PLAGUED BY RECURRENT UTI’S? HERE’S WHAT TO DO ABOUT IT

Recurrent Urinary Tract Infections (UTIs) are UTIs that keep coming back even after treatment. These reinfections could occur because the urinary tract got a new infection, or the last treatment did not completely clear out the previous infection.

What are Urinary Tract Infections?

Urinary Tract Infections (UTIs) are infections affecting any part of your urinary tract. Your urinary tract is a system consisting of

Kidneys that filter body waste from your blood into the urine
Your ureters transport urine from your kidneys to your bladder
Your bladder which stores the urine
Your urethra transports the urine outside of your body

Urinary Tract Infections are grouped into upper UTIs and lower UTIs depending on what part of your urinary tract is affected. Your upper urinary tract consists of your kidneys and ureters, while your lower urinary tract is made up of your bladder and urethra.

The microbes responsible for most UTI infections are bacteria, with the most common being Escherichia Coli (E. coli). Sometimes, however, UTIs may be caused by fungi, and very rarely viruses. Although men can get urinary tract infections, UTIs are more common in women, with as many as 50-60% of women having UTIs at least once in their lives. Having a urinary tract infection once is uncomfortable but having recurrent UTIs that come every other month can be a different level of pain and annoyance. Unfortunately, about 1 in 4 young adult women will have recurring UTIs. How do you know if you have recurrent UTIs? Well, if you have had at least two infections in the past six months or three in the past year, you have ‘Recurrent UTIs’.

Symptoms of Recurrent UTIs

Recurrent UTIs come with symptoms of UTIs at frequent intervals. These include:

frequent and strong urge to urinate, often with little urine being expelled
burning feeling when you pee
dark, cloudy, or bloody urine
urine with a strong smell
lower back or abdomen pain
pelvic pain
fever or chills

With a kidney infection, you may also have:

Nausea
Vomiting
Upper back or side pain

Note: a UTI that shows up in urine testing but is not causing any symptoms (ie an ‘asymptomatic UTI’) is usually self-limiting and will rarely progress to anything serious. These non-bothersome UTIs can be observed and do not require antibiotic treatment. Avoiding unnecessary antibiotics can avoid possible medication side effects and the creation of antibiotic resistance.

Risk Factors for Recurrent UTI’s

What You Can Do to Minimize Risk

The Female Anatomy

Generally, women are more likely to have recurrent UTIs than men. The reason for this can be linked to basic anatomy. The most common UTI-causing bacteria, E. coli, resides naturally in your gastrointestinal tract, down to your anus, and can be found in your poop too. The distance between a woman’s anus and her urethra is very short, making it easy for the bacteria to travel to her urethra. Furthermore, a woman has a short urethra, which also makes a trip up to the bladder easy. Because of this anatomy, a woman is more susceptible to a urinary tract infection, unlike men who have longer urethras and more distance between their urethra and anus to keep the bacteria away from the bladder.

Sexual Activities

Sexually active women are more likely to have recurring UTIs than women who aren’t having sex. This is because, during sex, it is very easy to transfer bacteria originally from nearby the anus into the urethra. Different sexual activities including simple vaginal penetration or the use of toys that can be moved around can introduce bacteria to the urethra. If you have anal sex, you and your partner should ensure you clean your genitals before engaging in further sexual activities that can introduce bacteria to the urethra. The frequency and intensity of your sexual activities can also increase your chances of getting a UTI. Having sex with multiple or new partners can also expose you to more UTIs. Essentially, the more you have sex, the higher your chances of recurrent UTIs. It is not uncommon for women to have bacteria in their urine after sex. So, experts have advised that to help avoid recurrent UTI’s caused by sexual activities, women should pee immediately after sex to “flush” the bacteria out. Although this seems to help some women, it is not a hard and fast rule.

Use Of Certain Contraceptives

People who use contraceptives such as a diaphragm during sex are more likely to have UTIs. This is because diaphragms put pressure on the urethra, which may inhibit complete emptying of the bladder. Non-lubricated latex condoms can also increase friction during sex and increase the risk of getting a UTI. The use of spermicides may also make you more susceptible to recurrent UTIs. Asides from the fact that spermicides may irritate some women, they may also kill off lactobacilli, a normal flora in the vagina, making it easier for E. coli to move in. If you use any of these contraceptives, you may want to discuss with your family doctor other options that do not predispose you to UTIs.

Menopause

The physical changes that accompany menopause in women can also set a woman up for recurrent UTIs. For instance, the bladder cannot contract as strongly as pre-menopause, making it hard to empty completely. Urine that sits around in the bladder for longer periods of time puts you at greater risk of a UTI. Also, the quantity of lactobacilli reduces during menopause, allowing easier entrance and growth of E. coli bacteria.

Genetics

Some women are genetically more susceptible to recurrent UTIs even if they do everything right to minimize risk. If your mum or your sister has recurrent UTIs, you may have them too.

Treatment of Recurrent UTIs

There are different ways you can manage recurrent UTIs, and you should discuss with your doctor the best treatment option for you. Your family doctor may refer you to a specialist (a urologist) if you need further discussion and management. The main lifestyle modification you can make to minimize the risk of recurrent UTIs is to increase your daily water intake to at least 1.5L a day (in addition to another fluid intake). An easy way to do this is to have a 500mL water bottle which you fill up and start drinking at the start of every meal. Aim to have finished the bottle by the start of your next meal. This increase in hydration helps to flush out the urinary tract and prevent UTIs. In terms of medication options, your doctor would most likely recommend one of the following:

Daily Prophylactic Antibiotic:

Your doctor may prescribe a daily low-dose prophylactic antibiotic used to prevent UTIs such as Nitrofurantoin, Trimethoprim/Sulfamethoxazole, or Cefalexin. This method is the most common and reliable in preventing a recurring infection. However, there is a risk of the bacteria developing resistance to the antibiotic, so you have to work with your doctor on managing that.

Post-Coital Antibiotic:

You may also be prescribed antibiotics that you only have to use after having sexual intercourse if you find that is one of your UTI triggers. This will prevent the bacteria introduced into your urethra from settling down in the bladder and multiplying.

Self-Start Antibiotic:

If you have been diagnosed with recurrent UTI before and this cleared with antibiotics, your doctor may give you a standing prescription so that you can start the antibiotics yourself at the first sign of symptoms. Starting medication right away can prevent the UTI from progressing. Reach out to your doctor to inform them of your symptoms before starting the medication. Estrogen can also be helpful in peri-menopausal women to decrease their risk of recurrent UTI. Would you like to talk to a doctor about your UTI symptoms, ways to minimize your personal risk, and get a prescription if needed? Let’s connect you to a doctor in few minutes at www.mdconnected.ca

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