Guest Author - Denise Howard, M.D., M.P.H.

Recurrent urinary tract infections are a frustrating problem for premenopausal and menopausal women. An infection is considered recurrent when an initial infection is adequately treated and another infection then occurs. If this happens more than twice in 6 months or more than 3 times in a year then it is considered a problem.

A urinary tract infection occurs when bacteria grow in the bladder and adhere to the cells lining the bladder. These bacteria typically travel from the vagina and invade the urethra and bladder. Bacteria normally colonize the colon and the vagina but are usually different types. When bacteria from the colon start to grow in the vagina, the risk of a bladder infection increases. Factors that seem to increase the risk of recurrent infections include sexual intercourse and a low estrogen state which occurs in menopausal women.

Common symptoms of a urinary tract infection include pain with urination, urinating more frequently, small voided volumes and urgency of urination. These symptoms can be annoying and distracting. If left untreated the infection can ascend into the ureter and to the kidney. At this point it is called pyelonephritis. The symptoms include abdominal, flank, and back pain as well as a fever. The infection at this point is much more serious and may require hospitalization for treatment. In older women the infection can become life threatening.

An evaluation should include a urine culture to confirm a bacterial infection and to identify the bacteria involved. In addition sensitivity studies can be performed to find the appropriate antibiotic for treatment. In some cases a cystoscopic examination of the bladder may need to be done to look for bladder stones or other foreign bodies that might be contributing to the infection. An imaging test such as a CT scan of the ureters and kidneys may also be needed to look for abnormalities such as stones that may be the source of the infections.

Treatment should include a 5-7 day treatment with the appropriate antibiotic for an infection limited to the bladder and a 10-14 day course if involvement of the kidney is suspected. Options for managing the recurrence include self start treatment, postcoital suppression and chronic prophylaxis. With the self start option, a woman can initiate previously prescribed antibiotics for 3-5 days at the first sign of an infection. Postcoital suppression entails taking a single antibiotic after each episode of intercourse. Chronic prophylaxis consists of taking a single antibiotic every day for approximately 6 months to prevent the onset of an infection.

Other methods for prevention are also available. Drinking plenty of water, wiping from front to back after using the bathroom, urinating before and after intercourse and the avoidance of douching are a few examples. Acidification of the urine by drinking cranberry juice or taking cranberry tablets is helpful. Initiating vaginal estrogen therapy in menopausal women is also effective.

Urinary tract infections are a common reason women seek health care. The symptoms can be uncomfortable and annoying but if left untreated can develop into a more severe infection. It is very important to seek care from an experienced health care provider such as a Urogynecologist, Urologist or Gynecologist if this infection becomes recurrent.