One of the common problems we see in our practice is recurrent urinary tract infections. At least a third of women will have a urinary tract infection diagnosed by age 24. Recurrent urinary tract infections are defined as 2 or more in 6 months or 3 or more in one year. There are many potential predisposing factors for developing a UTI, and it is also fairly common to see another condition misdiagnosed as a UTI and treated only to see the symptoms persist or recur. New research has given us much information regarding the normal bacterial environment in the bladder (no, the bladder is not a sterile organ!). For this reason, proper diagnosis and treatment is essential. There are several predisposing factors to development of recurrent urinary tract infection. Potential risk factors include: incomplete bladder emptying, menopause (with vaginal atrophy), accidental bowel leakage with or without diarrhea, improper hygiene, kidney stones or other foreign bodies in the urinary tract, and a compromised immune system, among others. Many women discover they are prone to UTI following intercourse. When we see a woman in the office complaining of this problem, we first obtain a careful history and perform a thorough physical examination. Making sure that a proper culture is collected every time and that the proper antibiotics are given for the appropriate amount of time is very important. The American Urological Association does not recommend ciprofloxacin as a first-line treatment for urinary tract infection. There are often better choices for antibiotic treatment. Evaluation for predisposing factors is always an important part of the plan as we try to develop an effective prevention strategy.
So what are the current prevention strategies we recommend? First, hygiene when toileting is important. Wiping from front to back and avoiding flushing the toilet while sitting is a simple first step. Next, assuming fluid intake is adequate, we recommend regular daily intake of probiotics, which has been demonstrated in several studies to improve the immune system and help prevent infection. We also often add a cranberry preparation (our preferred is Ellura ® or Theracran, because they contain the largest concentration of the proanthocyanidins, which are the active ingredient in cranberries) daily to the regimen. Many women have found freeze-dried Aloe Vera extract helpful for their symptoms, and since this is not likely to be harmful (unless you are allergic to Aloe!) I encourage them to try it. For our postmenopausal patients, there is good evidence that vaginal estrogen therapy (not systemic for menopausal symptoms, but local therapy in the vagina) reduces the incidence of UTI. Those who can’t tolerate those preparations can take Osphena or use vaginal laser therapy to treat atrophy.
If these simple measures are not effective, we may add a non-antibiotic anti-infective medication. Finally, some patients need to take a prolonged course of a low dose antibiotic to prevent recurrence long enough to get back to normal. Of course, a more thorough evaluation is necessary when the most conservative measures are not effective. Often, we will discover that the problem is not a urinary tract infection at all, but another problem masquerading as a UTI due to similar symptoms. Most important: once the problem becomes “recurrent”, an evaluation is needed. For more information call 561-701-2841.
Linda Kiley, MD
Dr. Kiley is a Board Certified subspecialist in Female Pelvic Medicine and Reconstructive Surgery, and is also Board Certified in general Obstetrics and Gynecology.