Recurring Urinary Tract Infection

UTIs are usually caused by bacteria. In most cases, the bacteria enter the body through the urethra which is adjacent to the vagina. The bacteria travel up toward the bladder or kidneys. If the bacteria are not killed by the person's immune system, an infection can occur.

A UTI may cause any of the following symptoms:

• fever if the infection ascends into the kidneys (this is called pyleonephritis). Howver, most women with bladder infections do not experience fever.
• the need to urinate frequently accompanied by a feeling of urgency to void
• painful urination
• pain in the abdomen or on the sides of the back below the ribs (with pyleonephritis)
• nausea and vomiting (with pyleonephritis)
• incontinence, or involuntary loss of urine
• a sensation of fullness in the lower abdomen
• blood in the urine

Recurrent UTIs can occur for many reasons, including:

• problems with the immune system
• the use of a urinary catheter to empty the bladder
• abnormalities in kidneys, ureters, bladder or urethra can cause repeated infections. The ureters are tubes that carry urine from the kidneys to the bladder. The urethra is a tube that carries urine from the bladder to the outside of the body.
• damage to part of the urinary system
• sexual intercourse, which seems to trigger UTI in some women
• poor hygiene, such as wiping from back to front after a bowel movement or not changing the underwear often.

Prevention of recurring urinary tract infections can involve several steps:

• A person should drink 4-8 glasses of water every day
• A person should urinate when the urge is felt, rather than holding urine in the bladder for long periods of time.
• A person should urinate when the urge is felt, rather than holding urine in the bladder for long periods of time
• A woman can urinate after sexual intercourse
• A woman who develops UTIs after sexual intercourse may take antibiotics, such as sulfamethoxazole/trimethoprim (i.e., Bactrim, Septra) or nitrofurantoin (i.e., Macrodantin) before or with each act of intercourse
• A person who has a urinary catheter in the bladder needs to have the device changed or cleaned often.

A history of the symptoms is taken by a healthcare provider. A urine sample may be sent to a lab for a urinalysis and a urine culture. This may be obtained with a clean-voided specimen where the urethra is cleaned before voiding or it may be obtained by the medical care provider inserting a catheter through the urethra into the bladder.

Infected urine often contains bacteria and white blood cells, the infection-fighting cells of the body. Normal urine contains little or no bacteria or white blood cells.

Recurring UTIs can damage the urinary system. If a woman has three or more UTIs a year she should have a workup by a urologist. A UTI can spread to the blood, causing sepsis. That can cause severe illness and even death.

UTIs are usually not contagious. However, infections of the urethra are generally spread through sexual contact.

A person who has an abnormality in the urinary system may be able to have surgery to correct the problem. Otherwise, antibiotics, such as sulfamethoxazole/trimethoprim (i.e., Bactrim, Septra), nitrofurantoin (i.e., Macrodantin) or a quinolone antibiotic are given to treat the UTI. Most woman only needs to take these antibiotics for three days.

With recurrent infections the regimen should be extended to one week.

A person who has an artificial device, such as a urinary catheter, in the bladder should have the device changed or cleaned regularly.

Antibiotics may cause allergic reactions and stomach upsets. Other side effects vary depending on the medication used.

The person can usually go back to normal activities once the symptoms have gone away. Among women with frequent recurrences, the urologist may want to look into the bladder with a lighted scope called a cystoscope or X-rays may be ordered to evaluate the bladder, ureters and kidneys, called an intravenous pyelogram (IVP).

Often, a person with recurring UTIs is asked to give a urine sample after treatment is completed. A urinalysis and urine culture can be done to check that the bacteria are gone from the urinary tract.