{"id":10115,"date":"2020-04-01T09:00:59","date_gmt":"2020-04-01T13:00:59","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=10115"},"modified":"2024-05-29T14:14:39","modified_gmt":"2024-05-29T18:14:39","slug":"recurrent-uti","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/recurrent-uti\/","title":{"rendered":"What to do if you have recurring UTIs"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">Most of us use the bathroom throughout the day without much thought, but when you have a urinary tract infection, something as simple as peeing can suddenly become strenuous, smelly, and downright painful.<\/span><\/p>\n\n<p><span style=\"font-weight: 400;\">Your urinary tract is the system of \u201cplumbing\u201d that allows you to pee, and it includes everything from your urethra and bladder all the way up to your kidneys. A urinary tract infection, or UTI, occurs when any part of that urinary system becomes overgrown with bacteria that doesn\u2019t belong there. This causes symptoms like pain or burning during urination, frequent urination or trouble voiding, cloudy or foul-smelling urine, and pain in the abdomen or lower back.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">While having one UTI in a lifetime is more than enough, some people cope with recurrent UTIs and don\u2019t know how to handle them. If you have had more than one UTI in recent months, you might be suffering from recurrent infections. Here\u2019s everything you need to know about the possible causes, treatment, and prevention of UTIs.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Why does my UTI keep coming back?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">There are many different reasons why someone might have recurrent urinary tract infections. Although there are a few hygienic practices that can cause them (like not wiping front to back after a bowel movement if you\u2019re female), the majority of infections are caused by factors completely out of your control.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">According to<\/span> <a href=\"https:\/\/www.providence.org\/doctors\/profile\/202627-lauren-anne-cadish\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">Lauren Cadish<\/span><\/a><span style=\"font-weight: 400;\">, MD, urogynecologist at Providence Saint John\u2019s Health Center, anatomical anomalies can put people at increased risk. This includes people born with a tendency for urine to go backward from the bladder back up the ureters, the tubes that bring urine from the kidneys down into the bladder. However, Dr. Cadish says this is typically diagnosed in childhood, so it shouldn\u2019t come as a surprise to an adult suffering from recurrent UTIs.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Other common risk factors for recurrent UTIs include:<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Bladder or kidney stones<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Nerve injury or disease of the bladder that prevents it from emptying fully<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Kidney disease and transplant<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Autoimmune disorders or other medical conditions that compromise the immune system\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Bowel problems, like diarrhea or fecal incontinence (Escherichia coli, or E. coli, is the bacterial culprit in<\/span> <a href=\"https:\/\/www.ucsfhealth.org\/conditions\/urinary-tract-infections\"><span style=\"font-weight: 400;\">90% of all UTIs<\/span><\/a><span style=\"font-weight: 400;\">)<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Some causes of UTIs can be easily identified and resolved. Remembering to empty your bladder in a timely manner, drinking enough fluids to flush out your urinary tract, and managing bowel movements are simple ways to avoid some of the common causes of UTIs, explains Julie Stewart, MD, a urologist at Houston Methodist Hospital.\u00a0\u00a0<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Men versus women<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Though both men and women get UTIs, women are disproportionately affected. Why? Because of basic female anatomy as it relates to the urethra, the tube that transports urine from the bladder out of the body.\u00a0<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cThe urethra in a woman is relatively short, typically about four centimeters,\u201d says Dr. Cadish.\u00a0 \u201cBecause men\u2019s urethras have to traverse through the prostate and the length of the penis, their urethras are much longer and bacteria have a harder time getting up into the bladder than in women.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">There\u2019s another normal part of female anatomy that can increase the risk of UTIs, too: the vagina. According to Dr. Cadish, women have bacteria that normally live inside the vagina, but that bacteria sometimes travels to the urinary tract or bladder and causes a UTI. Hormonal changes may also make a woman more vulnerable to UTIs; the infections are more common after menopause and, often, before menstruation (<\/span><a href=\"https:\/\/academic.oup.com\/jid\/article\/195\/5\/623\/842036\"><span style=\"font-weight: 400;\">thanks to the drop in estrogen<\/span><\/a><span style=\"font-weight: 400;\">).