It's really annoying when you get a urinary tract infection (UTI) too, isn't it? The pain, discomfort, and frequent urination that come with it... Sometimes, just when you think you've taken the medicine and are feeling better, it comes back. This is really annoying. So, if you get these types of urinary tract infections repeatedly, it means you may have a condition called 'recurrent urinary tract infections'. Let's talk about this in detail today.
What is recurrent urinary tract infection (UTI)?
Simply put, if you get two or more urinary tract infections (UTIs) in six months , or three in a year , doctors call it a recurrent UTI. The word "recurrent" means "recurring."
This is called something else, and you may have heard it before:
- Chronic urinary tract infection (Chronic UTI)
- Persistent urinary tract infection (UTI)
- Frequent urinary tract infections (UTI)
Whatever you call it, the meaning is the same. It means that you have an infection in your urinary tract, and even after treatment, it comes back after a while. This can be really annoying and can interfere with your daily activities. That's why, if you have symptoms of a UTI, and the symptoms come back soon after treatment, you should definitely see a doctor . Then you can get the most suitable treatment or advice on how to prevent it.
What are the symptoms of recurrent urinary tract infections?
The symptoms of recurrent urinary tract infections are similar to those of a regular UTI. You may have one or more of these:
- Burning or pain when urinating (Dysuria)
- Suprapubic pain, meaning pain below the navel
- Urine that is yellowish or has a foul odor
- Needing to urinate more often than usual (Frequent urination)
- Urinary incontinence
- A sudden, uncontrollable need to urinate, but only a small amount of urine comes out (Urge incontinence)
- Small amounts of blood in the urine (Hematuria)
If you have symptoms like these, don't ignore them.
How quickly can a UTI recur?
Recurrent urinary tract infections usually recur within a month of treatment, but some people may experience recurrences several times a year, even after treatment.
Why do these urinary tract infections recur?
The main reason for recurring urinary tract infections is bacteria – especially E. coli – entering your urinary tract. E. coli usually lives in your lower gastrointestinal tract. Sometimes, this bacteria can enter your urethra through your rectum.
Women, in particular, may be at increased risk of bacterial entry in this way in situations such as:
- After using the toilet, wipe from back to front (this is the wrong way, you should always wipe from front to back).
- After sexual intercourse or after activities such as digital penetration and masturbation.
- Not urinating frequently (bacteria can grow when urine is held in the bladder for too long).
- When you have a condition like diarrhea, or when it's difficult to keep clean after defecating.
In addition to E. coli, several other types of bacteria can cause recurrent UTIs. For example:
- `(Enterococcus faecalis)`
- `(Klebsiella)`
- `(Proteus mirabilis)`
- `(Staphylococcus)`
What other underlying medical conditions can cause frequent UTIs?
Certain underlying health conditions can also make you more likely to develop recurrent urinary tract infections. These include:
- Vaginal dryness and thinning (Vaginal atrophy): This is a condition that occurs especially with menopause. It can also be caused by treatments for some types of cancer, such as breast cancer.
- Having fluid-filled cysts (diverticula) in your urethra or bladder. These can trap urine and bacteria and cause infections.
- Urinary retention : This can cause bacteria to grow in the urine that remains in the bladder and cause infections. This can be caused by conditions such as vaginal prolapse, diabetes, stroke, and neurological disorders such as multiple sclerosis and Parkinson's disease.
- Having kidney stones .
- Congenital urinary abnormalities : These can cause changes in the structure of the urinary system, making it more susceptible to infections. Examples include ureteropelvic junction (UPJ) obstruction, vesicoureteral reflux (VUR), ureteroceles, and ectopic ureters. These are complex medical conditions that can only be diagnosed by a doctor.
Is there a link between autoimmune diseases and recurrent UTIs?
