Recurrent UTIs are defined as:
- ≥ 2 infections in 6 months
- ≥ 3 infections in 1 year
UTIs occur when bacteria (usually E. coli) infect the bladder, urethra, or kidneys. Recurrence is common and often manageable with targeted strategies.
You may be at risk if:
• You are female (shorter urethra)
• You are postmenopausal (low oestrogen thins urinary tract tissues)
• You have diabetes, kidney stones, or a weakened immune system
• You use spermicides or diaphragms
• You have frequent sexual intercourse (“honeymoon cystitis”)
Common Causes of Recurrence
- Incomplete Eradication: Bacteria not fully cleared by prior antibiotics.
- Anatomical Factors:
- Bladder prolapse
- Urethral strictures
- Residual urine after voiding
- Behavioural Triggers:
- Dehydration
- Delaying urination
- Wiping back-to-front
- Spermicide use
- New Infections: Re-exposure to bacteria.
Diagnosis & Testing
Your gynaecologist may recommend:
- Urine Culture: Identifies bacteria and antibiotic sensitivity.
- Imaging: Ultrasound/CT to check for stones or structural issues.
- Cystoscopy: Camera exam of the bladder (if structural problems suspected).
- Post-void Residual (PVR) Test: Measures urine left in the bladder after voiding.
Management & Treatment
1. Acute Infection Treatment
- Antibiotics: 3–7-day course based on culture results.
- Symptom Relief:
- Phenazopyridine (for burning/pain)
- Hydration (2–3L water/day)
- Heat pads for cramping
2. Prevention Strategies
- Lifestyle Changes:
| Do | Avoid |
| Wipe front-to-back | Spermicides/douches |
| Urinate after sex | Tight synthetic underwear |
| Drink 6–8 glasses of water/day | Dehydration |
- Medical Prevention:
- Low-dose antibiotics: Take nightly or post-sex (e.g., nitrofurantoin).
- Vaginal Oestrogen: (Postmenopausal) Restores protective vaginal flora.
- Probiotics: Lactobacillus strains (oral/vaginal) support healthy flora.
Risks of Untreated rUTIs
- Kidney infections (pyelonephritis)
- Sepsis (life-threatening)
- Kidney scarring
Frequently Asked Questions
Q: Are rUTIs my fault?
A: No! Anatomy, genetics, and medical history play key roles.
Q: Can cranberry juice prevent UTIs?
A: Evidence is mixed. Concentrated cranberry capsules (36mg PACs/day) may help, but juice is high in sugar.
Q: Do I need antibiotics forever?
A: Usually short-term (6–12 months). Many transition to non-antibiotic strategies.
Q: Can my partner reinfect me?
A: Rare – UTIs aren’t sexually transmitted, but sex can introduce bacteria.
Q: Does menopause increase UTI risk?
A: Yes – vaginal oestrogen reduces risk by 50–75%.
eGynaecologist Advice:
- You must seek gynaecological consultation if you suspect recurrent urinary tract infections are associated with menopausal symptoms.
- You should seek immediate gynaecological consultation if your urine infection is complicated with back/flank pain, nausea or vomiting, blood in urine or confusion, especially in elderly.
