What Makes It A Recurrent UTI?

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Urinary tract infections (UTIs) are among the most common infections affecting women. A UTI occurs when bacteria enter the urinary tract and multiply. An infection can involve any part of the urinary system, including the urethra (which carries urine from the bladder out of the body), bladder, ureters (which carry urine from the kidneys to the bladder), or kidneys.

A recurrent UTI is generally defined as having two documented UTIs within six months or three within one year. Approximately 30% to 40% of women who experience a UTI will go on to have recurrent infections. The most common bacteria associated with recurrent UTIs is E. coli.

Symptoms of a UTI

Common symptoms may include:

• Burning or pain with urination
• Frequent urination
• A strong or sudden urge to urinate
• Feeling like you need to urinate even when very little urine comes out
• Pressure or discomfort in the lower abdomen
• Cloudy or foul-smelling urine, particularly when accompanied by other symptoms
• Occasionally, blood in the urine

Symptoms that may indicate the infection has spread beyond the bladder:

• Fever
• Chills
• Significant back or side pain
• Nausea or vomiting
• Feeling very ill or unusually weak

If these symptoms occur, medical evaluation should be sought immediately.

Causes of Recurrent UTIs

There are many possible causes and risk factors for recurrent UTIs. One of the strongest risk factors is a history of previous UTIs.

Other contributing factors can include:

• Anatomical factors: Kidney stones, urinary tract abnormalities, or other blockages can make infections more likely.
• Hormonal changes:  As women enter perimenopause and menopause, declining estrogen levels can contribute to changes in the urinary and vaginal tissues that increase the risk of UTIs.
• Sexual activity: Sexual activity can introduce bacteria into the urethra. Because the female urethra is relatively short, bacteria can more easily travel into the bladder.
• Incomplete bladder emptying: Retaining urine in the bladder can increase the opportunity for bacteria to multiply.
• Urinary incontinence: Leakage of urine can sometimes contribute to an increased risk of infection.
• Bowel issues: Constipation and diarrhea may contribute to UTIs because of the close proximity of the rectum to the urethra.
• Underlying health conditions: Conditions such as poorly controlled diabetes can increase UTI risk. Excess glucose in the urine may create an environment that promotes bacterial growth.

Diagnosis of a Recurrent UTI

A recurrent UTI is typically diagnosed by a healthcare provider after reviewing your medical history, symptoms, and previous urine tests. Your provider may obtain another urinalysis and urine cultures when symptoms are present to confirm an infection and identify the bacteria responsible.

In certain situations, additional testing may be recommended. If there is concern about a structural abnormality of the urinary tract, kidney stones, blockage, or another underlying cause, your healthcare provider may recommend imaging studies or a cystoscopy, a procedure that allows the provider to examine the inside of the bladder using a small camera.

Prevention of Recurrent UTIs

Acute UTIs are generally treated with antibiotics when a bacterial infection is confirmed. For women who experience recurrent UTIs, there are also several strategies that may help reduce the risk of future infections. Prevention should be individualized based on your medical history and risk factors.

Options may include:

• Increasing water intake: dilutes urine and promotes regular urination, which can help flush bacteria from the urinary tract
• Cranberry supplements: contain compounds that may make it more difficult for certain bacteria, particularly E. coli, to adhere to the lining of the urinary tract and cause an infection
• D-mannose: a type of sugar that may interfere with E. coli attaching to the urinary tract lining,
• Vitamin C: increases the acidity of urine which is thought to create a less favorable environment for bacterial growth
• Vaginal estrogen: for those experiencing menopause related changes to help restore the health of the vaginal and urinary tissues
• Managing constipation or diarrhea: reduce the movement of bacteria from the rectal area toward the urethra
• Methenamine (Hiprex): acidifies the urine which can help prevent bacteria from growing
• Post-coital antibiotic prophylaxis when appropriate: to prevent infections secondary to sexual activity

If these measures are unsuccessful and recurrent UTIs continue, a healthcare specialist may recommend additional options, including prophylactic (preventive) antibiotics or, in select cases, antibiotic bladder instillations.

When to See a Specialist

Recurrent UTIs are common in women and can be frustrating, but there are many ways to evaluate, treat, and potentially prevent them. If you are experiencing recurrent infections, consider discussing your symptoms with your healthcare provider. A referral to a specialist, such as a urologist, may be helpful when infections continue or when there is concern about an underlying urinary tract problem.

The good news is that recurrent UTIs don’t have to be something you simply live with. With the right evaluation and an individualized prevention plan, many women can significantly reduce the frequency of infections.

About the Author:

Dr. Fornati Bedell is a board certified urologic surgeon. She specializes in general urologic diagnoses including female pelvic health and bladder disorders. Dr. Bedell is passionate about public health specifically improving the health of entire communities  through research, education and disease prevention.