Recurrent Urinary Tract Infections
Recurring UTI Infection in Women

UTI Guide


Recurrent Urinary Tract Infections


Recurrent UTI Infections Explained
What Are The Symptoms?
What Are The Causes?
How Are They Diagnosed?
How Are They Treated?
How Are They Prevented?

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Urinary Tract Infection Guide
Reproductive Disorders

What Is A Recurrent UTI Infection?

An estimated 20 percent of women will experience at least one urinary tract infection during her lifetime. Of these women, 25 to 50 percent can expect another infection within a year. A smaller number (3-5 percent) experience ongoing recurring urinary tract infections. Recurrent infections are categorized as either relapse or re-infection. A relapse is where there has been failure to cure the original infection with (or without) treatment. Relapses are more commonly associated with serious kidney infections (pyelonephritis). Re-infection is where the original infection was cleared by antibiotics but occurs again within weeks. It can be caused by the same strain of bacteria or a different one. Re-infections are usually passed through fecal bacteria and work their way up the urinary tract. Most cases of recurring UTI infections are caused by re-infections. Some women appear to be more prone to recurrent infections than others. This could be due to a weakened immune system, hormone changes, a physical irregularity in the urinary tract or in some cases, hygiene practice. Interestingly, about one third of women who have recurrent infections as adults had their first initial infection as a child.

What Are The Symptoms?

Most Recurring UTI's are infections of the lower urinary tract and manifest as cystitis/bladder infections. Symptoms usually appear in clusters and most commonly include:

1. Urgent need to urinate frequently.
2. Burning, painful sensation when urine is passed.
3. Urine may have a strong smell, or appear cloudy. Occasionally some blood may be present.
4. Abdominal bloating.
5. Pain in the pelvis or lower back.

About 5 percent of cases are consistent with an acute kidney infection (infection of the upper urinary tract). These infections tend to be caused by bacteria from outside the body traveling up the urinary tract, through the bladder and eventually reaching the kidneys. Women's urethras are short (much shorter than men’s) and close in proximity to the anus, a main source of bacteria. This may explain why they are 4 times more likely to develop a kidney infection than men. See urinary tract infections treatment for information about therapies.

At first the symptoms of a kidney infection may draw NO attention to the kidneys; the first indications may be chills, turning hot and cold accompanied by a fever and pain in the joints. As the infection worsens cystitis symptoms occur, including a sense to urinate more frequently. This may be followed by:

1. Changes in urine color.
2. Loss of appetite.
3. Headaches.
4. Nausea and vomiting.
5. Symptoms do not come and go; they are continuous and may feel worse when the patient moves around.

What Causes Recurring UTI's?

Scientists have not discovered a cause for recurrent infections, but suspect the following may contribute:

• Sexual intercourse.
• Use of contraceptive diaphragm and spermicides.
• Oral contraceptives.
• Tampon use.
• Not taking care to wipe front to back after a bowel movement.

Factors which have NOT been proven to have an association with infection:

• Panty hose (tights).
• Menstrual hygiene products.
• Bike riding.
• Holding onto urine.
• Coffee & tea.
• Bathing or swimming.

Other possible contributory factors:

• Estrogen deficiency, as experienced by perimenopausal and postmenopause women.
• Physical abnormalities in the urinary tract, but these have not been well studied.
• Frequent bouts of stress: see dangers of stress.
• Polycystic kidneys where bacteria remain and populate in cysts.
• Kidney stones.
• Those with spinal cord injuries or MS (multiple sclerosis) can experience as many as 18 new infections a year.

How Are They Diagnosed?

Recurrent UTI's are diagnosed in the same way as regular UTI's (see urinary tract infection diagnosis). There is no special test. Diagnosis is based primarily on the frequency of episodes. A recurrent infection is diagnosed where:

1. Symptoms return two or more times within 6 months.
2. Symptoms of a single episode last longer than two weeks.
3. Symptoms last longer than 48 hours after antibiotic treatment has started.

As with cystitis, a urinalysis may be taken in the doctor's surgery to test for white blood cells which indicate an infection. A urine culture may be sent to a lab to investigate the bacteria causing the infection. An abdominal ultrasound or KUB (abdominal x-ray) may be taken to investigate the kidneys, bladder and urethras. As studies now show that nearly 95 percent of all women with recurrent UTI's have normal internal tracts, these tests are used less often. In the past women with recurrent infections were perhaps over investigated which led to unnecessary expense.

How Are They Treated?

The same antibiotics prescribed for a once off episode of cystitis or bladder infection is generally prescribed for a recurrent case. However, the period of treatment is usually longer (7 to 14 days, instead of 3 to 5 days). In some cases a stronger antibiotic such as norfloxacin or ciprofloxacin may be prescribed.

For women who develop an acute kidney infection a follow-up urine culture should be obtained on week 1 and 4 following the last day of treatment. As an additional precaution, studies show a 95 percent decrease in recurrences of cystitis symptoms by continual use of low-dose antibiotics. Prophylactic (continual) use of antibiotics over a 6-12 month period may be prescribed in cases where a woman experiences 2 or more UTI episodes within a 6 month timeframe. Only about a quarter of the regular dose is necessary, usually taken at bedtime. Should a woman experience symptoms immediately after finishing a 12 month course, treatment may be extended another 12 months. If the patient is not happy to take antibiotics as a preventative every day, another effective alternative is taking an antibiotic immediately after sexual intercourse. Topical antiseptic creams do not seem to have the same successful results.

Can Recurring UTI's be Prevented?

As doctors still do not know the cause of recurrent UTI's (there may be several), outside of taking prophylactic antibodies, there are few obvious prevention techniques. Increasing your daily intake of fluids to flush out bacteria is probably helpful, as well as ensuring your wipe from front to back after urinating or a bowel movement. See also Natural treatment for urinary tract infections for advice on supplements and remedies. Also, take a look at our list of books on urinary tract infections for some published self-help guides.

  Related Articles on Recurrent Urinary Tract Infections

For more female issues, see the following:

Interstitial Cystitis - Causes, symptoms and treatment advice.
Urinary tract infections in older women: Prevention
Vaginitis Infections: Signs and treatment
Douching Equipment: How it works!

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