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A Patient's Guide to Recurrent Urinary Tract Infections

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A Patient's Guide to Recurrent Urinary Tract Infections

4 min read


Urinary tract infections are clinical bacterial infections involving the urinary system. Read the article to learn more.

Written by

Dr. Davie Wong

Medically reviewed by

Dr. Preetha. J

Published At February 19, 2019
Reviewed AtSeptember 16, 2023

What Are Recurrent Urinary Tract Infections?

Recurrent urinary tract infections are chronic urinary infections that either do not respond to treatment or keep recurring. In chronic urinary infections, the involvement of other organs of the urinary system is observed.

The urinary system is made up of a urinary path involving -

  • Kidneys - Function to filter the blood and remove the waste water from the body, and form urine.

  • Ureters - These are the tubes that carry urine from the kidneys to the bladder.

  • Bladder - This collects and stores urine.

  • Urethra - Urethras are tubes that collect urine from the bladder and carry it outside the body.

If the infection involves the urinary bladder, it is known as cystitis, if the urethra is involved, it is called urethritis, and sometimes it can affect the kidneys.

Urinary tract infection is seen at any age. However, women are more prone to develop a urinary tract infection, as well as diabetic patients.

Generally, the urinary tract is sterile. However, infection-causing pathogens present in the small intestine or perianal region can stimulate the infection.

What Are the Causes of Urinary Tract Infection?

Urinary tract infection is mostly caused by bacterial infections. The urinary system is prone to develop bacterial infections, as the urinary system is composed of the bladder and urinary tract involving the urethra.

Bladder infections are caused by Escherichia coli (E.coli) bacteria, also called cystitis. In general, Escherichia coli (E.coli) is found in the intestine of the human body, which is totally normal and does not cause any harm to the system. The infection is caused by bacteria, reaches the urinary tract from the intestine by tiny microbial fecal matter. This might happen during sexual intercourse. Anal sex raises the chances of getting urinary tract infections.

Urethral infection, called urethritis, is also caused by Escherichia coli (E.coli). The other significant pathogens responsible for urinary tract infections are Proteus mirabilis, Staphylococcus saprophyticus, Staphylococcus epidermidis, and Klebsiella pneumonia. In diabetic patients, Klebsiella and group B streptococcus infections are more common. Pseudomonas infections are more common in patients with prolonged catheterization.

What Are the Signs and Symptoms of Recurrent Urinary Tract Infections?

Recurrent urinary infections have the following signs and symptoms -

  1. Frequent urination.

  2. Bloody and dark urine.

  3. Burning sensation while urinating.

  4. Pain in the lower abdomen.

  5. Pain in the lower back region.

If the infection involves kidneys and other parts of the urinary system, the following symptoms are noted -

  1. Fever.

  2. Nausea.

  3. Chills.

  4. Fatigue.

How to Diagnose Recurrent Urinary Tract Infection?

The diagnosis can be made with the help of past medical history. Some lab tests can also be performed to confirm the infection -

  • A urine test is performed to examine the content of the urine.

  • Urine culture is advised to check the causative pathogen for the treatment of the infection.

  • A kidney function test is performed to check the abilities of the kidneys to function.

  • Abdominal ultrasound sonography is done to detect the damage caused to the kidney or other underlying problems like kidney stones.

  • In severe cases of recurrent urinary tract infection, cystoscopy is also performed by an experienced health care provider. In the procedure of cystoscopy, a thin, long tube with a lens called a cystoscope is inserted inside the urethra and bladder to check and examine the condition of the urinary tract and to determine the cause of the infection.

What Are the Treatment Modalities for Recurrent Urinary Tract Infections?

Urinary tract infection is curable, but recurring infection should be considered a severe problem.

  • Counseling is very important for the patient to understand their own condition and get educated about personal hygiene.

  • The patient is advised to take a plenty of water to overcome the infection.

  • Preventive measures should be taken before and after sexual intercourse to avoid recurrent infection.

  • Antibiotic therapy is a core treatment for urinary tract infections.

  • Supportive treatment is also indicated.

How to Reduce the Risk of Recurrent Urinary Tract Infection?


As a woman gets older, hormonal changes cause alterations to the vagina and its

contents, predisposing it to urinary tract infections. Topical estrogen applied inside the

vagina can reduce the risk of infections.

Sexual Activity:

Some women find urinary tract infections coinciding with sexual intercourse. Avoid the

use of spermicide compounds, as these have been associated with an increased risk of

infections. It is advisable to urinate after intercourse to reduce the risk of infection.

Fluid Intake:

Drink at least 2 to 3 liters of fluids per day to help flush out any bacteria that might be

present in your bladder and urinary tract.

