Urinary Tract Infections (UTIs) & Recurrent Urinary Tract Infections (rUTIs)

• Any spermicide use within the previous year, especially if used with a diaphragm.
• Atrophic vaginitis.
• Chronic diarrhoea.
• Cystocele.
• First UTI when young (prior to 16 years of age)
• Genetic predisposition (usually through bacterial/vaginal mucosal adherence factors)
• Higher frequency of sexual intercourse.
• Increased post-void residual urine (incomplete bladder emptying)
• Inadequate fluid intake (low urinary volumes)
• New or multiple sexual partners
• Mother with a history of frequent or multiple UTIs
• Urinary incontinence
• Use of spermicide coated condoms
• Not washing hands before wiping vaginal area after voiding
• Taking baths instead of showers
• Wiping and washing the vaginal area (incorrectly) from back to front
• Not using clean, soft washcloths to clean the vaginal area when washing
• Not cleaning bladder opening area first when washing
• Failing to use a gentle, liquid soap when washing the vaginal area
• Not using vaginal oestrogen, when appropriate, in postmenopausal women

Interstitial cystitis or primary bladder pain syndrome as it is called nowadays is not an infection, but it may feel like a bladder infection. Women with this condition may feel pain when having sex. The more severe cases can affect your life and your loved ones. Some people with primary bladder pain syndrome have other health issues such as irritable bowel syndrome, fibromyalgia, and other pain syndromes.

Most people with cystitis will not get a kidney infection, but occasionally the bacteria can travel up from the bladder into one or both kidneys. If treated with antibiotics straight away a kidney infection does not cause serious harm, although you’ll feel very unwell.Also there is no evidence that recurrent urinary infections can lead to chronic renal insufficiency.

Some individuals suffer from recurrent UTIs, and, while uncomfortable and inconvenient, repeated infections are not typically a sign of cancer.In some cases though bladder cancer needs to be ruled out. Also, research suggests that recurrent and persistent urinary tract infections may increase the risk of bladder cancer.

Do

• wipe from front to back when you go to the toilet
• pee as soon as possible after sex
• drink plenty of fluids, especially water – so that you pee regularly during the day and do not feel thirsty
• have a shower rather than a bath – this stops exposing your genitals to cleaning products for too long
• wash the skin outside the vagina (vulva) with water before and after sex
• change soiled nappies or incontinence pads promptly
• keep the genital area clean and dry

Don’t

• do not use scented soap, bubble bath or talcum powder
• do not use spermicide with diaphragm or condoms – try non-spermicidal lube or different type of contraception
• do not hold your pee in if you feel the urge to go
• do not rush when going for a pee – try to fully empty your bladder
• do not drink lots of alcoholic drinks or coffee – they may irritate your bladder
• do not have lots of sugary foods or drinks – they may encourage bacteria to grow

• Stay hydrated. Drinking water regularly can help treat a urinary infection.
• Urinate when the need arises.
• Use probiotics.
• Take enough vitamin C.
• Wipe from front to back.
• Practise good sexual hygiene.

Most of the time an ultrasound examination of the urinary tract along with a good medical history and physical examination are enough. In cases where other symptoms or signs co-exist ,other tests like cystoscopy ,CT scans and gynaecological consultation may be necessary.

Lifestyle modifications along with supplements like cranberry, d-mannose and Vitamin C when necessary.In postmenopausal women with signs and symptoms of atrophic vaginitis, local oestrogens can be prescribed as they are proven to be very helpful.The exact scheme should be decided after you discuss the available options with your doctor.

The simple answer is yes. If all conservative measures fail ,someone can use long term antibiotics to prevent recurrences . Post sexual intercourse antibiotic prophylaxis is a very good option for infections that happen after sexual activity. Also the instillation of some medications inside the bladder is very efficient as they help heal and restore its inner lining which is usually defective in patients with recurrent infections.

Last but not least , the oral vaccine is an excellent option as it has a proven efficiency in reducing the episodes of infections.Unfortunately it is not available in all countries.