UTI risk factors for males

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Note: references to "female", "male", "women", and "men" in this article refer to sex assigned at birth, not gender.

About 20% of all urinary tract infections (UTIs) occur in men and up to 14% of males will experience at least one UTI in their lifetime (1,2).

The biological occurrence of a UTI is the same in both males and females: bacteria ascend up the urinary tract through the urethra and cause an infection. There are many ways that the bacteria can get there but the anatomical difference between males and females can cause differences in the reason why someone might get a UTI. Males have a longer urethra than females, therefore bacteria has more time to ascend up the urinary tract. This gives males more time to flush bacteria from the urinary tract. Since the length of the urethra is much shorter in females, it is easier for bacteria to make their way up to cause infection.

Many reasons why males get UTIs can be attributed to age-related factors. According to the National Institute of Diabetes and Digestive and Kidney Diseases at the NIH, males over 50 are at risk for enlarged prostate glands that increase in size with age and gradually restrict the flow of urine which can cause a UTI.

In addition to enlarged prostate, another way males can get UTIs are from chronic bacterial prostatitis (2,3,4). Given the anatomical location of the urinary tract and the prostate, some prostate conditions that have been linked with UTI risk include:

• Prostatitis: infection or inflammation of the prostate; the inflammation could restrict urinary flow. Having a lower UTI can also lead to acute or chronic bacterial prostatitis (5).
• Benign Prostatic hyperplasia (BPH): enlargement of the prostate gland that is age-related. The prostate gland can double or triple in size.
  • The increase in size contributes to urinary retention by pinching the urethra. Due to the enlarged prostate the bladder is not able to fully empty and bacteria have the opportunity to multiply and potentially cause an infection (6)
  • In addition the bladder muscles may become weak from continually trying to pass urine through a narrow urethra and this may cause the bladder to not empty completely (4).
• Prostate Cancer: growth of cancerous cells inside the prostate. This can cause problems with urination as well. One study found that men who have UTIs have a higher probability of developing genitourinary cancers such as prostate cancer (7).
• Acute prostate problems may be triggered by certain foods, as well as stress, depression, chronic pain condition, genitourinary area trauma and repeated biopsies (8).

Outside of prostate-related causes, there are several other factors that can contribute to UTI risk:

• Kidney stones restricting the flow of urine
• Spinal cord injuries
• Bacteria from catheters or urethral strictures (narrowing of the urethra from scar tissue from previous infections or from surgical procedures)
• Diabetes
• Parkinson’s disease
• Multiple sclerosis
• Biofilm can also be a cause of recurrent UTIs

During a UTI, bacteria can form a structure called biofilm on the bladder wall, which can often be responsible for recurrent UTIs (rUTI). Biofilm is a protective shield that can form on the bladder wall.⁠ These biofilms allow bacteria to stick to each other and to surfaces. Bacteria lay dormant within the biofilm until an opportunistic moment, at which point they can break free, replicate, and cause a new infection and UTI symptoms.⁠

Biofilm-forming infections can be difficult to get rid of because the biofilms protect the bacteria from antibiotics and immune defenses. If you think you’re dealing with recurrent UTIs, we recommend seeking care from a medical professional who specializes in these types of infections. You can learn more about biofilm and UTIs here.

As discussed, UTIs can happen for various reasons. For males, UTI risk may increase with certain prostate related conditions mentioned above. Prostate health could play a big factor in reducing the risk of UTIs in males. Age is the most influential factor for prostate related health concerns, but there is also a correlation between BPH and conditions such as obesity, high blood pressure, sedentary lifestyle, diabetes, prostatitis (prostate inflammation), and diets high in sugar, red meat, and refined grains (8).

Lowering the risk of an enlarged prostate and prostate cancer has been associated with certain lifestyles such as exercising regularly and eating a Mediterranean-style diet, which emphasizes plant based foods and healthy fats (8,9).

If you suspect you have a UTI, we recommend visiting a medical professional for proper diagnosis and antibiotic treatment.

1. Griebling, T. L. (2005). Urologic diseases in America project: trends in resource use for urinary tract infections in men. The Journal of urology, 173(4), 1288-1294.

2. Maxwell, K. (2022, October 7). Recurrent uti in men: prevalence and causes. Live UTI Free. Retrieved from https://liveutifree.com/recurrent-uti-in-men/

3. Urinary tract infection in men. UHS Health Topic - Urinary Tract Infection - men. (n.d.). Retrieved from https://www.healthyhorns.utexas.edu/HT/HT_urinarytractinfection_m.html

4. U.S. National Library of Medicine. (n.d.). Enlarged prostate | BPH | benign prostatic hyperplasia. MedlinePlus. Retrieved from https://medlineplus.gov/enlargedprostatebph.html

5. U.S. National Library of Medicine. (n.d.). Prostate diseases. MedlinePlus. Retrieved from https://medlineplus.gov/prostatediseases.html

6. Speakman MJ, Cheng X. Management of the complications of BPH/BOO. Indian J Urol. 2014 Apr;30(2):208-13. doi: 10.4103/0970-1591.127856. PMID: 24744522; PMCID: PMC3989825.

7. Huang, C. H., Chou, Y. H., Yeh, H. W., Huang, J. Y., Yang, S. F., & Yeh, C. B. (2019). Risk of Cancer after Lower Urinary Tract Infection: A Population-Based Cohort Study. International journal of environmental research and public health, 16(3), 390. https://doi.org/10.3390/ijerph16030390

8. Harvard Health. (n.d.). Prostate health Retrieved from https://www.health.harvard.edu/topics/prostate-health

9. Mediterranean diet. Cleveland Clinic. (n.d.). Retrieved from https://my.clevelandclinic.org/health/articles/16037-mediterranean-diet