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">But before you think men get off easy when it comes to UTIs, that\u2019s not necessarily the case. \u201cWhile women are at much higher risk of UTIs, the longer urethras in men put them at higher risk of not being able to empty their bladder well, often the result of a prostate problem,\u201d says Dr. Cadish. Insufficient emptying due to an enlarged prostate can cause frequent UTIs.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">Though UTIs are not typically a sign of cancer, they are linked to both prostate and bladder cancer in other ways. A<\/span>\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5207623\/\"><span style=\"font-weight: 400;\">2017 study<\/span><\/a><span style=\"font-weight: 400;\"> published in <\/span><i><span style=\"font-weight: 400;\">PLoS One<\/span><\/i><span style=\"font-weight: 400;\"> found that men who visited a doctor more than five times per year for lower urinary tract infections were more likely to develop prostate cancer than men who didn\u2019t suffer from recurrent infections.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Elsewhere, bladder cancer is often linked to frequent UTIs because one of the<\/span> <a href=\"https:\/\/www.urmc.rochester.edu\/patients-families\/health-matters\/june-2015\/could-persistent-uti-like-symptoms-be-bladder-canc.aspx\"><span style=\"font-weight: 400;\">first signs is blood in the urine<\/span><\/a><span style=\"font-weight: 400;\">, a symptom easily dismissed in women as the result of bladder infection or hormonal changes. In other words, women are often diagnosed later with bladder cancer than men, having had many of their early cancer signs mislabeled as UTIs.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">How is a recurrent UTI diagnosed?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">According to Dr. Stewart, the criteria for diagnosing recurrent UTIs was recently re-evaluated by the American Urological Association (AUA). \u201cRecurrent UTIs are defined as two UTIs in six months or three UTIs within one year,\u201d she says, \u201cbut they need to be cases of culture-proven, bacterial cystitis with symptoms.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400;\">In other words, you\u2019ll need to have confirmed cases of bacteria from a urine sample and noticeable UTI symptoms to qualify. Dr. Stewart explains that some people regularly test positive for bacteria without symptoms and others have symptoms without a positive culture (possibly due to bladder irritation rather than bacterial infections). Those scenarios should be treated differently than a patient who presents with both.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cA urine culture includes a check of sensitivities, meaning that we can tell which antibiotics will kill that infection and which will not,\u201d explains Dr. Cadish, adding that a diagnosis of UTI really means that the specific bacteria causing the infection has been identified in a culture. From there, a healthcare provider can prescribe an appropriate course of<\/span> <a href=\"https:\/\/www.singlecare.com\/blog\/how-do-antibiotics-work\/\"><span style=\"font-weight: 400;\">antibiotics<\/span><\/a><span style=\"font-weight: 400;\"> for that particular infection.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">It\u2019s important not to neglect symptoms of UTIs; if left untreated, your UTI can become a<\/span>\u00a0<a href=\"https:\/\/www.mayoclinic.org\/diseases-conditions\/kidney-infection\/symptoms-causes\/syc-20353387\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">kidney infection<\/span><\/a><span style=\"font-weight: 400;\">, a serious and potentially life-threatening problem known as pyelonephritis.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">How is a recurrent UTI treated?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">If you meet the criteria for recurrent UTIs, your primary care provider will likely refer you to a urologist who can begin to do some detective work.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cIt\u2019s our job as surgeons to understand if there are risk factors like anatomical or autoimmune issues,\u201d says Dr. Stewart. \u201cWe look for causes and intervene on them if we can\u2014like treating a kidney stone if there is one\u2014but the majority of patients do not have a clear cause or \u2018smoking gun.\u2019\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400;\">This is known as an uncomplicated urinary tract infection, and while it can be frustrating to not find a clear cause or explanation, urologists can still work with you to develop a treatment plan. Typically, the<\/span><a href=\"https:\/\/www.singlecare.com\/conditions\/uti-treatment-and-medications\/\"> <span style=\"font-weight: 400;\">treatment for recurrent UTIs<\/span><\/a><span style=\"font-weight: 400;\"> includes antibiotic therapy as-needed with a medication like:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><a href=\"https:\/\/www.singlecare.com\/prescription\/bactrim\"><span style=\"font-weight: 400;\">Bactrim<\/span><\/a><span style=\"font-weight: 400;\"> (sulfamethoxazole-trimethoprim)<\/span><\/li>\n<li style=\"font-weight: 400;\"><a href=\"https:\/\/www.singlecare.com\/prescription\/macrobid\"><span style=\"font-weight: 400;\">Macrobid<\/span><\/a><span style=\"font-weight: 400;\"> (nitrofurantoin)<\/span><\/li>\n<li style=\"font-weight: 400;\"><a href=\"https:\/\/www.singlecare.com\/prescription\/keflex\"><span style=\"font-weight: 400;\">Keflex<\/span><\/a><span style=\"font-weight: 400;\"> (cephalexin)<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">The antibiotic used depends on the strain of bacteria shown in the urine culture.