Posted On: November 13, 2026

UTIs 101: Symptoms, Treatment, and When to See a Specialist

Few things derail a day faster than the burning, the constant trips to the bathroom, and the nagging pressure of a urinary tract infection (UTI). UTIs are one of the most common infections I treat, and about half of all women will have at least one bladder infection in their lifetime.¹ Most clear up quickly with treatment and never return, but for some women they keep coming back, and each new infection means another round of antibiotics and more worry about a deeper issue.

In this article, I’ll cover the basics every woman should know about UTIs, from symptoms to treatment. Then I’m delighted to introduce Dr. Sara Hamade, a urogynecologist who answers questions about recurrent UTIs, when it makes sense to see a specialist rather than your primary care physician, and the pelvic health concerns that often come with UTIs.

What Is a UTI?

A urinary tract infection happens when bacteria, often from the skin or rectum, enter the urethra and infect the urinary tract.² Most UTIs are bladder infections, also called cystitis. A kidney infection, or pyelonephritis, is less common but more serious, and it can develop when a bladder infection goes untreated and the bacteria travel up to one or both kidneys.^1,2

Who Is More Likely to Get UTIs?

UTIs are more common in women, and anatomy is a big part of the reason. Women have a shorter urethra that sits close to the rectum, which gives bacteria a shorter path to the bladder.^1,2

Other things that raise the risk include:

• Recent sexual activity (a UTI is not a sexually transmitted infection)
• Certain birth control, such as diaphragms or spermicides
• A previous UTI
• Pregnancy
• Diabetes or a weakened immune system
• Difficulty emptying the bladder, kidney stones, or recent catheter use^1,2

Once you’ve had one UTI, another is more likely, and about a quarter of women who have a bladder infection go on to have repeat infections.^1,2

Men can get UTIs too, although men under 50 rarely get bladder infections. In older men, an enlarged prostate, also called benign prostatic hyperplasia (BPH), is a common contributor. BPH affects nearly a third of men 65 and older, and as the prostate grows it can keep the bladder from emptying completely, which raises the risk of infection.⁴ When men do get a UTI, they may need a longer course of antibiotics, because bacteria can move into the prostate.^1,3

What Are the Symptoms of a UTI?

The classic signs of a bladder infection include:

• Pain or burning when you urinate
• Frequent or intense urges to urinate, even when little comes out
• Pressure or cramping in the lower abdomen or groin
• Blood in the urine^2,5

Call your physician right away if you have a fever, chills, back or side pain, or nausea or vomiting. These can be signs that the infection has reached your kidneys, and kidney infections need prompt treatment.^2,5

How Are UTIs Diagnosed?

A UTI is diagnosed with a urine sample, which usually means two tests. A urinalysis checks for white blood cells and blood that point to infection, and a urine culture identifies the bacteria so your doctor can choose an antibiotic that will work against them. Culture results usually take a few days.⁶ For women with repeat infections, imaging or a look inside the urethra and bladder (cystoscopy) can help find an underlying cause.⁶

How Are UTIs Treated?

Antibiotics are the standard treatment for a bladder infection. Which antibiotic you get depends on the bacteria involved and any drug allergies you have, and how long you take it depends on how severe the infection is and whether it has come back.³ Even when you start feeling better, finish every dose as prescribed.^2,3

A few other things help while you recover:

• Drink plenty of fluids. Water is best.³
• An over-the-counter pain reliever such as ibuprofen or acetaminophen, or a heating pad on your abdomen or back, can ease the discomfort.³
• Call if your symptoms don’t improve, get worse, or you have side effects from the antibiotic.²

If you think you have a UTI, call your physician as soon as symptoms start, because testing your urine before you begin antibiotics helps make sure you get the right treatment.

Ask the Expert: When UTIs Keep Coming Back — with Dr. Sara Hamade

When a patient has three or more confirmed UTIs in a year, blood in the urine on two occasions without signs of infection, or persistent symptoms like leakage, pelvic pressure, or pain, I refer them to a specialist.

