What can I do about recurring UTIs?

If you get UTI more than once per year, here’s what you can do to stop it

Do recurring UTIs happen often?

As you probably know, urinary tract infections (UTI) are one of the most common bacterial infections among women. By the time you reach your mid-30s, there’s on average a 50% chance that you already had at least one UTI in your life so far. The burning pain during urination and constant urge to pee is an unpleasant experience many women are only too familiar with.

Unfortunately, it’s also quite common that UTI reoccur frequently. Estimates differ from study to study, but there’s a 30%-50% likelihood that if you already had a UTI you’ll get a second one or even more yet within 12 months. One of the likely reasons behind the sickness’ recurrence is that when treating the first UTI probably not all bacteria were killed. E.coli, which is the primary bacteria type that causes UTI, is a tenacious enemy and sometimes antibiotics don’t do a thorough job of fighting it.

Recurring UTI often also are termed chronic UTI, but to meet the definition of “chronic” it requires three positive bacteria tests during 12 months or two infections within a six-month period. According to the National Institute of Diabetes and Digestive Kidney Diseases, about 25% of women will develop such chronic UTI at one point in their lives. Elderly women and diabetic women are at a higher risk of doing so than other parts of the female population.  

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How to avoid recurring UTIs?

Unless you have a weakened immune system, it’s actually rather simple to significantly lower your risk of developing UTI. It all comes down to proper genital hygiene and lifestyle changes.

  • Wash your genitalia (vagina and anus) regularly and, when on the toilet, always wipe from the front to the back. The E.coli bacteria that get the urinary tract infected most often stem from the woman’s own digestive tract. In blunt English: the bacteria come from the anus and accidentally — for example because of poor toilet hygiene — enter the vagina. So, take care and time to clean yourself properly after a visit to the bathroom. If available, use a bidet to rinse your anus and vagina. Bidets used to be stand-alone genital wash basins (you probably saw them first in a French hotel room), but now they often are integrated in high-end toilet bowls and seats. 
  • Another subcategory of genital hygiene is sex hygiene and it’s just as important as toilet cleanliness. It doesn’t hurt cleaning penis and vagina during sex, especially if anal sex is involved. Carefully clean the penis and/or change condoms after anal sex. Certain birth control choices can also increase the risk of bacterial infection. When using diaphragms and internal condoms, always make sure they are clean and dry before you insert them. If you already had UTI in the past, you may want to avoid using spermicidal gels and creams, as they can increase the risk of UTI occurring again. 
  • Make it a habit to pee after sex, as this will wash any bacteria out of the urethra. If you are worried about recurring UTI, drink plenty of water before sex so that you have enough urine in your bladder available to urinate after sexual intercourse. Some women swear by cranberry juice (unsweetened) and that it’s effective for preventing UTI. They drink it around the time they have sex, either before or after. There’s not a lot of scientific evidence for that, but it doesn’t hurt — it just tastes a bit sour. 
  • As for lifestyle changes, the most important thing would be to pay more attention to always staying hydrated. Drink enough water, not in one go but spread out across the whole day, so that you urinate frequently. Each time you pee, you flush out your urinary tract and thus reduce the risk of bacterial infections. 
  • Tight underwear or pants can increase UTI risk, especially in the summer months. Having your vagina packed in warm and sweaty underwear is just what E.coli needs to get started on building up enough mass for a UTI. Often it’s more the fault of the pants than the underwear (think tight jeans!). So, you may want to opt for looser pants or dresses instead. 

If you pay attention to these few simple steps, you greatly improve your chances of avoiding another UTI outbreak. 

There’s one special advice for diabetic women: manage your blood sugar levels carefully! Bacteria thrive on glucose, as this is what fuels their metabolism. If you don’t control your glucose levels well, your urine will be sugary and thus can nurture fast bacterial growth.

How common are drug-resistant UTIs?

If you had a UTI once before, you know that it’s normally treated with antibiotics. There are about ten different antibiotics for UTI, with Bactrim, Cipro, and nitrofurantoin being the most commonly administered ones. The problem is that UTI happen so often — about 150 million cases globally per year — and antibiotics are used so frequently, that over the past decades bacteria have become increasingly resistant against individual antibiotics. For example, a 2018 study in the United Kingdom found that one third of UTI cases in Britain are resistant to mainstream antibiotics and require more specialized treatment. 

Because of this increasing drug resistance it’s increasingly common practice for hospitals and doctors to test patients’ urine to determine which bacteria is causing the UTI and which antibiotic promises the best results. That’s called antibiotic sensitivity testing, and it’s a must if you suffer from chronic or recurring UTI. 
  

References

  1. Pujades-Rodriguez, Mar, et al. “Lower Urinary Tract Infections: Management, Outcomes and Risk Factors for Antibiotic Re-Prescription in Primary Care.” EClinicalMedicine, vol. 14, Sept. 2019, pp. 23–31, www.thelancet.com/journals/eclinm/article/PIIS2589-5370(19)30120-8/fulltext, 10.1016/j.eclinm.2019.07.012. Accessed 29 Jan. 2020.
  2. Fihn, S D, et al. “Use of Spermicide-Coated Condoms and Other Risk Factors for Urinary Tract Infection Caused by Staphylococcus Saprophyticus.” Archives of Internal Medicine, vol. 158, no. 3, 1998, pp. 281–7, www.ncbi.nlm.nih.gov/pubmed/9472209, 10.1001/archinte.158.3.281. Accessed 31 Jan. 2020.
  3. The Lancet. “Balancing Treatment with Resistance in UTIs.” The Lancet, vol. 391, no. 10134, May 2018, p. 1966, www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31077-8/fulltext, 10.1016/s0140-6736(18)31077-8. Accessed 31 Jan. 2020.
  4. Storme, Oscar, et al. “Risk Factors and Predisposing Conditions for Urinary Tract Infection.” Therapeutic Advances in Urology, vol. 11, Jan. 2019, p. 175628721881438, www.ncbi.nlm.nih.gov/pmc/articles/PMC6502981/, 10.1177/1756287218814382. Accessed 31 Jan. 2020. 
     

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