A urinary tract infection (UTI) appears when bacteria invade the urinary tract, which causes infection as well as inflammation. The urinary tract includes the kidneys, ureters (the tubes transferring urine from the kidneys to the bladder), and urethra (the tube that carries urine to the outside world). It is generally assumed that the urinary tract is sterile. The infection can be in the kidneys (upper UTI) or bladder (lower UTI or what commonly is just called “UTI”). UTIs are common in females, and bladder infection represents most of these infections. Roughly 20% of women develop at least one UTI during their lifetime.
The characteristic symptoms of “UTI” (bladder infection a.k.a. “lower UTI”) in the adult are mainly painful or burning urination with associated urinary frequency and urgency. Additionally, bladder or lower abdominal fullness/discomfort is frequently present. Bloody urine may accompany the above symptoms. Another consideration is urinary incontinence. These “accidents” with uncontrolled loss of urine may be the only symptom in the elderly. Symptoms such as fevers, chills, and low back pain are more frequently reported in patients with a “kidney infection” or “upper UTI”.
The “gold standard” for the diagnosis of UTI is a positive urine culture, which means a certain number of bacteria grow in the patient’s urine over 2 days or so. Initially, a UTI should be categorized as complicated or uncomplicated. E. coli is the most common cause of UTIs. Among the bacteria responsible for the remainder of UTIs are other “colonic” bacteria and some “Staph” species. Overall, the incidence of UTI in women tends to increase with advancing age.
Experts agree the continuous unidirectional flow of urine helps to minimize UTIs by constantly flushing bacteria out, and anything that interferes with this increases the host’s susceptibility to UTI. But what about a recurring UTI? A “recurring UTI” is three or more episodes of a UTI in the last year or two episodes within the previous 6 months. Even with effective treatment, however, about 25% of women will experience a recurrence. Most recurring UTIs are thought to represent reinfection with the same organism. E. coli is responsible for causing approximately 75% of recurring UTIs. Recurring UTIs are common in women. Almost one in five women will get a recurring UTI, including healthy women with normal urinary tract anatomy. Women who have more than three UTIs are more likely to continue having them.
UTI in Men
Men can also have recurring UTIs, but this is not as common in men as in women. In many cases, men with recurring UTIs have some type of urinary obstruction. Symptoms of a recurring UTI in men and women are typically the same as a single acute UTI. Some authorities believe men who have not been circumcised can experience frequent UTIs if there is a build-up of bacteria and urine in the foreskin. The take-home message is a UTI is never a simple one in males and needs urologic evaluation as to why it occurred.
How are Recurring UTIs Contracted?
Common conditions that can lead to recurring UTIs include residence in a nursing home or hospital, diabetes mellitus, kidney or bladder stones, having a catheter, previous urinary tract surgery, sexual activity, having an infected or enlarged prostate (BPH), and being born with an abnormality of the urinary tract. Established risk factors for recurring UTIs include intercourse in the past month (> 9 times), age at first UTI > 15, maternal history of UTI, new sexual partner in the past year, and spermicide use in the past year. In postmenopausal women, the risk of recurring UTI is primarily increased by the sequelae of lower estrogen levels and changes in normal vaginal bacteria that favor easier growth of harmful ones. Interestingly, frequency of sexual intercourse is the strongest predictor of recurring UTIs in women presenting with recurrent UTIs.
How are UTIs and Recurring UTIs Treated?
UTIs are treated based on symptoms diagnosed after a urine culture is obtained. This establishes the diagnosis and guides precise antibiotic therapy based on the reported sensitivity results. Uncomplicated recurring UTIs in women can be treated with a three-day or longer course of antibiotics (single day not recommended) as determined by their healthcare professional. For some cases, antibiotic prophylaxis in form of a small everyday dose for recurring UTIs is prescribed. In fact, continuous daily and post-coital (after sex) low-dose antibiotic regimens have been shown to decrease recurring UTIs by almost 95%. This is utilized only in a small number of cases as determined by the physician since both can lead to rapid development of resistant infections.
In addition to antibiotics, simple things patients can do to help prevent recurring UTIs consist of drinking plenty of fluids (water), not postponing urination, urinating frequently and to completion. Interestingly enough and contrary to popular belief, comprehensive studies have not shown any benefit for other commonly prescribed methods including cranberry juices or extracts, donning cotton underwear, and cleaning from front-to-back after a bowel movement or urination.
In summary, recurring UTIs can be a major health problem. If you feel you have the symptoms of an acute or recurring UTI, we encourage you to contact our practice. Our highly-qualified team of urologists is here to answer questions and provide treatment options for your recurring UTIs.