Recurrent UTI

What is a recurrent UTI?

A recurrent urinary tract infection (UTI) is when you get two or more UTIs within six months of each other or three UTIs within a year. “Recurrent” means it returns or happens again and again.

UTIs, or bladder infections, can be annoying, uncomfortable or even very painful. They’re even more frustrating when it feels like you can’t get relief from your symptoms. That’s why it’s important to talk to a healthcare provider if you have UTI symptoms and they come back shortly after treatment. You may need more personalized treatment or preventive advice.

What are other names for a recurrent UTI?

Other names for a recurrent UTI include:

• Chronic (long-term) UTI
• Persistent UTI
• Frequent UTI

What are the symptoms of a recurrent UTI?

Recurrent UTI symptoms are the same as a typical UTI. Common recurrent UTI symptoms include:

• Pain or a burning feeling when you pee (dysuria)
• Pain above your pelvis (suprapubic pain)
• Cloudy or foul-smelling pee
• Peeing more than usual (frequent urination)
• Leaking pee (urinary incontinence)
• Urgent, uncontrollable need to pee (urge incontinence), but only a little pee comes out
• Bloody pee (hematuria)

How fast can a UTI come back?

Recurrent UTIs usually come back about a month after treatment. But they may occur after treatment several times a year.

What causes recurrent UTIs?

Recurrent UTIs occur because bacteria — usually E. coli — gets into your urinary system. E. coli typically lives in your lower gastrointestinal tract, and it can sometimes transfer from your rectum to your urethra. If you have a vagina, increased transfer of bacteria can occur after:

• Wiping your anus (butthole) back to front after pooping
• Sexual intercourse or other sexual acts, including fingering (digital penetration) and masturbation
• Not peeing often enough
• Diarrhea or difficulty controlling or cleaning after pooping

Other bacteria that may cause a recurrent UTI include:

• Enterococcus faecalis
• Klebsiella
• Proteus mirabilis
• Staphylococcus

What underlying conditions cause frequent UTIs?

You may be more likely to have recurrent UTIs if you have:

• A thin and dry vaginal lining (vaginal atrophy), which happens with menopause or many treatments for certain cancers, like breast cancer
• Cysts in your urethra or urinary bladder that trap and hold pee and bacteria (diverticula)
• Incomplete bladder emptying (urinary retention), which can cause bacteria to grow and lead to a full-blown infection (urinary retention causes include vaginal prolapse, diabetes, stroke and neurologic disorders like multiple sclerosis and Parkinson’s disease)
• Kidney stones
• Congenital urinary abnormalities that change the anatomy of your urinary system, including ureteropelvic junction (UPJ) obstruction, vesicoureteral reflux (VUR), ureteroceles and ectopic ureters

What autoimmune diseases cause recurrent UTIs?

There isn’t a lot of research, but the use of immunosuppressants to treat autoimmune diseases such as lupus and rheumatoid arthritis (RA) may increase your risk of recurrent UTIs. Being on steroid medications is also associated with more infections, including UTIs.

Is a recurrent UTI contagious?

No, recurrent UTIs aren’t contagious. You can’t get them from anyone else, and no one else can get them from you.

What are the risk factors for a recurrent UTI?

The use of spermicides may increase your risk of recurrent UTIs. Spermicides may kill off some of the good bacteria (Lactobacilli) in your vagina that help prevent E. coli from growing.

You may also be more likely to get recurrent UTIs after menopause. Before menopause, it’s acidic inside the vagina. This acid helps prevent bacterial overgrowth and its transfer into the bladder.

After menopause, you lose that vaginal acidity with pH changes, so it’s easier for the bacteria to get in the bladder and cause an infection. After menopause, there are also fewer Lactobacilli in your vagina, a good bacteria.

Your bladder also tends to get weaker as you age. If your bladder muscles aren’t as strong, they can’t squeeze all the pee out.

If pee remains in your bladder for too long, it can create a good environment for bacteria to grow. There are many other conditions that can cause this, as mentioned above.

Other recurrent UTI risk factors include:

• Using a vaginal diaphragm
• Using a vaginal douche
• Long-term use of antibiotics that affect the balance of good and bad bacteria in your body

What are the complications of recurrent UTIs?

Recurrent UTIs may eventually increase your chances of developing:

• Kidney problems, including kidney infections (pyelonephritis) and kidney disease
• Blood infection (septicemia)
• Sepsis
• Chronic bladder pain
• Resistance to some types of antibiotics

If you’re pregnant, recurrent UTIs may cause:

• Preterm birth
• Low birth weight

How is a recurrent UTI diagnosed?

