A Patient's Guide to Recurrent Urinary Tract Infections

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.

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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?

Post-Menopause:

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

tract.

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.

Urologist:

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:

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.

Acupuncture:

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

Immunoprophylaxis:

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.