Too Many UTIs - an overview of recurrent UTIs and how to manage them

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Linda Brubaker, MD, FACOG is a board-certified urogynecologist who specializes in treating adult women with recurrent urinary tract infections and providing non-surgical solutions for bladder/bowel control problems and pelvic organ prolapse. Dr. Brubaker serves as the Female Pelvic Medicine and Reconstructive Surgery Interim Chair and Professor of Obstetrics, Gynecology, and Reproductive Sciences at UC San Diego.

You are not alone if you think you are getting too many urinary tract infections (UTIs). Frequent (or recurrent) UTIs are common, especially in women. It can leave a woman feeling powerless to prevent this health issues. This brief summary won’t take the place of a conversation with your doctor or a specialist who is knowledgeable about frequent UTI, but hopefully it will help you understand this condition and empower you to take action.

First, it is important to understand that women’s bladders have a community of bacteria, just like other places in the body. This community of bacteria, often referred to as the microbiome, typically contains a mix of bacteria. Just like any community, these bacteria should be working to maintain a healthy bladder and help you avoid infections.

Infections can happen when the bacterial balance is disrupted. It may be that the “good” bacteria are missing, the “bad” bacteria have taken over – or a mix of these causes.

Large NIH-funded studies are doing important research to help understand bladder health in women. Meanwhile, you may find it useful to learn a bit about UTIs.

Remember:  Bacteria live in the bladder – even when you are healthy. You don’t necessarily have an infection just because a test finds bacteria. Unless you are pregnant or have other specialized circumstances, unless you have UTI symptoms, it isn’t a good idea to test for UTI or treat with antibiotics based on positive test results alone.

Symptoms: UTI symptoms are typically a rather sudden onset of pain/pressure in the bladder area, often with a change in urinary patterns – more frequent or more urgent urination. It may be painful to urinate; some women see blood during the infection.   However, as women age, these symptoms may change and become more personal, with changes in how the urine looks or smells. Some women note other symptoms and some family members report changes in how their loved one is thinking or behaving during infection.

Warning Signs: It is rare for infection to become suddenly serious, but if you have fever (101.4 F with a thermometer), severe one-sided pain in your flank (side of your middle back) or feel really sick, you should head to an urgent care or ER setting.

Causes:  UTIs are caused by disruptions to the normal urinary bacterial community. These can happen after normal sexual activities, certain medical procedures, changes in bowel habits (diarrhea or constipation) and sometime, without any clear association at all.

Treatment: Fortunately, most healthy women can resolve a simple UTI on their own by drinking a great deal of water (not cranberry juice) and taking an anti-inflammatory medication, such as ibuprofen (as you would for a headache). Although antibiotics can address the symptoms as well and work more quickly than natural methods, they can cause further disruption to the urinary bacterial community. For infrequent, simple UTIs, 3-5 days of oral antibiotics is effective for most women.

UTI symptoms should resolve quickly (within a few days) and completely. If symptoms are slow to resolve (taking more than a week) or linger, it is prudent to visit your doctor to see if further evaluation is needed.

Sexual relationships: When UTIs are frequent, it is helpful to see if you can find out life events that are associated with the problems. For some sexually active women, normal sexual activities can trigger UTIs. Affected women may find that it happens so frequently, that the UTIs begin to impact their intimate life. Although the internet has a lot of advice about voiding or showering before/after intercourse, wearing certain types of underwear and other traditional remedies, it turns out that these things don’t improve the situation. Our best understanding is that there is a bacterial community mismatch between you and your male partner. It is as if you have different decorating styles and you are trying to decorate the living room – he wants traditional and you want modern. It will take some time to find a way forward. During this time, certain supplements and even low dose antibiotics around the time of intercourse can make a difference.

Low estrogen levels: For the majority of women affected with frequent UTI, the events don’t appear related to sexual activity. However, many affected women are aging successfully, having transitioned into menopause. Normal aging includes lower estrogen levels in the genito-urinary areas. These lower levels can make it difficult for the “good” bacterial to thrive. Simple replacement of low-dose estrogen into the vaginal twice a week can make all the difference.

There are many other prevention and treatment approaches that you can discuss with your doctor. It is not necessary to suffer with these problems.