Why Men Get UTIs

While UTIs are less common in men, they can happen.

Why are they less common in men?

As we said in our last post, these infections are often caused by E. coli from the rectum getting into the urinary tract via the urethra.

The female urethra is relatively short in length, making it easier for bacteria from the nearby rectum to enter and multiply. On the other hand, as shown below, the male urethra can be over five times the length and wider, giving the bacteria a much longer way to go. As such, men have some natural protection from developing these infections.

So why do men get UTIs?

For most men, the underlying cause behind their UTI is obstruction of the urethra. This prevents them from fully emptying their bladders or “pass water” when they urinate. As such, any bacteria in the urine that is left behind can multiply, causing an infection. These obstructions can be a result of many factors, but below are the four most common reasons:

1) Enlarged Prostate: In older men, an enlarged prostate is the most common cause of this obstruction, as when the prostate is enlarged, it pushes against the urethra. As men age, they may experience Benign Enlarged Hyperplasia, where the prostate increases in size. While the exact cause is unknown, it is thought to result from hormone changes.

2) Prostatitis: Much like the above, prostatitis, where the prostate becomes inflamed, can cause obstructions to the urethra. It can be caused by a traumatic injury to the prostate or an infection, where bacteria enter the prostate from urine or during sex. Prostatitis is more common in younger men.

Note: While late-stage prostate cancer may result in urethral obstructions, most cases of enlarged prostates are not caused by prostate cancer. Further, early-stage prostate cancer often shows no physical signs, so not having any urethral obstructions is not a reliable way to determine if you have the disease. Regular PSA screenings are the most reliable means of finding the disease in this early stage when it is most treatable.

3) Sexually Transmitted Infections: “While STDs are a different type of infection,” notes Consultant urologist Dr Elon Thompson, “they can cause urethral strictures, which lead to obstruction. This can lead to UTIs.” Urethral strictures, or scarring, can narrow the urethra.

4) Stones: These hard masses of minerals can block urine flow, giving bacteria a chance to multiply. Kidney stones are the most common, but other stones like bladder and urethral stones can occur and cause obstructions.

UTI Symptoms in Men

Some common symptoms of a UTI include:

• Pain or a burning sensation when urinating

• Frequent need to urinate (without an increase in fluid intake)

• Urinary urgency or a sudden urge to urinate

• Pain just above the pubic bone

• Cloudy urine

• Blood in urine*

• Strong ammonia odour

If your UTI is caused by an enlarged prostate (prostatitis), UTI symptoms may be accompanied by difficulties urinating (e.g. stop-start urination), pain in the perineum (i.e. the thin layer of skin between the scrotum and the anus), painful ejaculation and other symptoms.

*While UTIs can cause blood in urine, bloody urine can also be caused by other serious issues. When you have a UTI, bloody urine is likely to accompany other symptoms. Even if it is not, “anyone with blood in their urine needs to be evaluated,” Dr Thompson warns.

Preventing UTIs

Since obstruction is the most common reason men get UTIs, it can be difficult to prevent them as the causes are often outside of a man's control. Still, Dr Thompson offers some simple advice for overall health: "Exercise regularly (30 minutes a day, at least three times a week), consume a more natural, plant-based diet and drink mostly water to stay hydrated. While this won't necessarily prevent some of the common reasons for obstruction, like BPH or prostatitis, they can help to reduce the impact of those issues."