Dr. Sara Hamade is a fellowship-trained urogynecologist with UroGyn Care Center, and her office is right down the hall from ours in Fairfax. She completed her residency in obstetrics and gynecology at Inova Fairfax Hospital and her fellowship in urogynecology and reconstructive pelvic surgery through the Walter Reed/Inova program, and she focuses on pelvic floor disorders, including recurrent UTIs.

Below, she answers important questions many women have about UTIs.

Many women have never heard of a urogynecologist. What does a urogynecologist do, and how is that different from a general gynecologist, a urologist, or a primary care doctor?

A urogynecologist is a gynecologist who specializes in female pelvic floor disorders, which involve the bladder, vagina and uterus, rectum, and the muscles that support these organs. We usually complete four years of residency training in obstetrics and gynecology, followed by three years of fellowship training focused on pelvic floor disorders.

Common conditions that we treat include urinary leakage, overactive bladder, pelvic organ prolapse, bowel control problems, bladder and pelvic pain, sexual dysfunction, menopause-related pelvic health concerns, recurring blood in the urine, and recurrent UTIs.

Primary care doctors and general gynecologists are excellent resources for routine care and occasional UTIs. Urologists treat the urinary tract in both men and women, including kidney stones and urinary tract cancers. Urogynecologists focus specifically on women and on how the bladder, vagina, and pelvic floor work together.

How is a recurrent UTI different from an occasional one, and when should someone see a specialist?

Most women get a UTI at some point in their lives, and an occasional UTI is not usually a cause for concern. Recurrent UTI is generally defined as two or more infections within six months, or three or more within one year, with infections confirmed by positive urine cultures.

It is worth seeing a specialist if:

• You meet the definition of recurrent UTIs
• Your infections return soon after treatment or are resistant to several antibiotics
• You see blood in your urine
• You also experience leakage, pelvic pressure or a bulge, or difficulty emptying your bladder.
• You continue to have “UTI symptoms,” but your urine cultures repeatedly come back negative. This may indicate that something other than a bacterial infection is causing your symptoms.

When UTIs keep coming back, what is usually going on? Are there common causes in women in their 40s, 50s, and 60s?

First, it is worth mentioning that recurrent UTIs are rarely about hygiene. In midlife, one of the biggest contributing factors is menopause. As estrogen levels decline, the tissues of the vagina and urethra become thinner, and protective vaginal bacteria decrease. This can make it easier for bacteria that cause UTIs to grow and to reach the urinary tract.

Other common contributors include:

• Incomplete bladder emptying, sometimes related to pelvic organ prolapse.
• Bladder or bowel leakage.
• A history of pelvic surgery.

Often, recurrent UTIs result from a combination of factors, which is why a thorough evaluation can be helpful.

What does an evaluation with you look like for someone with recurrent UTIs? What tests might you run?

The first visit is mostly a conversation. I ask when the infections started, what the symptoms feel like, what previous urine cultures showed, which treatments have worked, and what the patient would prefer for prevention. I may then perform a gentle pelvic exam to look for menopausal tissue changes, prolapse, or other potential contributors.

Common tests include:

• A urinalysis and urine culture, ideally whenever symptoms occur, to confirm whether an infection is present and identify which antibiotic is likely to work.
• A post-void residual measurement, using a quick test or bladder scan after urination, to make sure the bladder is emptying well.

Besides antibiotics, what helps prevent recurrent UTIs? Are popular remedies like cranberry or D-mannose worth trying?

There are several ways to help prevent recurrent UTIs without taking daily antibiotics:

• Vaginal estrogen. For postmenopausal women, vaginal estrogen is a well-established, guideline-supported preventive option. It is available as a low-dose cream, tablet, or ring, and systemic absorption is generally low. Many women who have been told they cannot use systemic hormones may still be candidates for vaginal estrogen, but should discuss their individual situation with their primary care provider or gynecologist. If you’re a member of Eileen West, MD and Associates, Dr. West is happy to talk with you about vaginal estrogen as part of your menopause care and help you decide whether it’s right for you.
• Cranberry. The evidence suggests that cranberry products may modestly reduce the risk of another UTI in women who experience recurrent infections. It is safe for most people and may be worth trying.
• D-mannose. Although popular, the largest, best-quality study did not find that D-mannose prevented UTIs better than a placebo. It is unlikely to cause harm for most people, but I would not rely on it for prevention.
• Methenamine hippurate. This prescription medication is not an antibiotic and has been shown to be an effective option for UTI prevention, with evidence suggesting effectiveness comparable to low-dose antibiotic prophylaxis in some patients.
• Everyday habits. Maintain adequate hydration, urinate after sex if helpful, address constipation, and avoid spermicides if they seem to trigger infections.