To diagnose a recurrent UTI, a healthcare provider will:

• Ask questions about your symptoms
• Review your medical history
• Conduct a physical exam
• Recommend tests to confirm their diagnosis

What tests will be done to diagnose a recurrent UTI?

For most tests, you’ll need to provide a urine sample. You’ll pee into a special cup after washing your hands and genitals to prevent germs from getting into your urine sample (clean catch urine sample).

If a clean catch urine sample isn’t possible or providers think you have a contaminated sample, they may recommend using a urinary catheter to get a urine sample.

Healthcare providers will conduct the following tests on your urinary sample:

• Urinalysis. This is a series of tests in which lab technicians check your sample for signs of infection.
• Urine culture. Lab technicians check your sample to see if bacteria grow. It’s possible for different bacteria to cause a recurrent UTI after successful treatment.

Rarely, providers may recommend noninvasive imaging tests, especially if you still have blood in your pee after treatment or get kidney stones a lot. These tests usually include:

• Kidney ultrasound
• CT scan of your abdomen and pelvis

Providers may also recommend a cystoscopy. During a cystoscopy, they look in your bladder with a small camera (cystoscope) that they insert into your urethra. They may recommend a cystoscopy to check for abnormalities or foreign bodies inside your bladder that a CT scan can’t pick up.

How do I stop recurring urinary tract infections?

If your body starts transitioning to menopause (perimenopause) or you’re in postmenopause, the best way to prevent recurrent UTIs is with vaginal estrogen treatment. This is an estrogen that you use in your vagina. It’s not an oral pill or patch. You apply it as a cream, tablet or ring. It changes the pH of your vagina to restore its acidity. It’s safe for many people with a vagina to use. Very little — if any — estrogen gets into your bloodstream.

You need a prescription for antibiotics to treat an acute or active infection. Even if your symptoms go away, a healthcare provider may prescribe long-term, low-dose antibiotics. You may take these for as little as three months or up to a year or even longer.

If you tend to get UTIs after sexual activity, you may take one antibiotic pill just after sexual activity. If you don’t, a provider may prescribe a daily, low-dose antibiotic. These antibiotics may include:

• Nitrofurantoin (Macrobid®, Macrodantin®, Urotoin®)
• SMX-TMP (Bacter-Aid DS®, Bactrim®, Septra®)
• Trimethoprim (Proloprim®)
• Cephalexin (Keflex®)

However, taking antibiotics over a long period may cause antibiotic resistance and increase your chances of developing other types of infections.

Providers may also recommend nonantibiotic treatments, including:

• Cranberry extract supplements. Cranberry supplements contain chemical compounds that may help prevent E. coli from affecting your bladder.
• Methenamine hippurate (Hiprex®, Mandelamine®, Urex®). Methenamine hippurate is an antibacterial antiseptic medication that makes your pee more acidic, which can help kill bacteria.

How soon after treatment will I feel better?

Most people start to feel better a few days after starting antibiotics. It’s important to finish your entire prescription. If you don’t, you’re more likely to get a recurrent UTI. If you miss a dose, talk to a healthcare provider. Don’t take two doses at the same time to catch up on a missed dose.

Can recurrent UTIs be prevented?

If you tend to get recurring UTIs, it’s important to:

• Wipe your anus from front to back after pooping
• Drink lots of water to help flush bacteria out of your urinary tract
• Urinate regularly to keep your bladder flushed and relatively empty
• Use condoms or other types of birth control instead of diaphragms and spermicide
• Always pee after sexual intercourse or any other type of sexual activity

What can I expect if I have a recurrent UTI?

Most recurrent UTIs go away with antibiotics and preventive measures. But it’s important to pay attention to your body and how you’re feeling. Reach out to a healthcare provider if you start to feel UTI symptoms.

When should I see a healthcare provider?

Schedule an appointment with a healthcare provider as soon as you develop UTI symptoms. Schedule another appointment if your symptoms don’t go away or get worse even with treatment.

When should I go to the ER?

It’s a good idea to go to the emergency room if you have a recurrent UTI and the following symptoms:

• Back pain
• Fever
• Vomiting

These may be symptoms of a more serious infection.

What questions should I ask a healthcare provider?

Questions you may want to ask your provider include:

• Why do I keep getting bladder infections?
• Is the same bacteria causing my recurrent UTIs?
• What treatment do you recommend?
• What else can I do to prevent recurrent UTIs?
• What happens if I don’t treat a recurrent UTI?

How often is too often for a UTI?

Healthcare providers will diagnose a recurrent UTI if you get two or more UTIs within six months or more than three in a year.