Primary Care Physician
Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…
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Recurrent Urinary Tract Infections in Women
Posted in Acne by Dr. Sharon Orrange on Sep 05, 2008

Urinary tract infections (UTIs) can ruin vacations, honeymoons and result in an urgent care visit. The good news is: yes, they are a problem but there is no evidence that chronic UTIs lead to issues such as high blood pressure or kidney disease. Let's talk about why chronic UTIs happen and what to do about them.


Most recurrent UTIs are thought to represent re-infection rather than relapse though that is not always the case.


Who gets recurrent UTIs and how common is it? Recurrent UTIs are common among young, healthy women with anatomically and physiologically normal urinary tracts. In a study of college women with their first UTI, 27 percent experienced at least one recurrence within the six months following the initial infection and 2.7 percent had a second recurrence during this same time period. When the first infection is caused by Escherichia coli, women appear to be more likely to develop a second UTI within six months than those with a first UTI due to another organism.


Why does it happen? The bacterial causes of recurrent UTI are assumed to be the same as with a single infection. Most bacterial causes of UTI originate in the rectum, colonize the periurethral area and urethra, and ascend to the bladder. What is interesting is that evidence suggests that changes of the normal vaginal bacteria, especially the loss of lactobacilli, may predispose women to colonization with E. coli and to UTI. This is the reason we tell you not to douche, and not to use perfumed soaps or take long baths with bubble bath. Here is another opportunity to try Probiotics (with Lactobacilli) as well.


Reinfection versus relapse: For most physicians it is often impossible to distinguish between a relapse and reinfection.  A recurrent UTI is classified as a reinfection if the recurrence is caused by a different strain of bacteria than the one responsible for the original infection. In clinical practice, a recurrent UTI is defined as a relapse if the infecting strain is the same and the recurrence occurs within two weeks of the completion of treatment for the original infection. By contrast, a recurrent UTI arising more than two weeks after treatment is considered to be a reinfection, even if the infecting pathogen is the same as the original. The majority of recurrences of UTIs appear to be reinfections. In fact, long-term studies have shown that E. coli strains are capable of causing recurrent UTI one to three years later, despite appropriate treatment and disappearance of the organism in repeated urine cultures prior to the development of the next infection. However, most recurrences occur in the first three months after the initial infection.


Risk factors:  


1) Biologic or genetic factors: Women with recurrent UTI have been shown to have an increased susceptibility to vaginal colonization with bacteria compared with women without a history of recurrences. This difference is partially explained by the ability of the bacteria to stick to uroepithelial cells in some women and this appears to be genetic.


2)  Behavioral risk factors:  Sexual intercourse, diaphragm-spermicide use, and a history of recurrent UTI are strong risk factors for UTI. Even spermicide-coated condom use results in an increased risk of UTI. Recent antibiotic use, which adversely affects vaginal flora, also is strongly associated with an increased risk of UTI. The strongest risk factor is the frequency of sexual intercourse. Other risk factors include: having a new sex partner during the past year, having a first UTI at or before 15 years of age and having a mother with a history of UTIs


3)  Pelvic anatomy: Pelvic anatomy may predispose to recurrent UTI in some women, especially those who do not have other risk factors for UTI. As an example of this, the distance from the urethra to anus was significantly shorter in patients with recurrent UTIs in some studies.


4)  Postmenopausal women:In postmenopausal women factors that affect bladder emptying contribute to chronic/recurrent UTIs, with the main risk factors in those women being urinary incontinence, and the presence of a cystocele (bladder prolapse).


 


How can you prevent these from happening? A number of strategies have been used in an attempt to prevent recurrent UTIs. Although many approaches have not been adequately tested in studies, it is reasonable to consider them.


1)   Contraception: Women with recurrent UTIs who are sexually active or who use spermicides (particularly when used with diaphragms), should be counseled about the possible association between their infections and the use of spermicides.


2)   Voiding after intercourse and drinking lots of water:  Voiding right after intercourse and more liberal fluid intake may reduce the risk of recurrent


3)  Cranberry juice: Cranberry juice has been touted as an effective home remedy for preventing UTI. How does it work? Well studies have shown that cranberry juice inhibits adherence of bacteria to uroepithelial cells. How much do you have to drink? In some clinical trials consuming 300 ml of Cranberry juice decreased the chance of getting a UTI. In others, 50 mL 5 days a week decreased the frequency of UTI at six months,


4) Taking antibiotics to prevent recurrent UTI:  Antibiotic prophylaxis has been shown to be effective in reducing the risk of recurrent UTI in women. Prophylaxis has been advocated for women who experience two or more symptomatic UTIs within six months or three or more over 12 months. Individual decisions to be made with your doctor are whether you should use continuous antibiotics, or just antibiotics after intercourse... both of which are effective for prevention.


 


When you need to see a Urologist? Procedures such as urography and cystoscopy have not been shown to be necessary in women with recurrent UTIs. An evaluation by a Urologist for women with recurrent UTI generally results in unnecessary expense and potential toxicity. Having said that, further evaluation by a Urologist is recommended if there is suspicion about structural or functional abnormalities of the genitourinary tract.


