Recurrent UTI

What is a recurrent urinary tract infection?

A urinary tract infection (UTI) occurs when bacteria invade the bladder or kidneys. The bacteria can often be found naturally in our bowels or on our skin, but they are harmless there. However, when they get into the urinary tract, they can cause an infection.

Women in general get more UTIs. This is mainly because the female urethra (passage between bladder and outside) is shorter, which allows bacteria easier access into the bladder.

Typically a woman may have one UTI per year on average. But some women get them more often. If it occurs about four times a year, it’s considered a recurrent UTI. An estimated 2% to 10% of women get chronic UTIs, according to a review in the journal Climacteric.

UTIs tend to be more common in older men than younger men. This is likely because UTIs in men are often caused by not completely emptying the bladder. This is often due to an enlarged prostate, a condition common in older men.

UTIs are treated with antibiotics and go away quickly.

Most common symptoms

UTI symptoms can vary based on a person’s age, gender, and medical history. Most people will have:

• Burning during urination
• Urgent need to urinate with little urine coming out
• Frequent urination in small amounts
• Cloudy urine
• Foul smelling urine
• Blood in urine
• Older people may have less severe symptoms. They may also have a fever or feel confused. This may be due to their weakened immune responses.

Why does my UTI keep coming back?

When a UTI occurs, the bladder wall becomes inflamed. Once the UTI has been treated with antibiotics, the bacteria are typically killed. But the bladder wall remains irritated and inflamed.

Bacteria like an irritated surface. Once new bacteria gets back into the bladder, it gains a foothold in this irritated surface, setting off another infection. This leads to a cycle of infections.

Can a UTI be a sign of cancer or other problems?

The vast majority of UTIs are not a sign of a serious disease. Yet when they keep coming back, you should see a doctor. They will rule out other causes such as kidney stones, poor drainage of the kidney or bladder, or tumors, all of which are rare causes of UTI.

In rare instances, recurrent UTIs can lead to a life threatening condition called urosepsis (kidney infection) or bladder cancer.

Urosepsis

Urosepsis is when an untreated UTI has spread to the kidney, causing sepsis. Sepsis is the body's often deadly response to infection or injury.

Symptoms include fever, pain on the lower sides of your back, where your kidneys are located, nausea and vomiting, extreme tiredness, decreased urine, confusion, difficulty breathing, and abnormal heart function.

Bladder cancer

When recurring UTIs also have blood in the urine, your doctor may refer you to a urologist who specializes in problems with the urinary tract.

Blood in the urine (hematuria) can be caused by many things including a UTI, kidney stones, and bladder cancer. Early bladder cancer can cause bleeding without pain or other symptoms.

Other signs of bladder cancer are changes in urination habits that are similar to those of a UTI.

If your urologist is concerned about other causes, they may order more tests. These may include imaging (X-rays, CT scan, or ultrasound), or a cystoscopy (using a small scope to see inside the bladder).

How is a recurrent UTI treated?

A UTI is diagnosed with a urine test. The test is sent to a lab to determine which bacteria are causing the infection.

UTIs are treated with antibiotics. If you have an active UTI, your doctor will prescribe a course of antibiotics to take over several days.

If UTIs are recurrent, your doctor might prescribe lower dose antibiotics to take for several months. This keeps bacteria from invading the bladder, and allows the bladder to heal from the chronic inflammation of repeated infections.

Long-term use of antibiotics may cause some side effects, such as yeast infections or diarrhea.

Risk factors

Some people are more susceptible to UTIs:

• Women in menopause
• Men with prostate problems
• People who use a catheter to help them urinate

UTIs are not typically caused by poor hygiene, but there are factors that can increase risk:

• Having constipation
• Sexual activity (especially for women)
• Incontinence (urine leakage)
• A weakened immune system

Preventative tips

There are several ways to decrease the risk of UTIs:

• Probiotics can encourage the growth of your body’s “friendly” bacteria. This can prevent overgrowth of harmful bacteria. Probiotics are available over-the-counter and taken as a capsule or powder to add to a drink.
• Keeping bowel movements regular and soft can also decrease the risk of a UTI by reducing the overgrowth of bowel-related bacteria.
• Drinking plenty of water helps keep the urine diluted, which decreases bacterial growth.
• Drinking cranberry juice has been shown to lower the risk of UTIs.
• In postmenopausal women, the use of vaginal estrogen can improve the vaginal lining to decrease bacterial growth as well, according to the Cochrane Database of Systematic Reviews.
• Wipe from front to back after urinating or a bowel movement to help prevent bacteria in the anal region from spreading to the urethra.
• Empty your bladder after intercourse and drink a glass of water to help flush bacteria.
• Avoid irritating feminine products like deodorant sprays, douches, and powders, in the genital area.
• Consider changing your birth control method. Diaphragms, or unlubricated or spermicide-treated condoms, can all contribute to bacterial growth.