In this article we will describe 10 recurrent UTI facts. Let’s start with the basics.
1. Definition of recurrent UTIs
Frequent urinary tract infections (UTIs) are defined as 3 or more episodes of infection during a 12 month period. Doctors call these ‘recurrent’ UTIs.
2. What is a UTI?
A urinary tract infection (UTI) is an infection in any part of the urinary tract (system). The system includes the kidneys, ureters, bladder and urethra (and prostate in a man). The main function of the urinary system is make urine; which is the system for removing water and waste from the body. The kidneys and urinary tract are the body’s dustmen.
There are different types of UTI, and the symptoms are different. The doctors name for the type of infection, depends on which part of the urinary tract is affected, e.g.
- Kidney = pyelonephritis – causing pain in the back/side of tummy
- Bladder = cystitis – lower tummy pain at the front, burning when you wee, and weeing more frequently
- Urethra= urethritis – burning when you wee, and weeing more frequently
- Prostate = prostatitis (men only) – pain in genital area.
Urinary tract
Most infections involve the lower urinary tract – the bladder (cystitis) and urethra (urethritis). Cystitis is the commonest. For such infections, in adult women of child bearing age, there is not (usually) an underlying cause.
3. What bacteria cause UTIs?
- The most common bacterium is Escherichia coli (in 70 to 95% of cases)
- Less commonly organisms include Staphylococcus saprophyticus (approximately 5-10% of cases), Proteus mirabilis (more common in males, associated with urinary tract abnormalities, particularly stones), and Klebsiella species
- Streptococci rarely cause uncomplicated UTI; although a type called Lancefield Group B streptococci may cause infection in some women
- Candida (a fungus) species rarely cause UTI. When they do, they are usually linked to indwelling catheters in the bladder, immunosuppression (drugs or diseases that suppress the immune system) or contamination from the genital area.
4. How do UTIs enter the body?
Urinary tract infection (UTI) is usually caused by bacteria from the gastrointestinal tract. Entry of bacteria to the urinary tract can be:
- Retrograde – bacteria ascend through the urethra into the bladder
- Via the blood stream – more likely in people who are immunosuppressed
- Direct – for example with insertion of a catheter into the bladder, or surgery.
So. Tell me more about frequent (recurrent) urinary tract infections (UTIs).
5. What are the causes of frequent UTIs?
There is usually no identified ’cause’. But we may look for an underlying structural problem.
- Structural problems:
- Kidney or bladder stones
- Congenital problems (that you are born with) – e.g. a duplex (double) ureter
- Prostate problems (man)
- Cancer in the urinary tract
- Semi-inherited rare conditions (e.g. reflux nephropathy)
- N0n-structural problems (no specific cause):
- Suppression of the immune system
- (Perhaps) bacteria getting into the urethra during sex. The urethra is the passage that allows urine to exit the bod
- Changing oestrogen levels during menopause.
6. What tests need to be done (to find the cause of recurrent UTIs)
- A midstream sample of urine (MSU) – to see what bacteria may be causing infection
- Blood tests including urea and electrolytes (U&Es) which assess kidney function; a full blood count (FBC) and a C-reactive protein (CRP) looking for anaemia and infection
- A cystoscopy – a telescope put into the bladder
- An ultrasound of the bladder and kidneys (and prostate in a man)
- A computerised tomography (CT) scan of the urinary tract – this may be necessary in some people if the ultrasound is normal or nearly normal.
7. What is the treatment for recurrent UTIs?
Treat – and preferably remove – the underlying structural cause, when possible.
If an underlying cause cannot be found, these treatments may help:
- A low-dose antibiotic taken for at least six months and up to two years
- Rotating antibiotics
- Intermittent antibiotic therapy — for instance, taking an antibiotic after sex or starting a course of antibiotics at the first sign of a UTI
- In women, vaginal oestrogen therapy for UTIs related to vaginal dryness after menopause.
Which regular antibiotics?
- Trimethoprim 100mg at night, or
- Nitrofurantoin 50-100mg at night, or
- Amoxicillin 250mg at night, or
- Cefalexin 125mg at night.
In they do not work, ‘rotating antibiotics’ may be useful. This means having the antibiotics above, but changing them every 1-3 months.
8. Who requires specialist referral, and which specialist?
- Men, babies and children
- Very frequent, or very bad infections
- Suspected underlying structural cause (e.g. stones, or congenital abnormalities)
- Suspected underlying cancer – arrange an urgent 2-week wait referral.
It is best for a GP to refer you to a surgeon called a consultant urologist first. They specialise in UTIs and do operations and procedures (like cystoscopy) on the urinary tract – kidneys, ureter, bladder, urethra and prostate (in a man). If they do not find a cause, they may refer you on to see a consultant nephrologist (kidney physician, i.e. a thinker).
Whoever you see, further tests will be required, including a cystoscopy (a telescope put into the bladder) and ultrasound.
9. In terms of causes are men and women different?
Yes. If a man (or baby or child) has recurrent UTIs, it should be assumed – until otherwise proven – there is an underlying ‘structural cause’. Causes include stones, cancers and congenital abnormalities. You should then be referred to a hospital specialist (see point 8).
10. What lifestyle changes can help women with recurrent UTIs?
Expert opinions vary on whether certain lifestyle changes reduce the risk of UTIs (in women where no underlying cause is found). Nonetheless it may be helpful to:
- Drink plenty of liquids, especially water
- Urinate often, especially when you feel the need
- Wipe from front to back after urinating or having a bowel movement
- Gently wash the skin around your vagina and anus daily using a mild soap and plenty of water
- Empty your bladder as soon as possible after sex
- Avoid using deodorant sprays or scented feminine products in the genital area.
We would stress that much of this advice is borderline hocus-pocus, for which there is little or no evidence.
Some studies have shown that cranberry products may have infection-fighting properties to help prevent urinary tract infections. But evidence is limited and inconsistent. Cranberry does not help treat an existing UTI.
Summary
We have described 10 recurrent UTI facts. We hope you understand them better now.
Last Reviewed on 20 April 2024