UTIs in men: symptoms, causes, treatment and when to see a GP

The urinary tract includes the kidneys, ureters, bladder and urethra. The NHS says urinary tract infections affect different parts of the urinary tract and include cystitis (bladder infection), urethritis (infection of the urethra) and kidney infection. Patient.info explains that most urine infections in men are caused by bacteria that come from your own bowel, which cause no harm there but can cause infection if they get into other parts of the body, travelling to the urethra and then up into the bladder.

When the infection is just in the bladder and urethra it is called a lower UTI or cystitis, whereas if it travels up to one or both kidneys it is called an upper UTI or pyelonephritis, which Patient.info says can be more serious as the kidneys can become damaged by the infection. The NHS explains that women have a shorter urethra than men, which means bacteria are more likely to reach the bladder or kidneys in women, which is part of the reason UTIs are more common in women.

The NHS lists the symptoms of a UTI as pain or a burning sensation when peeing, needing to pee more often than usual including at night, needing to pee suddenly or more urgently, cloudy pee, blood in the pee, lower tummy pain or pain in the back just under the ribs, a high temperature or feeling hot or cold and shivery, a very low temperature below 36C, and feeling tired or weak. Patient.info describes bladder infection symptoms in men as pain on emptying the bladder, passing urine more frequently, passing small amounts, lower tummy pain, urine that may be cloudy, bloody or smelly, and a high temperature.

Symptoms of a kidney infection, according to Patient.info, include pain in the loin, a high temperature, feeling or being sick and 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 urinary symptoms, and the NHS likewise lists confusion, agitation and worse-than-usual incontinence as signs in older frail people.

The NHS pharmacist route for UTIs is for women and girls aged 16 to 64 who are not pregnant or breastfeeding, and men are not included. The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you think you may have a UTI and you are a man, you are aged 65 or older, you have a very high or low temperature or are shivering, you have diabetes, your symptoms get worse quickly or do not improve within 48 hours, you keep getting UTIs, you use a catheter, you have pain in the lower tummy or back just under the ribs, you have blood in your pee, or you have a weakened immune system. Some of these could be symptoms of a kidney infection, which the NHS says can be serious if not treated because it could cause sepsis.

Call 999 or go to A&E if you are confused, drowsy or have difficulty speaking, according to the NHS. If you are unable to pass urine at all when your bladder feels full and painful, that is a different emergency, urinary retention, and Patient.info says you should see a doctor immediately.

In many men there is an underlying reason. Patient.info lists an enlarged prostate gland, bladder problems such as conditions that make it difficult to completely empty the bladder, kidney problems such as kidney stones, having a urinary catheter and a poor immune system, and notes that in other cases a UTI occurs for no apparent reason. The NHS adds conditions that block the urinary tract, such as kidney stones, conditions that make it difficult to fully empty the bladder, such as an enlarged prostate, urinary catheters, a weakened immune system including poorly controlled diabetes or chemotherapy, and not drinking enough fluids.

Infection can spread. Patient.info says that occasionally bladder infection may spread to the kidney or to the prostate gland, causing prostatitis, and that this is why symptoms that do not settle should be reviewed.

Patient.info says that a urine test can confirm the diagnosis and identify the germ causing the infection. Further tests are not usually necessary if you are otherwise well with a one-off infection, but a doctor may advise tests of the 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, if there are symptoms suggesting a kidney is infected, if infections recur, for example two in a six-month period, if there have been kidney problems in the past such as kidney stones, if there are symptoms suggesting an obstruction to the flow of urine, or if blood-stained urine persists after antibiotics.

The tests listed by Patient.info include an examination of the prostate gland through the back passage, blood tests including kidney function and PSA, an ultrasound scan of the kidneys or bladder, an X-ray or CT scan to look for kidney stones, a look inside the bladder with a camera (cystoscopy) and tests of how well the bladder is working (urodynamic tests). Not everyone needs all of them.

Patient.info says a short course of antibiotics will usually clear the infection quickly, usually for seven days in men, and that medical advice should be sought if symptoms are not gone or nearly gone after the course is completed or are getting worse during treatment. Paracetamol will usually ease pain and fever, and plenty to drink helps prevent dehydration. Some bacteria are resistant to some antibiotics, so an alternative may be needed, which can be identified from the urine sample.

The NHS adds that it is important to take all the medicine you are prescribed even if you start to feel better, that you should rest and drink enough fluids so you pass pale urine regularly, and avoid drinks that may irritate the bladder such as fruit juices, coffee and alcohol. It also says that cranberry drinks and cystitis sachets have no evidence they help ease symptoms or treat a UTI if infection has already started.

Patient.info says the vast majority of men improve within a few days of starting treatment.

Patient.info says recurrent urine infections are defined as two or more infections in six months or three or more in a year and are unusual in men. Men with recurring infections may be referred to a urology specialist for tests to try to establish why they are occurring, and blood tests to assess the kidney and prostate gland and ultrasound scans of the kidneys, bladder and prostate are often arranged before the appointment. Sometimes preventive antibiotics are recommended, usually given daily at a low dose for several months.

The NHS says that if you keep getting UTIs you need to see a GP, who may prescribe a different or low-dose antibiotic or refer you to a specialist for further tests and treatments. It also describes long-term (chronic) UTIs where symptoms do not go away and urine tests may not show an infection, and advises speaking to your GP and asking to be referred to a specialist if you have been treated but still have symptoms.

Patient.info suggests drinking enough fluids to avoid dehydration, emptying the bladder when needed and not holding on, and passing urine soon after sexual intercourse. The NHS lists similar steps, including drinking plenty of fluids so you regularly pee during the day, keeping the genital area clean and dry, not using scented soap around the genital area, and not rushing when peeing so that you fully empty your bladder. If you have an enlarged prostate or other bladder emptying problems, treating those underlying problems matters for prevention.

On the NHS the first step is a GP, who can arrange a urine test and prescribe antibiotics, then investigate further if the pattern suggests an underlying problem. Referral to urology follows for recurrent or complicated infections. Private urology consultations can offer quicker scans or cystoscopy, but the investigation steps are the same, and it helps to bring your urine test results and antibiotic history to any appointment.