Understanding the Differences Between UTIs and Bladder Infections

Experiencing discomfort from a urinary tract infection (UTI) or a bladder infection can be more than just an inconvenience; it can significantly impact your daily life.

While the terms are often used interchangeably, a UTI can affect any part of the urinary tract, whereas a bladder infection, specifically known as cystitis, is localized to the bladder itself.

A UTI or bladder infection alike have the potential to derail your plans for the day. With symptoms of increased frequency, urgency, and painful urination you may find yourself wanting to stay close to a washroom and fast relief may become a top priority.

Understanding these distinctions can help you seek effective relief and prevention. In this blog, we’ll explore the causes behind these common conditions and provide insights into strategies for prevention so you can take charge of your health with confidence.

Understanding UTIs and bladder infections

Infections of the urinary tract can occur anywhere along the urinary tract, including the bladder. The entire urinary tract consists of:

• Kidneys (filter blood, make and concentrate the urine)
• Ureters (the tubes connecting the kidneys to the bladder)
• Bladder (stores the urine)
• Urethra (the tube that drains urine from the bladder and out of the body)

Together, the kidneys, ureters, bladder, and urethra work to remove waste from the body in the form of urine. When adequately hydrated, your body flushes the bladder and its connected tubes regularly. This washing prevents microbes from harbouring and invading the urinary tract. When a microorganism, like bacteria or less often fungi, infects anywhere along this tract, it is called a UTI. 

UTIs can be distinguished by the location of infection, for example:

• Acute Cystitis is an infection of the bladder and lower urinary tract 
• Pyelonephritis is  an infection of the kidneys and upper urinary tract

Alternatively, the severity can help differentiate the types of UTIs:

• Uncomplicated UTIs involve the lower urinary tract (bladder and urethra) and occur in otherwise healthy people with normal urinary tract anatomy. 
• Complicated UTIs are infections that extend beyond the bladder, occur in males, and people with anatomical abnormalities of their urinary tract system. This type can also occur after recent urological surgery or kidney transplant and individuals with diabetes, have a weakened immune system, or are pregnant. 

Causes of UTIs and bladder infections

The majority of the time (up to 95%), uncomplicated UTIs are caused by E. coli, a bacteria from the gut that likely made its way from the anus to the urethra. When the bacteria ascends along the urethra to the bladder, it can cause an acute cystitis or uncomplicated UTI, also known as a bladder infection. 

Sometimes, these types of infections can resolve on their own in a few days with preventive measures like increasing the intake of fluids. But other times, if left untreated, the infection can continue to ascend further up the urinary tract along the ureters to one or both kidneys, an infection known as pyelonephritis. This turns an uncomplicated UTI into a complicated UTI,  bringing along more health risks. This is because, from the kidneys, bacteria can enter the bloodstream and lead to more severe illnesses including:

• Bacteremia (infection of the blood)
• Urosepsis (sepsis originating from a UTI)

Alternative causes of UTIs can include:

• Spreading of bacteria to the kidneys from another part of the body through the bloodstream or lymphatic system. 
• A blockage in the urinary tract such as from a kidney stone, enlarged prostate, or prolapsed uterus causes stasis of urine and inhibits the body’s natural defense of flushing its plumbing to prevent bacterial growth. 
• Following surgery on your urinary tract.

In addition to women having a shorter urethra than men, certain health conditions can increase your risk of developing a UTI, including:

• Diabetes 
• Recent or recurrent UTIs
• Postmenopause
• Having a shorter distance between the anus and urethra 
• Pregnancy 
• Health conditions or taking medications that weaken your immune system

Symptoms of UTIs and bladder infections 

Presenting symptoms are important for making an accurate diagnosis of the problem. While both conditions can present with similar symptoms, distinguishing between them is essential for effective management. 

Uncomplicated UTIs or bladder infections commonly cause symptoms of:

• Pain or burning with urination.
• Increased urinary frequency, using the toilet more often than usual, and voiding smaller amounts.
• Increased urinary urgency, making you feel like you have to run to the bathroom.
• Pain above your pelvic bone (an area referred to as the suprapubic region). 

Complicated UTIs often have more systemic symptoms in addition to the above and may include:

• Pain on either side of your back, between the bottom of your ribs, and just above the hip (known as the flank region).
• Fever or chills
• Nausea or vomiting 
• Blood in the urine 

Diagnosing UTIs and bladder infections

UTIs can present very similarly to other infectious or non-infectious disease processes, such as interstitial cystitis (a non-infectious irritation of the bladder), infection of the prostate, or a sexually transmitted infection (STI). 