 


Dr O.  


 

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15
[continued from #14.]
This was an all day thing, and because of that, I couldn't concentrate on my test well enough, and didn't do as good as I wanted...

lol sorry this was such a long, pointless story, I just felt like throwing it out there.

but since then, I've learned the things that helped me out, is to ALWAYS always always use the restroom after having sex. Like, almost RIGHT away. Always whipe from front to back, and not to use toilet paper that leaves pieces behind. -_-

And when UTI's do reoccur, AZO pills REALLY help with easing the pain and helping you go more. I always keep two or three boxes in the medicine cabinet now just in case. =]
By DianaxLynn  Apr 03, 2010
14
The first time I got a UTI was after the very first time I had sex, when I was 16.

It was horrible. I had it IN school, and WORSE, it was durring the "TAKS" test, a yearly assessment test required for all Texas students [I'm sure there's similar tests for students in other states.] They were real strict about taking the chances of students cheating, so in each testing room, ONE student was aloud to go to the restroom at a time, and only ONE person at a time in each restroom in each hallway, so there was always a teacher there and a long line of students waiting to go to the bathroom..

It wasn't like I had a Dr.'s note or anything, so in my terrible, terrible pain I had to wait just like everyone else. a LONG time. and it didn't help that each time I felt like I had to go, waiting in that long line for 10 minutes, and by them time I got into the restroom only a few drops would come out. And by the time I got back to the testing room, I had to go again!
By DianaxLynn  Apr 03, 2010
13
I have episodes when my bladder feels like its a balloon full of water and cramps up like I need to go. But I urinate just a little with no relief. I drink lots of water when this happens. Sometimes it helps. I stand alot at work and this seems to help, sitting makes it worse. Right now I am on antibiotics to see if I can get relief. Detrol did not help me. I don't have a leaky bladder. Just empting it totally. Its a very uncomfortable feeling. Any suggestions would be appreciated. Joy714
By joys714  Jan 02, 2009
12
1) I dont know of any evidence that Vagifem helps recurrent UTIs...IF you have atrophic vaginitis (vaginal dryness after menopause) it MAY help but stop using it if you get UTIs after it
2) Khnurse: I think using Dial in moderation should be fine and shouldnt contribute to MRSA colonization
By DrOrrange  Oct 04, 2008
11
However, you should not use Dial Soap daily. I worked for an Orthopedic Surgeon and he always told all his patients not to because of it being antibacterial. We live in the south and MRSA is really bad especially since the hurricanes. Anyway he said the body becomes immune to this soap and that why we get MRSA and such.
By khnurse  Oct 02, 2008
10
Dr. O, I've read that using Vagifem & other similar products can help w/preventing UTIs, but it seems like more often than not, I develop UTI symptoms (but not necessarily a UTI) the day after using the Vagifem (tablet). I try to be very careful to make sure the applicator does not come in contact with anything prior to entry. Is there anything that could be causing irritation? Thank you.
By SeaNymph  Sep 18, 2008
9
Seanymph great points again...i havent heard the black pepper thing but thats certainly easy to stay away from.
Kagel exercises should certainly help.
By DrOrrange  Sep 18, 2008
8
Dr. O, what about doing cagel exercises?

I was told by a very experienced urologist to stop eating black pepper as it can be an irritant. And, something as simple as wiping front to back can also make a big difference. It's also best to not wear undies to bed.

In addition to Fibromyalgia, there are also other diseases that UTI's tend to "co-exist" with, like Lyme.
By SeaNymph  Sep 17, 2008
7
Bluebutterfly55: Really it is not advocated that we use soap at all to clean the vagina BUT a non perfumed soap (DOVE always the first example of that) is what to use.
By DrOrrange  Sep 07, 2008
6
Some of those with what seems like chronic UTI that also have fibromyalgia might be suffering from IC or vulvadynia, the symptoms feel quite similar.
By asilinc298  Sep 07, 2008
5
Wearing thongs or underwear that isn't cotton doesn't help either, just to let everyone know. I have no idea what the best soap is to use, but the one I have found that doesn't irritate me is Dial. My bf uses that b/c of his allergies, and it's an antibacterial soap. THe feminie wash and stuff from whatever company it is always irritates me, probably the worst actually.
By kelly7463  Sep 06, 2008
4
Well, since the subject was mentioned.........What is the best kind of soap to use for feminine hygiene??
By BlueButterfly55  Sep 06, 2008
3
Thank you for the information.........very good..........cranberry juice and I will become good friends....... :-))
By BlueButterfly55  Sep 06, 2008
2
I have had problems with this since I was a tiny girl..at least 2x a year now..Thank you for this information!
By kidsintowe03  Sep 06, 2008
1
Very good information and helpful. I am proned to them because I have recurrent kidney stones.
By soulsearcher83  Sep 06, 2008
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