Recurrent UTI: Causes, Symptoms, Prevention

Roughly 1 in 3 women face an uncomplicated urinary tract infection (UTI) before they turn 24. 

Men can have them too. 

The lifetime prevalence of at least a single symptomatic UTI in female patients can be more than 50%, with around 26% of women having a recurrence in 6 months of a follow-up after treating their UTI. (1)

Ailments that get in the way of normal immune function, like diabetes or HIV, can make men prone to recurring UTIs. 

Plus, men who have unprotected sex or are uncircumcised are at greater risk of a chronic UTI. 

The question is, what causes a recurrent UTI in women and men? 

And what are the right ways to treat and prevent them? 

The guide below can answer all your queries.

What is a recurrent UTI?

UTI is a type of bacterial infection. It can affect the bladder, kidneys, ureters, or/and urethra. Chronic, recurrent, or repetitive UTI means developing 2 or more infections in 6 months or 3 infections in 1 year. 

Having recurrent UTI symptoms usually means there are new infections with different bacterial organisms.

If the organism stays the same, this is a relapsing infection. The patient didn’t properly get rid of the source, which could be prostatitis, urinary stone, or abscess.  

It’s crucial to differentiate a UTI relapse (the same organism) from rapid reinfection (a different organism). 

Relapsing infections refer to a recurrence within 2 weeks of finishing therapy with the same organism. In comparison, reinfection is when a new infection is more than 2 weeks upon completing the treatment, even if the organism remains the same. Most recurrent UTIs are reinfections that don’t need a thorough evaluation.

How long is too long for a chronic UTI to last? 

People worry about their health, particularly about how long a UTI will last. See a doctor if the UTI lasts more than 2 to 3 days. 

A week of antibiotic treatment can help reduce the symptoms. Patients with frequent UTIs typically use low-dose long-term antibiotics for over 1 week after the symptoms decrease. 

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Are recurring UTIs common?

Constant UTI is one of the most widespread problems in urological clinics. And these health problems happen more in women than men, with an 8:1 ratio. 

Roughly 50% to 60% of women experience at least a single UTI in their lifetime. About 1 in 3 of them can have a symptomatic UTI that requires antibiotic treatment. (2)

Chronic UTI in the elderly is an even bigger problem. The UTI incidence rate drops during middle age but increases in older patients. 

Research shows that more than 10% of women over 65 experienced a UTI in the last 12 months. The numbers skyrocket to almost 30% in women older than 85. (3)

Then there is recurrent UTI during pregnancy. UTIs recur in around 4-5% percent of pregnancies. Talking to a specialist to manage a recurrent UTI in pregnancy is important. 

As you can see, the UTI frequency is relatively high.

Signs and symptoms

Wondering how it feels to get a UTI often? The symptoms of a long-term UTI can vary based on which area of the urinary tract suffers. 

Some of these signs can include:

  • Needing to urinate more frequently than usual at night
  • Cloudy urine
  • Smelly or dark color urine
  • Burning or painful sensations when urinating
  • Urgent need to urinate
  • Pain in the back, just below the ribs
  • Pain in the lower tummy
  • Blood in the urine
  • Increased body temperature 
  • Reduced body temperature

A UTI lasting 2 weeks can lead to changes in behavior in elderly patients. It can make them feel confused or agitated. Some might be prone to incontinence (wetting themselves). 

Regardless of whether these symptoms of recurrent urine infection happen in female or male patients, it’s important to understand the causes and get to the root of the problem. 

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Causes

Persistent UTI is primarily the result of reinfection by the same pathogen. Being frequently intimate predisposes you to a recurrent UTI. 

Recurrent UTIs in men and women can happen not because of hygiene factors but because they are simply prone to it. Genes are some of the most impactful frequent UTI causes.

Their bodies are naturally more receptive to the bacteria, making them susceptible to kidney or bladder infections. 

Studies indicate that 6 out of 14 genes in humans could be linked with a predisposition to recurrent UTI in patients. (4)

Other chronic UTI causes include antibiotic resistance. If bacteria is resistant to a specific antibiotic, it continues to spread and multiply. 

This adds more fuel to the fire, making the infection harder to treat. There are other potential causes of constant UTI, like a predisposing condition. (5)

Experts evaluated what causes a recurrent UTI. Based on the results, in patients with type 2 diabetes, many different mechanisms could increase the odds of getting urinary tract infections. 

This includes immune system disorders, diabetic nephropathy, the drop of sugars in the urine (glucosuria), and damaged nerves that control automatic body functions (autonomic neuropathy). (6)

Is the way you wipe in the bathroom one of the reasons for recurrent UTI? 

Wiping back to front increases the odds of developing a UTI instead of wiping front to back. (7)

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Why won’t my UTI go away with antibiotics?

A UTI keeps coming back after antibiotic therapy. Am I doing something wrong? 

Antibiotics are the go-to choice for managing most UTIs. But, not all patients will respond well to them. 

There are 3 reasons this could happen:

  • Another health condition is causing UTI-like symptoms
  • A different type of virus, fungi, or bacteria is the source of the infection
  • The bacteria you are trying to treat has antibiotic resistance

Some health problems that mimic the symptoms of UTI are acute cystitis, overactive bladder, kidney stones, genital herpes, and more. 

If the urinalysis is carried out by skipping an extra urine culture, then there is a possibility the antibiotics for recurrent UTIs you are taking are not the right ones. 

In case of an antibiotic-resistant infection, your GP will ask you to do a urine culture to test which bacteria is causing the problem. They can then pinpoint the best course of action to kill it. When other antibiotics fail, doctors usually prescribe Pivmecillinam and Fosfomycin.

Is recurrent UTI serious?

A persistent urine infection is painful and uncomfortable. Chronic infection usually resolves with extended antibiotic therapy. It is important to monitor the symptoms since the UTI can emerge again. 

