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)

–          Nausea/vomiting

Risk factors

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.

 

3.       Sex

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.

 

4.       Postmenopausal

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.

 

5. Others

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.

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12 Comments

  1. hi doc,

    about two days ago i’ve started to feel a strange sensation when urinating, especially towards the end. it’s kind of a tingling/ticklish sensation in the pelvic area. what could this be?

    also, i’ve had mid cycle spotting for about 2 years now, but recently only during the ovulation period, i have post-coital bleeding. during the other times there’s no post-coital bleeding. my gynae said that i may have cervical polyps but i checked at another gynae and they said there was nothing?!? pap smear was normal too. what could the problem be?

    • Your strange sensation when urinating could be a sign of infection. You may want to consult your doctor to get an assessment and some tests done (e.g. urine test, vaginal swab)
      Whereas for the post-coital bleeding, you should consult your gynaecologist again to find out if anything else needs to be done to investigate this, for example an Ultrasound scan.

      • Hi doctor, thanks for ur advice. Turns out i had a bladder infection. Id like to know how long do i have to wait before i can go swimming? And how long do i have to wait before having sex?

        Also, for endometrial polyps removal, is there anything i cant eat or drink before and after the surgery? Like how long do i have to abstain from alcohol.. and also intercourse. Thanks for ur help!

        • I don’t think you need to restrain yourself from swimming. It is best to wait for your symptoms to resolve before having sex.
          For endometrial polyps surgery, it is best to consult your doctor for pre-surgery advice. Usually 6-8 hours of fasting is required before any surgery that requires general anaesthesia. It is best to abstain from alcohol and sex for at least 48 hours.

  2. Hi Doc,
    Recently I have some pain and itchy at my vagina area. And I have some brownish red discharge but my menses is already over for about a week. And every morning I will have diarrhea. May I know what is wrong with me. Thanks.

    • I am not sure if your diarrhea has anything to do with the other symptoms. Pain and itching are 2 signs of infection. So is a discharge. Brownish red discharge signifies blood and when there is abnormal bloody discharge present, we have to think of other sinister possibilities like cancer although they are much rarer than infection. You should see your doctor.

  3. Gozie Ezenwa

    Dear Dr,
    I have been having itches around my private parts (Vagina) for a very long time now and its driving me nuts. Sometimes I see yellow discharge and I urinate regularly. Please doctor, Is there any drug I need to take to stop the itching? Help me because the problem is giving me sleepless night.

    • First thing you need to do is to see your doctor and find out what kind of infection you have. Only then can your doctor know what kind of medicine to prescribe you. You are welcome to visit us anytime. Click here for location info.

  4. Hello Doc,
    I regularly drink 6-8 glasses of water everyday but I felt an awkward pain in my abdomen and I’m having problem urinating. What could this be Doc? Thanks.

    • You have to be a bit more specific about what your mean when you say ‘problem urinating’. If you are experiencing burning pain, this could be an infection. If you feel a constant need to urinate but each time you go it’s not much it could be a bladder stone or over-active bladder syndrome. I am assuming you are a woman which means you could also have a cystocoele. Again ‘awkward pain’ in your abdomen is much too non-specific. I think you had best see a doctor to find out what exactly is wrong with you. If you wish to see us, click here for contact details.

  5. Hi Doc,

    Every short time i need to go to visit the toilet. Like it’s coming out anytime. It’s been quite a long time i’m having this problem. what should i do?

    • You mean you have urinary frequency and urgency? Maybe a bit of urinary incontinence? That does sound like you could have a UTI. Or you could have other issues causing bladder irritation like interstitial cystitis. You need to see your doctor.

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