Although there is not a lot of research on this, it is thought that the use of immunosuppressants, which are used to treat autoimmune diseases such as lupus and rheumatoid arthritis (RA), may increase the risk of recurrent UTIs. Similarly, long-term use of steroids can also increase the risk of UTIs and other infections.
Are recurrent UTIs contagious?
No, not at all. Recurrent urinary tract infections are not contagious. You cannot catch it from someone else, and you cannot spread it to someone else.
What are the risk factors for recurrent UTI?
Some things can increase your risk of developing recurrent UTIs:
- Use of spermicides : When used, these can destroy the beneficial bacteria (Lactobacilli) in the vagina that prevent the growth of bad bacteria like E. coli.
- After Menopause : Before menopause, the vagina is acidic. This acidity prevents bacteria from growing and entering the bladder. After menopause, the pH of the vagina changes and loses its acidity. Bacteria can then easily enter the bladder and cause infections. Also, the number of beneficial bacteria (Lactobacilli) in the vagina decreases after menopause.
- Weakening of the bladder with age : As the bladder muscles weaken with age, it may not be possible to squeeze out all the urine. When urine stays in the bladder for a long time, it creates a good environment for bacteria to grow.
- Use of a vaginal diaphragm .
- Using special liquids to wash the vagina (Vaginal douche) (This is not really a good thing, because it disrupts the natural balance of the vagina).
- Long-term use of antibiotics : This can disrupt the balance between good and bad bacteria in the body.
What are the possible complications of recurrent UTI?
If you ignore recurring urinary tract infections, over time, you may increase your risk of developing conditions such as:
- Kidney-related problems : such as kidney infections (Pyelonephritis) and kidney disease.
- Septicemia ( germs entering the bloodstream )
- Sepsis (a serious infection that can be life-threatening).
- Chronic bladder pain .
- The development of antibiotic resistance to some antibiotics (meaning that they no longer work).
Recurrent UTIs during pregnancy can lead to preterm birth and low birth weight . Therefore, if you are pregnant, you should be very careful about the symptoms of UTIs.
How do you recognize a recurring UTI?
If you suspect you have recurrent UTIs, a doctor will diagnose the condition in the following way:
- Asks about your symptoms .
- Your medical history is being asked.
- Does a physical examination .
- Special tests are recommended to confirm the diagnosis.
What kind of tests are done?
Most tests require you to provide a urine sample . Before taking this, you should wash your hands and genital area thoroughly and urinate into a special cup to prevent germs from entering (this is called a ``clean catch urine sample'').
Sometimes, if it is not possible to obtain a sample this way, or if the sample is thought to be contaminated, the doctor may insert a urinary catheter and obtain a sample.
These tests are performed using your urine sample:
- Urinalysis : In this test, laboratory technicians look for signs of infection in your urine sample.
- Urine culture : This tests to see if bacteria grow in your urine sample. Sometimes, even after successful treatment, a UTI can recur due to a different type of bacteria.
Very rarely, especially if you still have blood in your urine after treatment, or if you have frequent kidney stones, doctors may recommend painless imaging tests . These usually include:
- Kidney ultrasound test
- A CT scan of your abdomen and pelvis
Sometimes doctors may also recommend a cystoscopy, a procedure to examine the bladder . In this procedure, a small camera (cystoscope) is inserted through your urethra into your bladder. This test can help to check for any abnormalities or foreign bodies in the bladder that may not be seen on a CT scan.
How to stop these recurring urinary tract infections?
If you are in perimenopause or postmenopause, one of the best ways to prevent recurrent UTIs is to take vaginal estrogen treatment. This is not a pill or a patch. It is a cream, tablet, or ring that is inserted into the vagina. It changes the pH of the vagina, restoring its acidity. It is safe for most women to use. Very little estrogen (maybe none at all) is absorbed into the bloodstream.
To treat an existing acute infection, you will need a doctor's prescription for antibiotics . Even if your symptoms go away, your doctor may prescribe long-term, low-dose antibiotics . These can range from as short as three months to as long as a year or longer.