An accurate history of your symptoms can sometimes be enough for your healthcare provider to make a preliminary diagnosis, especially if you are experiencing pain with urination, increased frequency, and urgency as the classic trio. However, given that there is a long list of conditions that can also cause that same trio of symptoms, a lab test to analyze your urine and culturing it for bacterial growth will help confirm the diagnosis. 

Some common diagnostic tests you may see when investigating symptoms of a UTI can include: 

A urinalysis can identify signs of infection with white blood cells and nitrites.

A urine culture provides important information for choosing the right course of treatments, to ensure the bacteria causing infection does not have resistance to certain antibiotics and the chosen treatment will in fact kill the bacteria.

Imaging like an X-ray, ultrasound, CT, or MRI is not routinely ordered for simple UTIs. However, it may be requested when investigating recurrent UTIs, concerns of obstruction, or structural abnormalities, such as a dilated ureter that allows urine to reflux up to the kidney, increasing the risk of UTIs.

Blood tests to survey kidney function or culture for bacteria (bacteremia) are less commonly done in the community. You are more likely to see this type of test if you’re experiencing more severe illness from UTIs requiring hospital admission.

Treatment options for UTIs and bladder infections

Bacteria cause most UTIs and can sometimes resolve spontaneously with increased hydration. But if symptoms last longer than two days, it may be time for a course of antibiotics. 

The list of antibiotics that can treat UTIs is quite lengthy. Canada has established guidelines to help healthcare providers choose the best antibiotic, providing first-line therapy choices, second-line, third-line, and alternative options. 

Choosing the right antibiotic is not only chosen based on the bacteria identified in the urine culture or type of UTI diagnosed (complicated vs. uncomplicated) but also impacted by: 

• Allergies to antibiotics
• Other pre-existing medical conditions
• Interactions with other prescribed medicines 
• Antibiotic resistance identified in the urine culture test
• Tolerability of the antibiotic 
• Availability of the antibiotic 
• Accessibility or cost of the medicine 

Some common first-line antibiotics for uncomplicated UTIs or bladder infections include: 

• Trimethoprim/sulfamethoxazole 
• Trimethoprim 
• Nitrofurantoin 

If you treat a UTI with antibiotics, your symptoms may clear up faster than you finish your antibiotics. But you must complete the full course of antibiotics as prescribed to ensure all bacteria are cleared from your urinary system and the bacteria don’t build antibiotic resistance. Bacteria that are resistant to antibiotics can be difficult to treat and cause serious illness.

Prevention strategies for UTIs and bladder infections 

Although pending approval from Health Canada, some countries have approved the use of an under-the-tongue (sublingual) vaccine for preventing UTIs.

While we await approval of these novel preventive strategies, there are tried-and-true home remedies that some swear by to help prevent or clear their UTIs. Although effective for some people, not all strategies have evidence to support them. 

• Cranberry. Recent studies support the use of cranberry to reduce the risk of UTIs in some people by 26%. Reach for pure cranberry with no added sugars or find it in capsule form. 
• Hydrate. Providing you don’t have a chronic kidney or heart condition requiring a daily fluid restriction, increasing your fluid intake can help flush out your bladder and make it more difficult for bacteria to colonize and spread. 
• Empty your bladder when it’s full. Avoid holding urine for prolonged periods of time. Holding for too long provides bacteria more time to attach to the bladder and invade.
• Practice good hygiene. Although lacking evidence, it is thought that wiping front to back may help prevent introducing bacteria from the gut to the lower urinary tract. Also, consider emptying your bladder after having sex, avoid vaginal douching or adding bubbles, fragranced soaps or oils to baths.
• Reduce or limit caffeine and alcohol intake. These can both mimic similar symptoms of needing to empty your bladder more often. 
• Vaginal Estrogen. The drying and thinning of the vagina (vaginal atrophy) commonly experienced post-menopause is associated with increased UTIs. 

Some of these strategies may help prevent UTIs in some people. If you find yourself with these maddening symptoms that don’t go away in a day or two, it’s nothing to ignore. Untreated bladder infections can spread to the kidneys and beyond and risk causing serious illness.

However, if you’re among the 6.5 million Canadians that don’t have a primary care provider and you’re unsure where to go, Maple can help. Through Maple, you can connect with a primary care provider in minutes, such as a doctor or nurse practitioner, through text or secure audio and video call, 24/7. With Maple, you can say goodbye to those awful symptoms without the need to sit in waiting rooms or after-hour clinics, and if you need antibiotics, then prescriptions can be picked up from your local pharmacy or delivered straight to your door.

Taking charge of your health starts with knowing when to seek help and having the right resources at your fingertips.

The information presented here is for educational purposes and is not meant to replace the advice from your medical professional. Virtual care is not meant for medical emergencies. If you are experiencing an emergency like chest pain or difficulties breathing, for example, please call 911 or go to your nearest emergency room.