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Recurrent urinary-tract infections

Coping with chronic urinary tract infections
Women have a higher risk of having recurrent UTIs. Find out what you can do.

If you frequently need to go to the bathroom but only urinate a small amount, you may have a urinary-tract infection (UTI), which can also cause a burning sensation. Each year, UTIs are behind more than 8.1 million visits to health care providers, according to the National Kidney Foundation.

About 10 in 25 women will develop a UTI during their lifetime compared to just three in 25 men. Women are also more likely to have multiple UTIs. Nearly 20 percent of women who’ve had one will have another one, the National Kidney Foundation reports, and 30 percent of those will have a third.

Of the women who have had three UTIs, 80 percent will have recurrences or “chronic” UTIs, defined as two or more culture-documented bladder infections in a six-month period or three within a year.

Suffering from recurrent UTIs is not only potentially painful, but it can also be frustrating.

What is the urinary tract?

The urinary tract starts with the kidneys, which filter blood and turn waste into urine. The ureters are tubes that carry the urine from the kidneys to the bladder, from which it passes through the urethra to exit the body.

The most common types of urinary-tract infection are cystitis, a bladder infection, and urethritis, an infection in the urethra. Kidney infections (pyelonephritis) are rare but more serious.

A UTI can be present at multiple sites.

What causes a urinary-tract infection?

A UTI happens when certain bacteria not typically found in urine get into the urinary tract and multiply. The typical culprit is E. coli, which exist in the intestines of humans and animals. From the urethra, the bacteria can spread upward into the bladder and, rarely, into the kidneys.

What are my risks for developing a urinary-tract infection?

In women’s bodies, the urethra is short and near the rectum. It’s easier, therefore, for bacteria to colonize a female bladder. Other risk factors include:

  • A lack of proper hydration. The urinary tract’s natural defense to intruding bacteria is to flush the system. Drinking water helps your body do its job.
  • Abnormal anatomy in the urinary tract.
  • A bladder that’s not entirely emptied.
  • Reflux. Children often get a UTI because the urine shoots back into the ureters from the bladder.
  • Sex. Not everyone will develop a UTI because of sex, but some people do.
  • An immune system condition, which can predispose you to develop a UTI.
  • A history of kidney stones.
  • Menopause. A lack of estrogen can affect the healthy bacteria in the vagina that normally acts as a barrier to keep E. coli from the urethra.
  • Prior surgery on the bladder.

What are the symptoms of a urinary-tract infection?

You may have one or more of the following:

  • An urgent or frequent need to urinate, but only a little comes out.
  • A burning pain when you urinate.
  • Urine with a strong odor
  • Cloudy, blood-tinged urine
  • An ache in your lower abdomen or back.
  • Fever or chills.

Other conditions can mimic a bladder infection, such as dryness due to a lack of estrogen or a sexually transmitted disease. Consequently, it’s essential to have the right diagnostic test. A urine culture will reveal if bacteria are present.

I’ve had two or more UTIs in six months. What will my doctor do now?

Your health care provider will perform a thorough evaluation. If warranted, your doctor may order an ultrasound of your kidneys or conduct a cystoscopy, during which a small camera is inserted into the urethra so the doctor can see into the bladder.

What is the treatment for recurrent UTIs?

Lifestyle changes can help:

  • Drink plenty of water.
  • Consume two 8-ounce glasses of cranberry juice a day or taking one supplement twice a day. Cranberry helps prevent the bacteria from binding to the urinary tract. (Tell your doctor about any medications you are taking. Cranberry juice can interact with certain pharmaceuticals.)
  • Fully empty your bladder.
  • Avoid products that affect the bacteria in the vagina, such as spermicides.

Is there a medication for recurrent URIs?

If lifestyle changes aren’t enough, your health care provider may recommend methenamine, which stabilizes the PH in your urine, so it’s inhospitable to bacteria. If you’re in menopause, you might find relief with a topical estrogen cream that encourages good bacteria in the vagina to keep E. coli from reaching the urethra.

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