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cThere are several antibiotics we\u2019ve agreed have the least \u2018collateral damage,\u2019\u201d says Dr. Stewart, \u201cand we try to treat the infection with the most appropriate antibiotic for the shortest duration that will be effective.\u201d<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">She adds that sometimes longer, daily low-dose <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/finish-antibiotics\/\"><span style=\"font-weight: 400;\">antibiotics<\/span><\/a><span style=\"font-weight: 400;\"> are needed to manage a more chronic infection due to other health problems. For example, a<\/span>\u00a0<a href=\"https:\/\/www.thelancet.com\/journals\/laninf\/article\/PIIS1473-3099(18)30279-2\/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">2018 study<\/span><\/a><span style=\"font-weight: 400;\"> in <\/span><i><span style=\"font-weight: 400;\">The Lancet Infectious Diseases<\/span><\/i><span style=\"font-weight: 400;\"> found that continuous antibiotic treatment was effective in preventing UTIs in patients who use catheters. Some women may also be told to take a single dose of an<\/span> <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1477561\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">antibiotic after sexual activity<\/span><\/a><span style=\"font-weight: 400;\"> to prevent bacterial growth.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If you have an active infection being treated with antibiotics, you may also need to use an OTC pain reliever, like acetaminophen or ibuprofen, until the antibiotic starts working. You can also take an OTC medication designed to help with several symptoms of UTIs, like<\/span> <a href=\"https:\/\/www.singlecare.com\/prescription\/azo-urinary-pain-relief\"><span style=\"font-weight: 400;\">Azo Urinary Pain Relief<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">How to prevent urinary tract infections<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Depending on why your provider suspects you\u2019re experiencing recurrent UTIs, there are a number of ways you can potentially prevent reinfection and avoid antibiotic treatment at least some of the time.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Medications and supplements<\/span><\/h3>\n<ol>\n<li style=\"font-weight: 400;\"><b>D-mannose<\/b><span style=\"font-weight: 400;\"> is a sugar commonly found in fruit, which is known to adhere itself to the E. coli bacteria in your bladder and prevent bacterial overgrowth in the lining of the bladder. Dr. Cadish recommends taking this OTC supplement at a dose of two grams daily. A<\/span>\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27424995\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">2016 study<\/span><\/a><span style=\"font-weight: 400;\"> in the <\/span><i><span style=\"font-weight: 400;\">European Review for Medical and Pharmacological Sciences<\/span><\/i><span style=\"font-weight: 400;\"> found D-mannose to be an effective treatment and prevention strategy for UTIs (and it doesn\u2019t carry many side effects).<\/span><\/li>\n<li style=\"font-weight: 400;\"><b>Methenamine<\/b><span style=\"font-weight: 400;\">, available by prescription, may be useful in preventing future infections (though it doesn\u2019t work to<\/span> <a href=\"https:\/\/my.clevelandclinic.org\/health\/drugs\/19603-methenamine-hippurate-tablets\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">treat existing ones<\/span><\/a><span style=\"font-weight: 400;\">). It\u2019s an older antibiotic that may have a cleansing effect on the urinary tract and is considered an antiseptic or antibacterial treatment, rather than one that can cure an active infection.<\/span><\/li>\n<li style=\"font-weight: 400;\"><b>Vaginal estrogen therapy<\/b><span style=\"font-weight: 400;\">, especially for postmenopausal women, is another option for prevention. Dr. Stewart says that because menopause changes the pH of vaginal tissues, it makes bacterial growth more likely. Replacing the estrogen in small amounts, she explains, can improve the pH of vaginal tissues and prevent overgrowth of \u201cbad\u201d bacteria while promoting the growth of \u201cgood\u201d bacteria.\u00a0<\/span><\/li>\n<\/ol>\n<h3><span style=\"font-weight: 400;\">Lifestyle changes<\/span><\/h3>\n<ol>\n<li style=\"font-weight: 400;\"><b>Drinking plenty of fluids<\/b><span style=\"font-weight: 400;\"> every day will help you flush normal bacteria out of your urinary tract, preventing overgrowth.<\/span><\/li>\n<li style=\"font-weight: 400;\"><b>Go to the bathroom frequently<\/b><span style=\"font-weight: 400;\">. Don\u2019t hold your urine for extended periods of time or rush through the process without fully emptying your bladder. Doing so can lead to an overgrowth of bacteria in your bladder.<\/span><\/li>\n<li style=\"font-weight: 400;\"><b>Address any ongoing GI issues<\/b><span style=\"font-weight: 400;\">, like constipation or diarrhea. Since most of the UTI-causing bacteria comes from the rectal area, having frequent bowel movements exposes you more often to contamination; meanwhile, being constipated can put<\/span> <a href=\"https:\/\/urology.ucsf.edu\/patient-care\/children\/constipation\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">pressure on the bladder<\/span><\/a><span style=\"font-weight: 400;\"> and affect its overall function (this is especially common in children).