<?xml version="1.0"?>
<ownershipDocument>

    <schemaVersion>X0202</schemaVersion>

    <documentType>4</documentType>

    <periodOfReport>2006-04-26</periodOfReport>

    <notSubjectToSection16>0</notSubjectToSection16>

    <issuer>
        <issuerCik>0000353020</issuerCik>
        <issuerName>INSITUFORM TECHNOLOGIES INC</issuerName>
        <issuerTradingSymbol>INSU</issuerTradingSymbol>
    </issuer>

    <reportingOwner>
        <reportingOwnerId>
            <rptOwnerCik>0001187134</rptOwnerCik>
            <rptOwnerName>HINSHAW JUANITA H</rptOwnerName>
        </reportingOwnerId>
        <reportingOwnerAddress>
            <rptOwnerStreet1>C/O INSITUFORM TECHNOLOGIES, INC.</rptOwnerStreet1>
            <rptOwnerStreet2>702 SPIRIT 40 PARK DRIVE</rptOwnerStreet2>
            <rptOwnerCity>CHESTERFIELD</rptOwnerCity>
            <rptOwnerState>MO</rptOwnerState>
            <rptOwnerZipCode>63005</rptOwnerZipCode>
            <rptOwnerStateDescription></rptOwnerStateDescription>
        </reportingOwnerAddress>
        <reportingOwnerRelationship>
            <isDirector>1</isDirector>
            <isOfficer>0</isOfficer>
            <isTenPercentOwner>0</isTenPercentOwner>
            <isOther>0</isOther>
            <officerTitle></officerTitle>
            <otherText></otherText>
        </reportingOwnerRelationship>
    </reportingOwner>

    <derivativeTable>
        <derivativeTransaction>
            <securityTitle>
                <value>Deferred stock unit</value>
            </securityTitle>
            <conversionOrExercisePrice>
                <footnoteId id="F1"/>
            </conversionOrExercisePrice>
            <transactionDate>
                <value>2006-04-26</value>
            </transactionDate>
            <deemedExecutionDate></deemedExecutionDate>
            <transactionCoding>
                <transactionFormType>4</transactionFormType>
                <transactionCode>A</transactionCode>
                <equitySwapInvolved>0</equitySwapInvolved>
            </transactionCoding>
            <transactionTimeliness>
                <value></value>
            </transactionTimeliness>
            <transactionAmounts>
                <transactionShares>
                    <value>3200</value>
                </transactionShares>
                <transactionPricePerShare>
                    <footnoteId id="F1"/>
                </transactionPricePerShare>
                <transactionAcquiredDisposedCode>
                    <value>A</value>
                </transactionAcquiredDisposedCode>
            </transactionAmounts>
            <exerciseDate>
                <footnoteId id="F2"/>
            </exerciseDate>
            <expirationDate>
                <footnoteId id="F2"/>
            </expirationDate>
            <underlyingSecurity>
                <underlyingSecurityTitle>
                    <value>Class A common stock, $.01 par value</value>
                </underlyingSecurityTitle>
                <underlyingSecurityShares>
                    <value>3200</value>
                </underlyingSecurityShares>
            </underlyingSecurity>
            <postTransactionAmounts>
                <sharesOwnedFollowingTransaction>
                    <value>12725</value>
                </sharesOwnedFollowingTransaction>
            </postTransactionAmounts>
            <ownershipNature>
                <directOrIndirectOwnership>
                    <value>D</value>
                </directOrIndirectOwnership>
                <natureOfOwnership>
                    <value></value>
                </natureOfOwnership>
            </ownershipNature>
        </derivativeTransaction>
    </derivativeTable>

    <footnotes>
        <footnote id="F1">Each deferred stock unit (&quot;DSU&quot;) represents the issuer's obligation to transfer one share of Class A common stock, $.01 par value per share (&quot;Common Stock&quot;), in accordance with the terms of the deferred stock unit agreement pursuant to which the DSUs were granted.  DSUs are granted under the issuer's Non-Employee Director Equity Incentive Plan, and are immediately vested upon grant.</footnote>
        <footnote id="F2">Promptly following termination of the undersigned's service on the issuer's Board of Directors, the issuer will distribute to the undersigned shares of Common Stock equal to the number of DSU's reflected in the undersigned's account at such time.</footnote>
    </footnotes>

    <remarks></remarks>

    <ownerSignature>
        <signatureName>/s/ Suta Tungsiripat, as attorney-in-fact for Juanita H. Hinshaw</signatureName>
        <signatureDate>2006-04-28</signatureDate>
    </ownerSignature>
</ownershipDocument>
