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Recurrent Urinary Tract Infections (UTIs)

Urinary tract infections are considered recurrent if you have 2 or more infections in 6 months or 3 or more infections in a year. Symptoms of urinary tract infections include urinary frequency and urgency, bladder or urethral burning, and discomfort in the bladder. Some women have little or no symptoms, this is called asymptomatic bacteriuria.

Common Symptoms & Concerns

  • Frequent urge to urinate, but only passing a small amount of urine
  • A burning sensation, pressure, or pain in the area of the bladder or when urinating
  • Milky or cloudy urine, even reddish if blood is present
  • Tired, shaky or washed out feeling.
  • Uncomfortable pressure above the pubic bone

About Recurrent Urinary Tract Infections (UTIs)

Causes for recurrent bladder infections:

  1. Genitourinary Syndrome of Menopause or hormonal imbalance
  2. Vaginal prolapse
    NOTE: As a urogynecologist, Dr. Ashford specializes in complex repairs such as pelvic organ prolaspe.  For detailed information about prolapse repair, please visit Minnesota Women's Care. 
  3. Vaginal pessary
  4. Urethral diverticulum
  5. Immune disorder or genetic predisposition
  6. Kidney stones
  7. Abnormal urinary tract shape or function
  8. A bacteria strain that is resistant to the antibiotic used
  9. Sexual intercourse
  10. Indwelling urethral catheter
  11. Spermicides or diaphragms for birth control

Effective bladder infection treatment

The most effective way of treating recurrent bladder infections is to treat the cause. To determine the cause, there are a number of options:

  1. A urine culture AND sensitivity is done.
    This test is performed not only to determine if there is a bacteria present in the urinary tract, but also to treat the bacteria in the lab with various forms of antibiotics to determine which antibiotic will most effectively kill the bacteria.
  2. CT scan or other imaging test of the urinary tract to rule out abnormalities
  3. Cystoscopy (scope to look into the bladder)
  4. Physical exam by healthcare provider

Based upon your situation you may not need all of these tests.


Management options for recurrent urinary tract infection

We treat any underlying cause discovered in the evaluation. If no specific cause is found, many management options are offered:

  1. A long-term, low-dose antibiotic for as long as six months to two years
  2. Intermittent or self-directed antibiotic therapy — This involves taking antibiotics around or before any lifestyle situation that tends to cause a bladder infection. For example before intercourse.
  3. Vaginal estrogen therapy
  4. Supplements:
    Cranberry tablets - 500mg orally, three times a day (not sugary cranberry juice)
    Probiotics - available at most drug stores and pharmacies may help
    Vitamin C - 500mg orally twice daily, acidifies the urine so bacteria don’t like to live there
    D-Mannose acts as an adhesion barrier. Dosing is 2000mg orally daily.
    Methenamine is a urinary antiseptic, it concentrates in urine as formaldehyde and kills bacteria

Life style changes

  • Drink plenty of liquids, especially water, to help flush out bacteria
  • Urinate often, especially when you feel the need
  • Wipe from front to back after urination or a bowel movement
  • Take showers rather than baths
  • Gently wash the skin around your vagina and anus daily using a mild soap and plenty of water
  • Use forms of birth control other than a diaphragm and spermicides
  • Empty your bladder as soon as possible after intercourse
  • Avoid deodorant sprays or scented feminine products in the genital area
  • Avoid douching

The most common cause of recurrent bladder infections, especially in menopausal women, is hormonal imbalance or Genitourinary Syndrome of Menopause.

Read more about this condition and the treatments used.