\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\"><b>Avoid frequent consumption of<\/b> <a href=\"https:\/\/my.clevelandclinic.org\/health\/diseases\/9135-urinary-tract-infections\/prevention\" target=\"_blank\" rel=\"noopener noreferrer\"><b>foods known to irritate the bladder<\/b><\/a><span style=\"font-weight: 400;\">, like caffeine, alcohol, and spicy foods.<\/span><\/li>\n<\/ol>\n<h3><span style=\"font-weight: 400;\">Hygiene tips<\/span><b>\u00a0<\/b><\/h3>\n<ol>\n<li style=\"font-weight: 400;\"><b>Wipe from front to back after bowel movements<\/b><span style=\"font-weight: 400;\">,<\/span> <span style=\"font-weight: 400;\">for women, to avoid spreading bacteria from the rectal area to the urethra. Men should also keep their genitals clean, especially after sex.<\/span><\/li>\n<li style=\"font-weight: 400;\"><b>Urinate soon after sexual intercourse<\/b><span style=\"font-weight: 400;\"> to flush out any bacteria transferred to the urethra.<\/span><\/li>\n<li style=\"font-weight: 400;\"><b>Keep the genital area dry and unrestricted<\/b><span style=\"font-weight: 400;\">. Wear cotton underwear, avoid hot tubs and ill-fitting undergarments, and don\u2019t use any feminine cleansing products like douches or deodorant.<\/span><\/li>\n<li style=\"font-weight: 400;\"><b>Use alternative forms of contraception<\/b><span style=\"font-weight: 400;\">. According to a<\/span>\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3784967\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">2013 review<\/span><\/a><span style=\"font-weight: 400;\"> of studies in <\/span><i><span style=\"font-weight: 400;\">Reviews in Urology<\/span><\/i><span style=\"font-weight: 400;\">, using spermicide and barrier methods of contraception (like diaphragms and condoms) may increase the potential for bacterial growth after intercourse.<\/span><\/li>\n<\/ol>\n<h3><span style=\"font-weight: 400;\">Natural remedies<\/span><\/h3>\n<ol>\n<li style=\"font-weight: 400;\"><b>Incorporate a daily source of cranberry<\/b><span style=\"font-weight: 400;\">. Anyone with recurring UTIs has probably been told to drink cranberry juice or take a cranberry supplement because the fruit may have a protective effect on the bladder. But the research\u2014and the medical recommendations\u2014are split. Dr. Cadish says cranberry juice and supplements won\u2019t hurt you, but won\u2019t help you much either. On the other hand, Dr. Stewart says there may be some truth to the connection between cranberries and bladder health: \u201cThere is something called PAC, a molecule that coats the bladder lining and might prevent E. coli from accumulating in the bladder [and causing infections].\u201d However, most OTC supplements don\u2019t have enough PAC to make a difference, warns Dr. Stewart; the<\/span> <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5930667\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">current research<\/span><\/a><span style=\"font-weight: 400;\"> suggests that a dosage of at least 37 milligrams may be needed to have an effect (and most supplements have only two milligrams).<\/span><\/li>\n<li style=\"font-weight: 400;\"><b>Take a daily probiotic<\/b><span style=\"font-weight: 400;\">. It may ward off UTIs. These good bacteria live primarily in your gut, but also in the vagina\u2014especially the probiotic<\/span> <a href=\"https:\/\/urogyn.coloradowomenshealth.com\/blog\/probiotics-for-uti\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">lactobacillus, which can reduce UTIs in women<\/span><\/a><span style=\"font-weight: 400;\"> who have a healthy vaginal flora.<\/span><\/li>\n<li style=\"font-weight: 400;\"><b>Add more vitamin C to your diet.<\/b><span style=\"font-weight: 400;\"> The hard evidence to support this strategy is lacking, but researchers think that vitamin C may inhibit bacterial growth by making your urine more acidic. One older<\/span> <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17611821\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">study from 2007<\/span><\/a><span style=\"font-weight: 400;\"> found that a group of pregnant women taking a combination of supplements including vitamin C were less likely to develop UTIs than the group of women whose supplements did not include vitamin C.<\/span><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">\u00a0It can be discouraging when UTIs keep coming back. Talk to your healthcare provider. With advice, you can find the right combination of treatments that will work for you.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Most of us use the bathroom throughout the day without much thought, but when you have a urinary tract infection, something as simple as peeing can suddenly become strenuous, smelly, and downright painful. Your urinary tract is the system of \u201cplumbing\u201d that allows you to pee, and it includes everything from your urethra and bladder [&hellip;]<\/p>\n","protected":false},"author":85,"featured_media":9735,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[8029],"tags":[],"coauthors":[8860],"class_list":["post-10115","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-education","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Recurrent UTI: Causes, treatment, and prevention<\/title>\n<meta name=\"description\" content=\"Urinary tract infections are treatable with antibiotics, but for some of us, UTIs come back. 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