Urine infection in men

Male genitals side view and urinary tract cross-section diagram

How common are urine infections in men?

UTIs are rare in men aged under 50. They become more common in older men. Urine infection is much more common in women.

In some cases an underlying problem can increase the risk of developing a UTI in men. These include the following:

• An enlarged prostate gland.

• Bladder problems. For example conditions that make it difficult to completely empty the bladder.

• Kidney problems. For example, kidney stones.

• Having a urinary catheter.

• A poor immune system.

In other cases the UTI occurs for no apparent reason.

Symptoms of a UTI in men will depend on where the infection occurs.

Infection in the bladder (cystitis) symptoms:

• Pain on emptying the bladder

• Passing urine more frequently.

• Passing small amounts of urine.

• Pain in the lower tummy (abdomen).

• Urine may become cloudy, bloody or smelly.

• A high temperature (fever).

Infection in the kidneys symptoms:

• Pain in a loin (the side of the lower back over the kidney).

• A high temperature (fever).

• Feeling or being sick (vomiting).

• Feeling generally unwell.

In some elderly men, the only symptoms may be a recent onset of confusion or just feeling generally unwell or unsteady, even without any actual urinary symptoms.

A urine test can confirm the diagnosis and identify the germ (bacterium) causing the infection. Further tests are not usually necessary if otherwise well with a one-off infection. However, a doctor may advise tests of the kidney, prostate gland 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 there are:

• Symptoms that suggest a kidney is infected (not just the bladder).

• Recurring urine infections, for example, two in a six-month period.

• Problems with the 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.

UTI tests may include:

• An examination of the prostate gland by examination of the back passage (rectum).

• Blood tests which may include kidney function tests and a specific blood test to check on the prostate, called prostate specific antigen, or PSA.

• A scan of the kidneys or bladder such as an ultrasound scan.

• An X-ray or CT scan to look for kidney stones.

• A look inside the bladder with a special camera (cystoscopy).

• Tests to see how well the bladder is working, called urodynamic tests.

• A short course of antibiotics will usually clear the infection quickly. This is usually for seven days in men. Medical advice should be sought if the symptoms are not gone, or nearly gone, after the course of antibiotics is completed, or if the symptoms are getting worse whilst on the treatment.

• Paracetamol 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).

The following can help prevent urine infections in men:

• Drinking enough fluids to avoid dehydration.

• Emptying the bladder when needed and not "holding on".

• Passing urine soon after sexual intercourse.

• Sometimes preventive antibiotics are recommended to prevent recurrent UTIs. These are usually given daily at a low dose for several months. The antibiotics are often rotated to prevent antibiotic resistance from occurring. The antibiotics used include: nitrofurantoin, trimethoprim, cefalexin and amoxicillin.

The vast majority of men improve within a few days of starting treatment. If symptoms do not improve despite taking an antibiotic medicine, then an alternative antibiotic might be needed. This is because some germs (bacteria) are resistant to some types of antibiotics. This can be identified from tests done on the urine sample.

Occasionally the infection may spread and cause you more significant symptoms. 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).

Recurring urine infection in men

Recurrent urine infections are defined as two or more infections in six months or three or more infections in a year. It is unusual for men to have recurring urine infections.

Men with recurring infections may be referred to a urology specialist for further tests to try and establish why they are occurring.

Blood tests to assess the kidney and prostate gland, and ultrasound scans to look at the kidneys, bladder and prostate gland, will often be organised before seeing the urology specialists.