Recurrent UTI: How to Stop the Cycle

Bladder Health, Featured Article, Healthy Living, Women's Health
on March 14, 2013
Woman with stomach pain.

If you’re prone to urinary tract infections (UTIs), you know they’re no fun. UTIs are painful, inconvenient and can sometimes require surgery to fix.

Women are the hardest hit: A woman’s lifetime risk for developing a UTI is higher than 50 percent, reports the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). Not only that, but each UTI ups a woman’s risk that she’ll have another. Here are eight reasons why UTIs keep coming back—and how you avoid a recurrence.

RELATED: Natural Remedies for UTIs

You have stones in your urinary tract. A UTI occurs when a microbe, usually a bacterium, enters the urinary tract, which consists of the kidneys, ureters, bladder and urethra. “Because stones can harbor bacteria, they act as breeding ground for infection,” says American Urological Association spokesperson Dr. Tomas L. Griebling, professor and vice chair of the department of urology at the University of Kansas in Kansas City.  “If you don’t get rid of the stones, infections often come back.” In fact, recurrent UTIs or blood in the urine are tip-offs that you might have a stone in your kidney, bladder or ureters. An ultrasound or CT scan can confirm or rule out their presence. Stones need to be removed through surgery or extracorporeal shock wave lithotripsy, which uses shock waves to break the stone into pieces so it can travel through your urinary tract and be excreted. The treatment used will depend upon the size of the stones and how many you have, says Griebling.

You have an anatomical abnormality. Some women may have diverticulae, or pouches, that allow bacteria to gather in the bladder or urethra. They may also have a blockage that prevents them from completely emptying the bladder, allowing bacteria to grow, according to the Urology Care Foundation. Typically, these problems are surgically treated.

You’re having sex. “Some women experience UTIs more commonly after having intercourse,” says Griebling. That’s because bacteria from the vagina can enter the urethra during sex. To lower the risk of getting a UTI, Griebling recommends that women urinate before and after intercourse. If you tend to develop UTIs following intercourse, your doctor may have you take a single dose of antibiotic after you have sex.

You never got rid of your previous UTI. One of the most common reasons for recurrent UTIs is that “the infection wasn’t appropriately or completely treated,” says Griebling. For instance, a week- to 10-day regimen of antibiotics is typically prescribed to treat UTIs. “A lot of women start feeling better after two or three days and don’t take all of the medication,” Griebling says. The result: Bacteria regroup and UTI symptoms flare up. Another possibility is that your doctor prescribed an antibiotic that isn’t effective against the particular strain of bacteria that’s causing your infection. “You might need to change antibiotics,” says Griebling. Indeed, some types of bacteria that cause UTIs are becoming resistant to the antibiotics used to wipe them out, according to recent research from Extending the Cure [LINK TO], which tracks changes in antibiotic use and resistance.

A urinalysis will confirm that you have a UTI, but your physician should grow the bacterium that’s causing your UTI in a urine culture—a two- to three-day process—to determine which antibiotic would do the best job of knocking it out. In the interim, he or she may prescribe a general-purpose UTI-fighting antibiotic. Depending upon what the culture shows, your doctor might switch your antibiotic. Once you finish treatment, a second culture should be done to make sure the UTI has cleared up, says Griebling.

You really have something else. Some women may actually have interstitial cystitis, a chronic inflammation of the bladder wall. “It’s very common for patients to be prescribed an antibiotic for an UTI, but a bacterium is not causing the problem,” says Griebling.  Interstitial cystitis is characterized by urinary discomfort, urgency and frequency as well as pelvic pain and pain during intercourse. Treatments include diet modification, bladder retraining, stress management, medication and surgery.

You’re in menopause. Typically, lactobacillus—normal bacteria which grow in the vagina—act as an important natural defense mechanism, killing the bacteria that cause UTIs, explains Griebling. The decreased estrogen levels of menopause prevent lactobacillus from growing. As a result, vaginal bacteria thrive and can travel to the nearby urethra. The antidote: Prescription estrogen cream or a tiny ring that’s inserted in the vagina and slowly releases estrogen, allowing normal bacteria to grow again.

You’re wiping yourself incorrectly. The preferred method: Wipe from front to back. If you wipe from back to front, you risk introducing microbes into your urethra. This tiny opening in front of the vagina through which urine leaves your body is the gateway to your urinary tract. 

You’re not urinating enough. While there has been debate about the link between holding it in and UTIs, why take the risk? “Stagnant urine in the bladder can potentially increase the risk of bacteria growing,” says Griebling.