People who deal with UTIs regularly might also experience some complications. The odds of them happening are low, but they can still happen. 

These complications are:

  • Kidney problems include kidney disease, kidney infection, and permanent kidney damage.
  • Bacteria enter the bloodstream, causing septicemia or sepsis, which is blood poisoning.
  • Life-threatening complications, like sepsis.
  • Higher risk of giving birth to newborns with lower birth weight.
  • Higher risk of premature delivery.

When to see a doctor

Frequent UTIs in women and men don’t always mean that you must see a specialist. But, there are specific situations where it is best to talk to your healthcare team. 

See a urologist for recurrent UTI if:

  • The UTI symptoms continue after finishing the treatment.
  • You can’t control the bladder or empty it completely.
  • There is blood in the pee after you finish antibiotic therapy.
  • Your symptoms are getting worse. 

Patients with recurrent infections consult with their doctor around 3 or more times a year. If there is any abnormality in the urethra, bladder, or kidney, a doctor can offer proper guidance and reduce the odds of recurrence. Medication adherence is also critical.

doctor

Treatment

Treatment of chronic UTI starts with proper medication. Patients should also follow a UTI diet and incorporate adequate lifestyle changes to set their health on the right track. Some are also opting for natural antibiotics for better results.

Medication 

Most patients receive antibiotic therapy for more than 1 week. But, recurrent UTI treatment guidelines are different. 

Patients can receive low doses of long-term treatment. This can last for 6 months or more. 

Recurrent UTIs in female symptomatic patients can also be managed with a single antibiotic dose after sex if the UTI is linked to sexual activity. 

For postmenopausal women, vaginal estrogen therapy can help treat recurrent UTIs. 

UTI diet 

Dietary habits are a key risk factor for recurring UTIs. Foods to avoid with a UTI are classic bladder irritants. This includes artificial sweeteners, soda, alcohol, and coffee. Anything too acidic, like too many limes, oranges, or lemons, can also irritate the bladder. 

Adding more veggies and fruits is best to supply the body with all the nutrients it needs. Beneficial antibiotic foods include blueberries, probiotics, and cranberry juice. (9)

foods to avoid with uti

Natural supplements 

Options like cranberry products, bearberry leaf, and D-Mannose can reduce recurrence and prevent UTIs

Can recurrent UTI be cured?

The treatment plans you receive should be enough to curb the symptoms. Recurrent UTIs tend to clear up with a long-term therapy approach. 

It’s best to spot the symptoms early on, so you can use adequate treatment. For 25-30% of women who had a UTI, the infection comes back in 6 months. 

Does urinary tract surgery help with UTI? 

You will be taking stronger antibiotics for a longer time. If something is wrong with the structure of the urinary tract, and it is causing the infection, then you might need surgery. 

How do I stop recurring urinary tract infections? 

Prevention starts early. Here are a couple of tips for preventing urinary tract infections:

  • Drinking plenty of water.
  • Avoid feminine products that irritate the skin, like douches or scented powders.
  • Washing up before sex and peeing after it.
  • Avoid going too long without peeing.

When it comes to preventing chronic urinary tract infections, many experts advise patients to wear cotton underwear. Avoid very tight clothing, as it can trap bacteria close to the urethra. Also, take regular showers rather than baths. 

Conclusion

Recurrent UTIs can happen to anyone. It’s important that you talk to your doctor about any of the signs you might be feeling. 

They may suggest you do susceptibility testing and provide a midstream urine sample. If you are more prone to infection, your doctor may offer you a low-dose antibiotic therapy to control the symptoms. 

But, medical therapy alone won’t be enough to achieve the desired result. You will need to pay attention to the food you eat if you want to give your body the break it deserves. Some people also like to include natural supplements. 

Talk to your healthcare provider to know which treatment option will work for you. Inpatient management is usually unnecessary for this kind of health problem. But, it’s a good idea to visit your doctor in a primary care setting from time to time. 

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Sources

  1. Aggarwal N, Lotfollahzadeh S. Recurrent Urinary Tract Infections. [Updated 2022 Jun 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. https://www.ncbi.nlm.nih.gov/books/NBK557479/
  2. Al-Badr A, Al-Shaikh G. Recurrent Urinary Tract Infections Management in Women: A review. Sultan Qaboos Univ Med J. 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3749018/
  3. Rowe TA, Juthani-Mehta M. Urinary tract infection in older adults. Aging health. 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3878051/
  4. Zaffanello M, Malerba G, Cataldi L, Antoniazzi F, Franchini M, Monti E, Fanos V. Genetic risk for recurrent urinary tract infections in humans: a systematic review. J Biomed Biotechnol. 2010. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847765/
  5. Kim A, Ahn J, Choi WS, Park HK, Kim S, Paick SH, Kim HG. What is the Cause of Recurrent Urinary Tract Infection? Contemporary Microscopic Concepts of Pathophysiology. Int Neurourol J. 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8497731/
  6. Salari N, Karami MM, Bokaee S, Chaleshgar M, Shohaimi S, Akbari H, Mohammadi M. The prevalence of urinary tract infections in type 2 diabetic patients: a systematic review and meta-analysis. Eur J Med Res. 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8817604/
  7. Persad S, Watermeyer S, Griffiths A, Cherian B, Evans J. Association between urinary tract infection and postmicturition wiping habit. Acta Obstet Gynecol Scand. 2006. https://pubmed.ncbi.nlm.nih.gov/17091423/
  8. Kontiokari T, Laitinen J, Järvi L, Pokka T, Sundqvist K, Uhari M. Dietary factors protecting women from urinary tract infection. Am J Clin Nutr. 2003. https://pubmed.ncbi.nlm.nih.gov/12600849/

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