Understanding and treating recurrent UTIs

When urinary tract infections keep coming back, specialist care can help identify the cause and break the cycle

Recurrent urinary tract infections (UTIs) can be frustrating, painful, and disruptive, especially when antibiotics provide only temporary relief.

If you’re experiencing UTIs that keep coming back—whether every few months or even more frequently—you may have recurrent UTIs. Whilst antibiotics can treat each individual infection, they don’t address the underlying reasons why the infections keep returning. Understanding and addressing these factors is key to breaking the cycle.

At The Women’s Health Vulvo-Vaginal & Genitourinary Clinic, we specialise in diagnosing and treating recurrent UTIs. Our team can help you identify why infections keep returning and develop a comprehensive prevention strategy.

Recurrent UTIs are not something you have to accept. Let us help you break the cycle.

Do you have recurrent UTIs?

You may have recurrent UTIs if you experience:

Two or more UTIs in 6 months, or three or more in a year
Burning or pain during urination
Urgent, frequent need to urinate
Lower abdominal or pelvic pain
Cloudy, strong-smelling, or blood-tinged urine
Symptoms that return shortly after finishing antibiotics
Feeling like you’re constantly on antibiotics
Impact on your quality of life and wellbeing

If this sounds familiar, it’s time for a specialist assessment.

Common causes of recurrent UTIs

1. Incomplete Bladder Emptying

If the bladder doesn’t empty completely, residual urine can become a breeding ground for bacteria. This can be caused by pelvic organ prolapse, pelvic floor dysfunction, or neurological conditions.

2. Post-Menopausal Changes

Low oestrogen levels after menopause cause thinning of the vaginal and urethral tissue, making it easier for bacteria to cause infection. The vaginal pH also changes, reducing protective bacteria.

3. Sexual Activity

Sexual intercourse can introduce bacteria into the urethra. Some women are particularly susceptible to post-coital UTIs.

4. Pelvic Floor Dysfunction

Tight, overactive pelvic floor muscles can interfere with complete bladder emptying and contribute to recurrent infections.

5. Anatomical Factors

Some women have a naturally shorter urethra or other anatomical variations that increase susceptibility to UTIs.

6. Bacterial Resistance

Frequent antibiotic use can lead to antibiotic-resistant bacteria, making infections harder to treat.

7. Biofilm Formation

Bacteria can form protective biofilms on the bladder wall, making them resistant to antibiotics and the body’s immune system.

8. Diabetes

Elevated blood sugar levels can increase susceptibility to infections, including UTIs.

9. Kidney Stones or Abnormalities

Structural abnormalities in the urinary tract can contribute to recurrent infections.

How we diagnose and treat treat recurrent UTIs

Comprehensive history

We’ll discuss:

How often you experience UTIs and when they occur
Patterns (such as after sexual activity)
Previous antibiotics and their effectiveness
Menopausal status and hormonal factors
Medical conditions, particularly diabetes
Fluid intake and voiding habits
Impact on your daily life

Thorough examination

A careful examination can reveal:

Signs of vaginal atrophy
Pelvic organ prolapse
Pelvic floor muscle dysfunction
Anatomical factors

Appropriate testing

When needed, we may perform:

Urine culture to identify the specific bacteria and antibiotic sensitivities
Post-void residual measurement to check bladder emptying
Pelvic ultrasound to assess for structural abnormalities
Urodynamic testing (in selected cases)
Blood glucose testing if diabetes is suspected

Personalised prevention and treatment plan

Appropriate antibiotics are given for acute cases.

Preventive strategies include:

Vaginal oestrogen therapy (for post-menopausal women):
D-Mannose
Cranberry products
Probiotics
Lifestyle modifications
Pelvic floor physiotherapy
Treating underlying conditions

Frequently asked questions

Q: Why do I keep getting UTIs?

A: Recurrent UTIs can have many causes, including hormonal changes, incomplete bladder emptying, sexual activity, or anatomical factors. Identifying your specific risk factors is key to effective prevention.

Q: Will I need to take antibiotics forever?

A: Not necessarily. Whilst some women benefit from long-term low-dose antibiotics, many can stop after 6-12 months once the cycle is broken. Other preventive strategies (like vaginal oestrogen or D-Mannose) can often maintain protection.

Q: Can cranberry juice really prevent UTIs?

A: Cranberry products may help prevent UTIs by preventing bacteria from sticking to the bladder wall. High-dose cranberry supplements are more effective than juice, which contains a lot of sugar.

Q: Are recurrent UTIs dangerous?

A: Whilst most UTIs are not dangerous if treated promptly, recurrent UTIs can lead to kidney infections if left untreated. They can also significantly impact quality of life.

Q: Could my symptoms be something other than a UTI?

A: Yes, conditions like bladder pain syndrome (interstitial cystitis) or overactive bladder can cause similar symptoms without infection. If your urine cultures are negative, further investigation is needed.

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Take the first step towards breaking the cycle

Recurrent UTIs can be frustrating and exhausting, but with proper diagnosis and a comprehensive prevention strategy, you can break the cycle and reduce or eliminate infections.