What Is a Urinary Tract Infection?
A urinary tract infection is an infection that affects any part of the urinary system — the kidneys, ureters, bladder, or urethra. Most UTIs involve the lower urinary tract (the bladder and urethra) and are called cystitis. When the infection reaches the kidneys, it becomes pyelonephritis — a more serious condition.
Globally, UTIs are among the most prevalent infectious diseases, affecting more than 150 million people annually. They are associated with significant morbidity and healthcare costs across all age groups — from newborns to the elderly — though women are disproportionately affected due to anatomical differences.
The Sri Lankan Picture
A cross-sectional study at Sri Jayewardenepura General Hospital found that over half of culture-positive UTI patients were female, consistent with global patterns. The mean age of patients was approximately 60 years, indicating that older adults — many of whom already have comorbidities — are particularly vulnerable.
- 36% – of Sri Lankan UTI cases caused by E. coli — the predominant pathogen
- 30.6% – acute kidney injury (AKI) complication rate among UTI patients in local hospital data
- 86.8% – of ESBL-producing (drug-resistant) UTI cases caused by E. coli in Sri Lankan research
- 88.5% – of UTI cases among diabetic patients in Sri Lanka were female
Antibiotic resistance is a growing threat. ESBL-producing organisms — resistant to many commonly used antibiotics — have been documented in Sri Lankan community UTI cases. Self-medicating at the pharmacy without a urine culture can render treatment ineffective and accelerate resistance.
Who Is Most Vulnerable?
While anyone can develop a UTI, certain groups face a significantly elevated risk:
- Women: the shorter urethra means bacteria travel more quickly to the bladder
- People with diabetes: high blood sugar creates an environment favourable to bacterial growth — a particularly significant risk in Sri Lanka, where approximately one in five adults has diabetes or pre-diabetes
- Elderly individuals: weakened immune function and other underlying conditions increase susceptibility
- People with structural urinary tract abnormalities: kidney stones, an enlarged prostate, or strictures can obstruct urine flow and promote infection
- Those using urinary catheters: a well-established risk factor confirmed in Sri Lankan hospital data
- People with a history of recurrent UTIs: some individuals experience repeated infections that may require prophylactic management
Recognising the Symptoms
Lower UTI (Cystitis)
- Burning or pain when urinating (dysuria)
- Frequent, urgent need to urinate
- Cloudy, dark, bloody, or foul-smelling urine
- Pelvic pressure or pain (in women)
- Discomfort in the lower abdomen
Upper UTI — Seek Emergency Care
- High fever and chills
- Back or side pain (flank pain)
- Nausea and vomiting
- These symptoms may indicate pyelonephritis — a kidney infection requiring immediate attention
Upper UTI symptoms are a medical emergency. Seek care immediately if you experience fever, back pain, and urinary symptoms together. Delayed treatment can lead to sepsis or permanent kidney damage.
The Danger of Self-Treatment
It is tempting — and common in Sri Lanka — to visit a pharmacy, describe symptoms, and walk out with a course of antibiotics. This approach is problematic for several reasons. First, not every burning sensation is a UTI: similar symptoms can result from sexually transmitted infections, interstitial cystitis, or bladder tumours. Second, self-prescribed antibiotics are often the wrong type, the wrong dose, or given for the wrong duration — leaving the infection incompletely treated and allowing resistant organisms to thrive.
A urine culture — which identifies the specific bacteria and determines which antibiotics it is sensitive to — is the gold standard for UTI management. Without this, treatment is essentially guesswork. This is particularly critical in the Sri Lankan context, given the documented presence of drug-resistant organisms in community-acquired UTIs.
When to See a Urologist
Most straightforward UTIs are managed by a general practitioner. However, you should seek specialist urology care if:
Escalate to a Urologist When
- You have recurrent UTIs (two or more per year)
- You are male — UTIs in men are less common and often indicate an underlying structural issue such as BPH or a kidney stone
- Symptoms do not resolve despite antibiotic treatment
- You have blood in the urine (haematuria), even without other UTI symptoms
- You have a history of kidney stones, an enlarged prostate, or previous urinary surgery
- You experience fever, back pain, or signs of systemic illness alongside urinary symptoms
Recurrent UTIs in particular warrant a thorough urological work-up, including urine culture, imaging, and where necessary, cystoscopy — a procedure that allows the urologist to visually inspect the inside of the bladder and urethra.
Preventing UTIs: Practical Steps for Sri Lankans
- Stay well hydrated — drinking 2 to 3 litres of water daily helps flush bacteria from the urinary tract
- Urinate regularly and completely; do not hold urine for extended periods
- Women should wipe front to back after using the toilet, reducing the risk of bacterial transfer
- Urinate after sexual activity to expel any bacteria that may have entered the urethra
- Manage underlying conditions such as diabetes — keeping blood sugar controlled reduces susceptibility
- Avoid excessive use of antibiotics without medical guidance; protect the effectiveness of the medicines that protect you
Comprehensive Urological Care at Hemas Hospitals Sri Lanka
At the Hemas Hospitals Sri Lanka Urology Care Centre, urine infection management is part of a comprehensive and specialised urological care model. With over a decade of experience and a team of skilled urologists, the Centre offers evidence-based diagnosis and treatment that goes beyond a prescription pad.
For patients with recurrent or complicated UTIs, the team provides thorough evaluation including urine culture analysis, advanced imaging, flexible cystoscopy, and tailored management plans. Structural problems — such as kidney stones or an enlarged prostate — that may be driving recurrent infections are identified and addressed at the same Centre, meaning patients receive integrated, joined-up care rather than fragmented treatment.
The Centre operates within the ACHSI-accredited Hemas Hospitals framework, providing internationally benchmarked safety and clinical standards — bringing world-class care to patients across the western region without the need to travel abroad.
Book a Urology Consultation Today
A UTI is not something to simply ‘push through.’ If your symptoms are recurring, severe, or not resolving, a specialist consultation could uncover an underlying cause and stop the cycle.
References
- Flores-Mireles AL, et al. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nature Reviews Microbiology. 2015;13(5):269–284. doi:10.1038/nrmicro3432
- Perera P, et al. The Clinical Profile of Patients With Culture-Positive Urinary Tract Infections Admitting to a Tertiary Hospital in Sri Lanka. Cureus. 2024;16(4). PMID: 38774169. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC11106549/
- Navaratne L, et al. Extended spectrum beta lactamase producing organisms causing urinary tract infections in Sri Lanka and their antibiotic susceptibility pattern. PMC. 2017. PMID: 28187754. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC5303299/
- Katulanda P, et al. Incidence of Urinary Tract Infections and Allergic Conditions among Type 2 Diabetes Mellitus Patients in Rural Hospital Clinics in Sri Lanka. International Journal of Diabetes and Clinical Research. 2018.
- Hemas Hospitals Wattala. Urology Care Centre. Available at: https://hemashospitals.com/services/wattala/urology-care-centre/. Accessed April 2026.