Recurrent Urinary Tract Infection (UTI) in women
What is UTI?
UTI is when there is presence of significant pathogens (bacteria, yeast) in the urine in the setting of accompanying symptoms of cystitis (bladder infection) or pyelonephritis (kidney infection).
UTI can be categorized into lower urinary tract infection which refers to cystitis, which represents the majority of these infections. Upper urinary tract infection refers to kidney infection.
What is recurrent UTI?
Recurrent UTI is when you get 2 or more infections in 6 months or 3 or more in 1 year. This is still very common in young healthy women who have normal, healthy urinary tracts.
The focus of this article will be on acute uncomplicated UTI.
Who gets UTI?
UTI is very common in women with up to 40% of women of childbearing age experiencing at least 1 episode of UTI in their lifetime. Conversely, UTI is rare in adult males <50 years of age but increases in incidence thereafter. Male urinary tracts have greater innate defences to infection and as such UTI in males is usually regarded as complicated (ie more commonly associated with anatomical abnormalities, possibilities of needing surgery to prevent further complications, etc).
Signs & Symptoms
– Pain or burning sensation during urination (dysuria)
– Urinary urgency (the feeling of a full bladder)
– Urinary frequency (needing to pass urine regularly)
– Lower abdominal discomfort
– Bloody urine (hamorrhagic cystitis)
– Flank pain
– Fever, chills, malaise (more frequently with kidney infection)
1. Being female + pelvic anatomy
Ladies out there must be wondering, why do women get UTI more often than men?
This is because in women, the female urethra is shorter and also closer to the anus making it easier for bacteria to get into the urinary tract system. As everyone is slightly different, pelvic anatomy also plays a role.
2. Genetic factors
Women with recurrent UTI have increased susceptibility to vaginal colonization with bacteria compared to women without a history of recurrences. This is due to an increased chance of these bacteria passing into the vagina. Also, a family history of UTI is also linked to an increase likelihood of recurrent UTI.
In young sexually active women, sexual activity is the cause of up to 80% of UTI, with frequency of sexual intercourse as one of the stronger risk factor for recurrent UTI; hence the term ‘honeymoon cystitis’. Other sexual behaviours such as spermicide usage or having a new sexual partner are linked to increase risk of recurrent UTIs.
This is due to bladder or uterine prolapse causing incomplete bladder emptying, leading to bacterial growth in the residual urine. As a result of loss of oestrogen there is a resulting change in the vaginal flora particularly around the urethra, which can lead to UTI.
Other risk factors associated with UTI/recurrent UTIs are pregnancy, presence of an indwelling urinary catheter, diabetes and also pre-existing urinary tract structural abnormalities.
Are there any ways to prevent recurrent UTI?
There have been numerous strategies used to try and prevent recurrent UTI, which are mainly behavioural approaches.
1. Changes in behaviour
As mentioned previously, sex is a known risk factor for having UTI/recurrent UTI. Changing certain behaviour such as decreasing or eliminating the usage of spermicide containing products would be expected to decrease the risk of UTI.
2. Ample fluid intake
Another common approach that I am sure you would have commonly heard is to drink more water and stay well hydrated. This is to increase the frequency of passing urine, which might be helpful in reducing the stagnation of urine within the bladder.
3. Urination after sex
Another reasonable piece of advice is to pass urine after sex. The idea behind this is to remove any pathogens from the peri-urethra area so as to reduce the incidence of UTI.
4. Cranberry juice
I am sure most of us have heard about this association between UTI and cranberry juice. The reasoning behind this is that cranberry juice stops the adherence of pathogens (bacteria/yeast) to the cells lining the urinary tract. Although clinical studies have not shown a significant reduction in occurrence of recurrent UTI with cranberry juice, there is likely little harmful effect other than an increase in calorie and glucose intake in trying cranberry juice.
Good news for those who love to drink cranberry juice.
The above suggestions are all behavioural approaches. Although they have not been widely studied and trialled, they are unlikely to be harmful and easy enough try.
5. Antibiotics – prophylaxis
Despite trying behaviour changes or if you think the behaviour change methods do not suit you and you are still experiencing recurrent UTI, then taking antibiotics over a period of time to prevent recurrent UTI has been demonstrated to be highly effective in reducing the risk of recurrent UTI.
The choice of approach depends upon the frequency and pattern of UTI recurrences and also patient’s preference. Antibiotic prophylaxis can be given as continuous prophylaxis, post-coital (after sex) prophlyaxis or self treatment.
If you find that you have been experiencing any of these symptoms suggestive of a UTI or having issues with recurrent UTI, please see your doctor as most infections can be easily managed. The earlier you address the infection, the easier it is to treat.Click here for our full range of Women’s Health Services
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