Symptoms of Lower Urinary Tract Infection
The four main symptoms of a lower urinary tract infection are dysuria, urinary frequency, suprapubic tenderness, and bladder spasms in severe cases. These symptoms characterize the clinical presentation of cystitis, which is an infection limited to the bladder.
Key Symptoms of Lower UTI
Dysuria: Pain or burning sensation during urination is a hallmark symptom of lower UTI and is highly specific, with more than 90% accuracy for UTI in young women when not accompanied by vaginal discharge 1.
Urinary frequency: Increased need to urinate is a common presentation of cystitis and is included in the clinical definition of uncomplicated UTI 1.
Suprapubic tenderness: Pain or discomfort in the lower abdomen above the pubic bone is a characteristic symptom of bladder inflammation 1.
Bladder spasms in severe cases: In more severe infections, patients may experience bladder spasms as the inflamed bladder tissue contracts 1.
Distinguishing Lower from Upper UTI
Lower UTI (cystitis) symptoms are typically localized to the bladder and urethra, while upper UTI (pyelonephritis) presents with additional systemic symptoms:
Lower UTI symptoms are primarily dysuria, frequency, urgency, and suprapubic tenderness 1, 2.
Upper UTI typically includes systemic symptoms such as fever, chills, flank pain, costovertebral angle tenderness, and sometimes nausea/vomiting 1.
Additional Lower UTI Symptoms
Other symptoms that may be present in lower UTI include:
Urinary urgency: A sudden, compelling need to urinate 1.
Hematuria: Blood in the urine, which may be visible (macroscopic) or microscopic 1.
Changes in urine appearance: Cloudy urine or changes in urine odor 1.
New or worsening urinary incontinence: Particularly in older adults 1.
Clinical Pearls and Pitfalls
Fever is typically absent in uncomplicated lower UTI (cystitis) and suggests upper tract involvement or pyelonephritis 1.
Symptoms alone are often sufficient for diagnosis of uncomplicated cystitis, though urinalysis and cultures may be used to confirm the diagnosis 1, 3.
In older adults, symptoms of UTI may present atypically and can include mental status changes, but these should not be attributed to UTI without the presence of localized urinary symptoms 1.
Asymptomatic bacteriuria is common, particularly in older adults, and should not be treated with antibiotics in the absence of urinary symptoms 1, 3.