When antibiotics are needed, they can often be used in a targeted way—for example, as a single dose after sex, or as a prescribed supply to start at the first sign of symptoms after providing a urine sample, when appropriate.

My urine smells strong or looks cloudy. Is that a UTI?

Not necessarily. Odor or cloudiness alone is not a reliable sign of infection. Typical UTI symptoms include burning with urination, urgency, frequency, and pelvic discomfort.

My test showed bacteria, but I feel fine. Do I need antibiotics?

Usually not. Bacteria in the urine without symptoms (asymptomatic bacteriuria) is common, especially as we age, and treatment can cause more harm than benefit through side effects and antibiotic resistance. Important exceptions include pregnancy and before certain endoscopic urologic procedures associated with mucosal trauma.

Which pelvic symptoms do women tend to brush off that are worth bringing up?

Many women assume these symptoms are simply a normal part of having children or getting older. They are common, but they are treatable. Please mention:

• Leaking urine when you cough, laugh, sneeze, or exercise, or not making it to the bathroom in time.
• Needing to urinate urgently or frequently, including waking up multiple times at night.
• Pressure, heaviness, or a bulge in the vagina, especially toward the end of the day.
• Difficulty emptying the bladder or bowels, or needing to press on the vagina to finish.
• Bowel leakage, including leakage of gas.
• Pain or dryness with sex, or ongoing bladder or pelvic pain.
• Blood in the urine should always be brought to a clinician’s attention.

If you could give women one tip for bladder and pelvic health, what would it be?

Speak up. Leaking, pressure, frequent UTIs, and painful sex are not just part of aging, and there are good treatments—many of them simple and non-surgical. If you are in menopause and experiencing recurrent UTIs, ask your doctor whether vaginal estrogen is right for you. It is one of the most underused tools we have.

When to Talk to Your Doctor About UTIs

Most UTIs can be diagnosed and treated by your primary care physician. If your infections keep coming back, or you notice any of the symptoms Dr. Hamade describes, start with a call to your physician, who can review your urine cultures and history with you and refer you to a specialist when one can help.

Final Thoughts

UTIs are common and very treatable, and the sooner you call about symptoms, the sooner a urine test can confirm what is going on and get you on the right treatment. If UTIs keep coming back, or you are living with leakage, pressure, or pain, Dr. Hamade’s advice is worth repeating: speak up. Your health is worth it.

Sources

1. National Institute of Diabetes and Digestive and Kidney Diseases. “Definition & Facts of Bladder Infection in Adults,” 2024.
2. Centers for Disease Control and Prevention. “Urinary Tract Infection Basics,” 2026.
3. National Institute of Diabetes and Digestive and Kidney Diseases. “Treatment for Bladder Infection in Adults,” 2024.
4. National Institute of Diabetes and Digestive and Kidney Diseases. “Enlarged Prostate (Benign Prostatic Hyperplasia),” 2024.
5. National Institute of Diabetes and Digestive and Kidney Diseases. “Symptoms & Causes of Bladder Infection in Adults,” 2024.
6. National Institute of Diabetes and Digestive and Kidney Diseases. “Diagnosis of Bladder Infection in Adults,” 2024.

Further Reading on Dr. Hamade’s Answers

1. American Urological Association. “Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2025),” 2025.
2. Cochrane Database of Systematic Reviews. “Cranberries for Preventing Urinary Tract Infections,” 2023.
3. JAMA Internal Medicine. “d-Mannose for Prevention of Recurrent Urinary Tract Infection Among Women: A Randomized Clinical Trial,” 2024.
4. The BMJ. “Alternative to Prophylactic Antibiotics for the Treatment of Recurrent Urinary Tract Infections in Women: Multicentre, Open Label, Randomised, Non-Inferiority Trial,” 2022.
5. Infectious Diseases Society of America. “Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America,” 2019.