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Urinary tract infections (UTIs), whether they are bladder infections (cystitis) or kidney infections (pyelonephritis), can be really painful, and there's no way to ignore them. By the time you get to the doctor, you really want treatment, and you want it now. Here's what is reasonable to expect.

  • If you aren't pregnant, and you're going to an ER, you'll probably be given low priority by the triage nurse. You will wait, wait, and wait some more. (If your ER doctor takes a nap while you are waiting, it's an aggravation, but you probably want him or her to be fully awake when treating you.)
  • Even if you get an appointment to see your primary care doctor, you aren't likely to get immediate action. There is a quick test for urinary tract infections that only requires putting a stick in a urine sample. This takes about three minutes. However, the test for white blood cells is only right about 50 percent of the time and the test for nitrites doesn't work at all if you don't have an especially strong infection. If you seem be sick, but the dip stick comes back negative, then someone is going to have to look at your urine under a microscope  and count what are called colony forming units. That can take several hours.
  • If there is blood in your urine, then the doctor has to rule out kidney stones, bladder cell cancer, and certain kinds of parasites that are more common in Africa and South America than in other parts of the world.
  • If you are pregnant, then the doctor may want to do a urine analysis that involves your spreading the labia and wiping down toward the anus with a towelette, urinating part of what is in your bladder into the toilet, urinating a "midstream catch" of the next urine into a sample container, and then urinating the rest of your into the toilet. If you can't do that, then a nurse will come into collect urine with a catheter. Pregnant women have to do this when they have already had a UTI during their pregnancy, if they have recently had an invasive procedure, or their symptoms don't get better after initial treatment.

Men are typically given hydrocodone (Vicodin) for pain from urinary tract infections. Women are typically given ibuprofen. There's no good reason for this other than that some scientists ran studies that started with pain relief before antibiotics and in those studies men happened to have been given hydrocodone and women happen to have been given ibuprofen. The fact is, many patients who have UTIs need something stronger, like morphine, but not every doctor will give out opiates. If you are in the United States, this may depend on where you live.

What kind of treatment can you expect?

If you go to a hospital ER, you may be given intravenous antibiotics. Your doctor's office probably will give you a prescription for antibiotic tablets. IV antibiotics work more quickly, but they do, after all, involve opening a vein and having you lie in a gurney while you wait for the medication to drip, drip, drip. They are also more likely to cause side effects and cause them quickly. Ironically, some antibiotics themselves cause kidney problems. However, they get the fastest and most powerful results of any kind of medical treatment.

Do antibiotics really work?

Well, not always. Not every antibiotic works for every infection. That's why the doctor will often send samples to the lab for cultures to identify the specific microorganism causing the problem. This procedure isn't just a matter of looking at a sample under a microscope. The lab will also find out which antibiotics actually work for your infection. In the meantime, it's important to take the broad-spectrum antibiotic you get while results are waiting, and don't stop any course of treatment early. You may just kill the "good bugs" and leave the "bad bugs" to multiply unchecked.

I would like to give you more cheerful news. These kinds of infections are hard to overcome, but you feel so much better when you do overcome them.

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