Recurrent Urinary Tract Infections (UTIS)

About

  • Urinary Tract Infection (UTI): Bacterial infection of the urinary system causing an inflammatory response
    • Can affect any part of your urinary system: Bladder, kidneys, urethra and/or ureters
    • Usual Uropathogens: Escherichia coli, Staphylococcus saprophyticus, Klebsiella pneumoniae and Proteus mirabilis
    • A threshold of 3 UTIs in 12 months is used to signify recurrent UTI
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  • The Pathogenesis of Recurrent UTI: Involves bacterial reinfection/bacterial persistence, with the former being much more common
    • Reinfection
      • Recurrence with the same organism in more than 2 weeks after treatment, a different organism or a sterile intervening culture
    • Bacterial Persistence
      • The same bacteria may be cultured in the urine 2 weeks after initiating sensitivity-adjusted therapy

Potential Causes

  • More prevalent in women
    • Urethra is closer to the rectum
    • Urethra is shorter
    • Diaphragm use
    • The use of products that can change the bacterial makeup of the vagina ie: spermicides, vaginal douches
    • Menopause due to hormonal changes resulting in modified vaginal bacteria
    • Invasion of E.Coli bacteria into the urinary tract as a result of:
      • Improper wiping
      • Toilet water backsplash
      • Sexual intercourse
  • In men
    • Enlarged prostate: The bladder does not empty completely, enabling bacteria to grow more easily
  • Neurogenic bladder: More prone to recurrent UTIs, as a result of issues with bladder muscle function (urinary retention)

Symptoms

  • Frequent urination
  • A burning sensation while urinating
  • Bloody/dark urine
  • Pain in your bladder/kidney regions

Diagnosis

  • Urine culture: To determine which bacteria are present
  • Cystoscopy: To look inside the urethra and bladder to see if there are any abnormalities/issues that could cause the UTI to keep coming back

Treatment

  • Antibiotics
    • For a week followed by long term, low-dose antibiotics after the initial symptoms subside
    • Post-intercourse
    • When on antibiotics, be sure to take probiotics to replenish good bacteria in your system
  • Estrogen therapy: For menopausal women
  • Water: Drink lots to dilute your urine and help flush out bacteria
  • Heat application: Use a heating pad/hot water bottle on your bladder