Urogynaecology

Recurrent urinary tract infections

 

Bladder infections are one of the most common infections, causing symptoms like a burning feeling with urination and the need to urinate frequently. Kidney infections are less common than bladder infections, and can cause similar symptoms, but they can also cause fever, back pain, and nausea or vomiting. Most cases of bladder infection in women are uncomplicated and easily treated with a short course of antibiotics.

Bacteria do not normally live in the urinary tract, but they do live close to the urethra in women. Urinary tract infections (UTIs) occur when these bacteria get into the urethra and travel up into the urinary tract.

The typical symptoms of a bladder infection include:

  • Pain or burning when urinating

  • Frequent need to urinate

  • Urgent need to urinate

  • Blood in the urine

  • Discomfort in the lower abdomen

Some women, get bladder infections frequently. In this case, it is important to confirm at least once that your symptoms (eg, burning, frequency, and urgency) are caused by a bladder infection. The best way to confirm an infection is through urine tests, including a urine culture.

Recurrent bladder infections are usually treated the same way as the initial infection, unless your infection is known or thought to be caused by a resistant bacteria. 

If you continue to get bladder infections, you may require further testing. This may include a CT scan, ultrasound and a cystoscopy (looking inside the bladder with a camera).  

Women with recurrent UTIs may be advised to take steps to help prevent them, including one or more of the following:

Over-the-counter products — Taking cranberry juice, cranberry tablets, Vitamin C or supplements called "D-mannose" or “Hiprex” can help prevent bladder infections.

Drinking more fluid — Increasing your fluid intake can help prevent bladder infections. 

Urinating after intercourse — This may help flush out the germs that could get inside the bladder.

Postmenopausal women — Postmenopausal women who develop recurrent bladder infections may benefit from using vaginal estrogen. Vaginal estrogen is available as a small vaginal insert (Vagifem), or a cream (eg, Ovestin).

Antibiotics — Preventive antibiotics may be recommended if you repeatedly develop bladder infections and have not responded to other preventive measures. Antibiotics are highly effective in preventing recurrent bladder infections but can cause side effects and promote the growth of resistant bacteria, which are more difficult to treat if they cause subsequent UTIs. Therefore, antibiotics for preventing UTIs should only be considered after trying the above preventive approaches. Preventive antibiotics can be taken in several different ways:

  • Continuous antibiotics – You can take a low dose of an antibiotic once per day or three times per week for several months to several years.

  • Antibiotics following intercourse – In women who develop UTIs after sex, taking a single low-dose antibiotic after intercourse can help to prevent bladder infections. This usually results in less antibiotic use than continuous antibiotics.

  • Self-treatment – A plan to begin antibiotics at the first sign of a bladder infection may be recommended in some situations. Before starting this regimen, it is important that you have had testing (urine cultures) at least once in the past to confirm that your symptoms were caused by a bladder infection. This is because it's possible to have symptoms of a bladder infection but not actually have an infection, in which case antibiotics would not be helpful.