Urine Infection in Men
Most urine infections in men 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.
UTIs are rare in men aged under 50. They become more common in older men. Urine infection is much more common in women.
What causes urine infection in men?
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 or kidney problems. For example, kidney stones or conditions that cause urine to pool and not drain properly.
- Having a urinary catheter.
- A poor immune system.
In other cases the UTI occurs for no apparent reason. There is no problem with the bladder, kidney, prostate gland, or immune system that can be identified.
In the average adult patient there should be a urine output of: 0.5-1 ml/kg/hr. This means that an average 70 kg man should produce 35-70 mls an hour.
Urine output decreases in older patients and the target urine output should be 0.25-0.5 ml/kg/hr. This means that a 70 kg man who is aged over 65 years should produce 17.5-35 mls per hour.
Symptoms of urine infection in men
Symptoms of a UTI in men will depend on where the infection occurs.
Infection in the bladder (cystitis) usually causes pain on emptying the bladder and causes urine to be passed more frequently. Often smaller amounts are passed at a time. There may also be pain in the lower tummy (abdomen). The urine may become cloudy, bloody or smelly. There may be a high temperature (fever).
Infection in the kidneys may cause pain in a loin (the side of the lower back over the kidney) and a high temperature (fever). It may lead to feeling or being sick (vomiting) or feeling 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 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 (and 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).
- A general blood test or 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 to look for kidney stones.
- A look inside the bladder with a special telescope (cystoscopy).
- Tests to see how well the bladder is working, called urodynamic tests.
What is the treatment for a urine infection in men?
- A short course of antibiotics will usually clear the infection quickly. This is usually for seven days in men (usually less in women). 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 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 there is a fever.
What is the outlook (prognosis)?
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). Occasionally it may lead to a swelling caused by a collection of pus (abscess) in the prostate gland.
Recurring urine infection in men
It is unusual for men to have recurring urine infections. Recurrent urine infections are defined as two or more infections in six months or three or more infections in a year. It would be usual for men with recurring infections to 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.
Further reading and references
Urinary tract infection (lower): antimicrobial prescribing; NICE Guidance (October 2018)
Smithson A, Ramos J, Nino E, et al; Characteristics of febrile urinary tract infections in older male adults. BMC Geriatr. 2019 Nov 2919(1):334. doi: 10.1186/s12877-019-1360-3.
Urological infections; European Association of Urology (2022)
Urinary tract infection (lower) - men; NICE CKS, February 2023 (UK access only)
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