Diagnosis & Treatment of
Recurrent Urinary Tract Infections

A urinary tract infection (UTI) is as uncomfortable as it sounds. Symptoms often include painful urination, frequent trips to the bathroom and a feeling of urgency.  Other symptoms may include lower abdominal or pelvic pain and pressure, blood in the urine, cloudy or pink/red urine, fever and strong smelling urine.  If you experience any of these symptoms, contact Dr. Portera.

There are several types of UTIs:

Cystitis This is an inflammation of the bladder and the most common UTI. The infection typically affects only the surface of the bladder and is brief & acute.

Urethritis As the name suggests, urethritis is an inflammation of the urethra. Urethritis usually results from recurrent infections, trauma to the area or from the catheterization process. Infections can also be contracted through sexual intercourse with partners who have sexually transmitted diseases (STD’s).

Pyelonephritis  Occasionally, bacteria will spread to the kidney from the bloodstream. Symptoms include a fever, pain in the back or side below the ribs, nausea, or vomiting.  Kidney infections are more serious and occur less frequently than bladder infections.

Not surprisingly, more than 4 million doctor office visits per year in the US are for UTIs.  If you experience three or more UTIs within a year, it is known as a recurrent UTI and should be addressed with your physician immediately.

Causes

Urinary Tract Infections typically arise from bacteria that normally live in the colon and rectum.  Once bacteria are introduced into the urethra, they multiply and travel up to the bladder. Urine flow from the bladder usually washes bacteria out of the body. ​

However, because women have a shorter urethra than men, bacteria can reach the bladder more easily and settle into the bladder wall. 

Several factors can contribute to the risk of Urinary Tract Infections.

Sexual intercourse

Use of contraceptive spermicide

Immune suppression

Pregnancy

Diabetes

Low levels of estrogen

Catheterization

The last two in the list require a little more explanation. Naturally occurring estrogen helps prevent recurrent UTI in women. After menopause, estrogen levels drop along with the number of vaginal lactobacilli, the “good bacteria” which prevent growth of intestinal bacteria in the vagina. This makes postmenopausal women especially susceptible to UTI.

​Catheters are associated with colonization of bacteria and increased risks of clinical infection. Using good hygiene and proper techniques can help keep catheters clean and prevent recurrent UTIs.  While single-use of sterile catheters reduces the risks, it does not prevent a UTI from occurring. It is therefore important to maintain proper care and use of catheters at all times while remaining alert to symptoms of UTI.

Treatment Options

Behavioral Modification

Prevention is the best treatment for UTIs:

Bathroom Behavior Periodically emptying the bladder by urinating every two to three hours may help to prevent UTIs.

Diet The use of cranberry products seems to decrease the ability of bacteria to adhere to the lining of the urethra and bladder. As cranberry juice can have a high amount of sugar, cranberry extract can be taken in capsule or pill form instead. Increasing water intake by one or two glasses per day may help limit the length of time that you have symptoms  and reduce the infections. However, drinking large amounts of water has not been proven to reduce UTIs.

Hygiene Proper hygiene in caring for the urethral area is another way to limit the amount or type of bacteria that can be drawn into the urethra. This is especially true in people who have decreased sensation in the  perineal region such as those with MS or who experience any amount of fecal incontinence. Using soap and water or commercially available cleansing wipes several times per day and frequent changing of incontinence pads as they become wet can minimize the amount of bacteria in the urethral area. Women should always wipe from the front of the vagina to the back of the anus after urination or a bowel movement.

Sexual Activity Ensuring proper lubrication to the vagina and voiding before and after intercourse are tactics to help prevent infection. Using diaphragms and spermicidal jelly and/or foam may increase the risk of infection, so it is important to evaluate what type of birth control you use. Some physicians encourage women who have a history of recurrent   infections to take an prophylactic antibiotic after intercourse, as it reduces risk of recurrent UTI by about 85%. Restricting the number of sexual partners can lower the risk of recurrent UTIs.

Vaginal Estrogen Estrogen reduces risk of recurrent UTI by repopulating the normal vaginal lactobacilli that keep bacteria from the rectum from multiplying and causing a bladder infection. Forms of vaginal estrogen are available at very low dosages that have minimal systemic absorption.Vaginal estrogen is a medication that needs to be prescribed by Dr. Portera. 

Catheter Use Proper cleansing and storage of catheters is important in one who intermittently catheterizes, as the catheter can be a vehicle to introduce infection. 

Pharmaceutical Depending on the severity of infection, Dr. Portera may prescribe an oral antibiotic. A simple UTI can be treated with a 3- or 7-day course of antibiotics. Length of an antibiotic treatment depends on the severity of the infection as well as the type of antibiotic prescribed.  As with most prescriptions, you should complete the full course of medication prescribed by Dr. Portera.  You may supplement pain relief by taking urinary analgesics, Tylenol, or non-steroidal anti-inflammatory medications. 

Urinary Tract Infections in the Elderly Because the elderly often do not experience or report obvious symptoms that younger people have, urinary tract infections can be easily overlooked. Confusion, feelings of general discomfort, disorientation, fatigue, weakness, behavior changes, falling, or new, acute incontinence are reported as common complaints.  Because these symptoms are so general, this often results in a delaying treatment, inviting the complication of sepsis to occur. UTIs can cause a change in behavior in older people and people with dementia. Masquerading as confusion, agitation, or withdrawal, UTIs may actually be the cause of behavioral shifts. The person may not be able to communicate how they feel, therefore it is very important to be familiar with the symptoms of a UTI and seek medical help to enable appropriate treatment.

Delirium In some cases, UTIs can cause a significant and distressing change in someone’s behavior. Usually developing over a day or two, when someone’s mental state changes drastically it is commonly referred to as an acute confusion state or delirium. If someone you know exhibits agitation or restlessness, increased difficulty with concentration, hallucinations or delusions, or becoming unusually sleepy or withdrawn they may be dealing with delirium. If the delirium is due to an UTI, treatment with an appropriate course of antibiotics may help to alleviate the symptoms. Regardless of what has triggered the delirium, seek medical help immediately.

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Center for Urinary and Pelvic Disorders
6215 Humphreys Blvd.
Suite 110
Memphis, TN 38120

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