If you have a history of UTIs after sex, your doctor may tell you to take a single antibiotic pill right after sex . Or, they may prescribe a low-dose daily antibiotic. Examples of these antibiotics include:
- `(Nitrofurantoin)` (available under trade names such as Macrobid®, Macrodantin®, Urotoin®)
- `(SMX-TMP)` (Coming under trade names such as Bacter-Aid DS®, Bactrim®, Septra®)
- `(Trimethoprim)` (comes under trade names such as Proloprim®)
- `(Cephalexin)` (comes under trade names such as Keflex®)
However, taking antibiotics for a long time can lead to antibiotic resistance and increase the risk of developing other types of infections.
Doctors may also recommend non-antibiotic treatments. Examples:
- Cranberry extract supplements : It is thought that chemical compounds in cranberries may help prevent E. coli bacteria from affecting the bladder.
- Methenamine hippurate (brand names include Hiprex®, Mandelamine®, Urex®): This is an antibacterial drug. It makes your urine acidic, which helps kill bacteria.
How soon will I feel better after starting treatment?
Many people start feeling better within a few days of starting antibiotics. However, it is important to finish the full course of medication prescribed. If you don't, you are more likely to get a UTI again. If you miss a dose, talk to your doctor. Do not take two doses at once to make up for a missed dose.
What should I expect as someone who has a recurring UTI?
Most recurrent UTIs resolve with antibiotics and preventative measures. However, it's important to pay attention to your body and how you feel. See a doctor as soon as you start to experience symptoms of a UTI.
Can you prevent UTI recurrence?
If you often get urinary tract infections, it is very important to do these things:
- After using the toilet, wipe from front to back .
- Drink plenty of water to flush bacteria from the urinary tract.
- Keep the bladder empty and urinate regularly to flush it.
- Use condoms instead of diaphragms and spermicides as family planning methods.
- Always urinate after sex or any other sexual activity .
When should I see a doctor?
Make an appointment to see a doctor as soon as you start to experience symptoms of a UTI. If your symptoms do not improve or worsen despite treatment, see a doctor again.
When should I go to an Emergency Treatment Unit (ETU) ?
If you have a recurring UTI and are also experiencing these symptoms, it's a good idea to go to the emergency room:
- Back pain
- Fever
- Vomiting
These may be signs of a more serious infection.
What questions should I ask the doctor?
Here are some questions you can ask your doctor:
- Why do I keep getting these urinary tract infections?
- Is it the same bacteria that causes my repeated UTIs?
- What treatment do you recommend?
- What else can I do to prevent UTIs from recurring?
- What happens if I don't treat this recurring UTI?
How many times do you get a UTI before it becomes "frequent"?
If you get a UTI twice or more within six months, or more than three times within a year, doctors diagnose it as a recurrent UTI.
Urinary tract infections can be very uncomfortable in your daily life, and the symptoms can be embarrassing. They can be even more distressing when they occur frequently. You may even feel anxious about it.
If you have symptoms of a UTI, it's important to see a doctor. They understand your feelings, and they want to help you get better as quickly as possible. They can treat your current infection, recommend preventative measures, and help you avoid getting a UTI again. They can also check for any underlying conditions or abnormalities in your urinary system.
Finally, remember this (Take-Home Message)
Okay, so let's remind you of the most important points from what we've talked about.
- Recurrent UTIs are something to take seriously. Don't ignore them.
- Correct diagnosis and treatment are essential. Do not self-medicate.
- Practicing prevention can make a big difference. Especially taking care of hygiene, drinking plenty of water, and practicing good sexual hygiene.
- If you have increased this problem with menopause, don't be afraid to talk to your doctor about things like vaginal estrogen treatment .
- You are not alone. There are many people who have this problem. With the right advice and support, this condition can be controlled.
Taking care of your health is the most important thing. Don't hesitate to seek medical advice if you experience any discomfort.
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