged kidney.
- Symptoms that suggest an obstruction to the flow of urine.
- Blood-stained urine which persists after treatment with antibiotics.
Tests may include:
- An examination of your prostate gland by examination of your back passage (rectum).
- A general blood test or a specific blood test to check on your prostate, called Prostate Specific Antigen, or PSA.
- A scan of your kidneys or bladder such as an ultrasound scan.
- An X-ray to look for kidney stones.
- A look inside your bladder with a special telescope (cystoscopy).
- Tests to see how well your bladder is working, called urodynamic tests.
What is the treatment for a urine infection in men?
- A course of an antibiotic medicine will usually clear the infection quickly. This is usually for seven days. You should see a doctor if your symptoms are not gone, or nearly gone, after a few days.
- Paracetamol or ibuprofen will usually ease any pain, discomfort, or high temperature (fever).
- Have plenty to drink to help prevent a lack of fluid in the body (dehydration) if you have a fever and feel unwell.
What is the outlook (prognosis)?
The vast majority of men improve within a few days of starting treatment. See a doctor if you do not quickly improve. If your symptoms do not improve despite taking an antibiotic medicine then you may need an alternative antibiotic. This is because some germs (bacteria) are resistant to some types of antibiotics. This can be identified from tests done on your urine sample.
Occasionally the infection may spread and cause you to be more unwell. Infection in the bladder (cystitis) may spread to the kidney (pyelonephritis). Infection may also spread to involve the prostate gland, causing infection of the prostate gland (prostatitis). Occasionally it may lead to a swelling caused by a collection of pus (abscess) in the prostate gland.
Further reading and references
Management of suspected bacterial urinary tract infection in adults; Scottish Intercollegiate Guidelines Network - SIGN (updated July 2012)
Guidelines on Urological Infections; European Association of Urology (2015)
Urinary tract infection (lower) - men; NICE CKS, October 2014 (UK access only)
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