Cranberry Products and D-Mannose:

Some people find that taking these products may reduce the number of urinary tract

infections. This is because they work by preventing bacteria from sticking to your urinary


Antibiotic Prophylaxis:

Antibiotics can be used to prevent urinary tract infections in some people. If lifestyle

changes do not adequately control your infections, then a low-dose oral antibiotic may

be right for you. For example, if your infections typically occur after sexual activity, then

you can take a single dose of an oral antibiotic after sex.


A health care provider may recommend consulting a urologist to assess if there are any

structural or functional problems with your urinary tract. The urologist may need to

perform a cystoscopy, a procedure where a small camera is inserted through the urethra

into your bladder to look for any problems that might be causing your infections.


Estrogen can help to stimulate the lactobacillus in the epithelium of the vagina, which reduces the formation of bacterial colonization and avoid the development of urinary tract infections.


Recent studies have stated that acupuncture can reduce the risk of developing the infection in adult women prone to get urinary tract infections.


Administration of immunoprophylaxis enhances the defense systems the helps to prevent recurrent urinary tract infections.

Conclusion -

Recurrent urinary tract infections are very common problems associated with urinary tract. E Coli is the main causative agent, and women are more prone to get the infection. It is always recommended to consult with a urologist to deal with the recurrent urinary infection and to get the best suitable treatment.

Frequently Asked Questions


What Can Be the Cause of Recurrent Urinary Tract Infections?

A recurrent urinary tract infection can be caused due to an infective organism that is not entirely cured. Frequent sexual activity can cause this condition. In some individuals, the genitalia may be placed differently, leading to recurrent UTIs. 


What Is the Role of a Urologist in Treating UTIs?

The urologist will help identify the cause of the occurrence of UTIs. The doctor may perform specific tests that will help in determining the cause. The tests may include the following:
- Cystoscopy.
- CT (computed tomography) scan of the urinary system.
- Urine culture.
- Urine analysis. 


Which Antibiotics May Be Used in the Treatment of UTIs?

The following antibiotics may be used in the treatment of UTIs. 
- Cephalexin.
- Ceftriaxone. 
- Sulfamethoxazole. 
- Nitrofurantoin. 
- Fosfomycin. 
- Trimethoprim. 


When Can UTI Infections Be Considered Recurrent?

A UTI infection can be considered chronic if the infection is recurrent. Chronic illness occurs when the UTI reoccurs at least twice within six months. The condition usually recurs within three months of the primary disease. 


Can Probiotics Prevent the Occurrence of UTIs?

The usage of probiotics has been known to reduce the occurrence significantly. Probiotics are known to be rich in a bacteria called lactobacillus. Lactobacillus are known to alter the pH balance of the vagina. Hence, probiotics can effectively prevent a UTI.


What if UTI Comes Back After Antibiotics?

Sometimes, UTIs can come back even after treatment with antibiotics. Such cases are known as resistant infections. Resistance to antibiotics can be due to various factors, such as overuse. 


What Happens if Antibiotics Do Not Work for UTIs?

If the infection does not respond to antibiotic treatment, it could mean any of the two:
- The infective organism is resistant to the antibiotic that is used. 
- The condition is chronic. 
Either way, it is better to get a complete checkup done. 


Which Vitamins Are Useful in the Treatment of UTIs?

Some vitamins are helpful in the treatment of UTIs. Vitamins such as Vitamin C and D can be effective in the treatment of UTIs. Vitamin C can be helpful as it helps balance pH levels and increases immunity.


When Should a Person Be Worried About UTI?

A person should be worried about UTI infection if it is recurrent. It should be taken seriously if the person experiences two or more bouts of illness within six months of duration. It can also be problematic if the urine cultures return positive multiple times. 


What Can Be the Triggering Factor for UTI?

The triggering factor for UTI can include- 
- The natural anatomy of the body. This can make the females more vulnerable to UTIs. 
- Sexual intercourse can act as a triggering factor for the onset of UTIs. 
- Menopause. 
- Usage of specific birth control methods.


What Happens if the UTI Is Persistent?

If UTI is persistent, it can cause chronic infection in the body. When this happens, it can spread to other body parts through blood. It may also lead to infection of the kidney. When it spreads through blood, it is known as sepsis, and this condition needs severe and immediate care.


What Is the Treatment for Multiple Resistant UTIs?

Treatment of multiple resistant UTIs involves a combination of various medications. The mixture is antibiotics. To have the best effect, these antibiotics are administered through intravenous injections. However, this form of treatment is the last resort. The antibiotics can also be chosen based on the organism causing the infection. 


How to Know if the Infection Has Spread to the Kidneys?

If the infection spreads to the kidneys, other symptoms may be associated with the UTIs. The other symptoms can include nausea, back pain, and fever associated with chills. The kidneys may be affected in the most complicated cases of UTIs. 
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Dr. Davie Wong
Dr. Davie Wong

HIV/AIDS specialist


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