Recurrent Urinary Tract Infections

Recurrent Urinary Tract Infections

UTI's

Recurrent urinary tract infections commonly refer to relapsing episodes of cystitis. Cystitis is an inflammatory disorder of the bladder, which is usually caused by infection. Normally, urine is sterile, but bacteria may enter the bladder through the urethra (the tube which carries urine out of the body). Since this tube is much shorter in females, women are much more likely to develop urinary tract infections than men. Since the urethra is close to the anus (the hole where stool exits the body), urinary tract infections are most commonly caused by bacteria found in the stool.

Common symptoms of a urinary tract infection are:

Frequent urination
Pain with urination (dysuria)
Urgent desire to void (at times with loss of urine)
Pain or pressure over the bladder
Sensation of incomplete bladder emptying
Blood in the urine

Cystitis is different from pyelonephritis which is an infection associated with flank pain, fever and chills. The goal of treating cystitis is to prevent episodes of pyelonephritis which may eventually lead to kidney scarring.

Diagnosis of a urinary tract infection is made on the basis of a urinalysis and urine culture. Although many urinary tract infections are associated with blood in the urine, the presence of blood in the urine does not mean that a urinary tract infection is present! Therefore, any patient with blood in the urine who does not have a simple cystitis, should have further evaluation of the urinary tract performed in order to exclude other inflammatory, infectious, or cancerous conditions of the bladder.

Cystitis is commonly treated with a 5 - 7 day course of antibiotics. Treatment of simple cystitis is based upon the patients clinical symptoms (see above) and the finding of blood, white blood cells, and/or bacteria in the urine. However, if a patient's symptoms fail to improve after the first course of antibiotics, a urine culture is imperative in order to document the presence of infection and to determine which bacteria are causing the infection so that appropriate antibiotics can be administered.

Recurrent urinary tract infection

At times, a patient may respond appropriately to antibiotics but develop another urinary tract infection within a short period of time. Urinary tract infections, which recur over time, are called recurrent urinary tract infections and require further evaluation.

Evaluation for recurrent urinary tract infections may include:

Repeated urine culture
X-ray study of the urinary system (ultrasound / IVP / CT scan)
Measurement of residual urine in the bladder after voiding
Cystoscopy

The goal of the evaluation for recurrent urinary tract infections is determine if there is an underlying cause for the repeated infection. Abnormalities in bladder or kidney anatomy, incomplete bladder emptying, kidney stones, etc. may all predispose to recurrent infections. Any abnormalities which are detected can then be treated in order to eliminate the source of infections.

Preventing recurrent urinary tract infections

Once the urinary tract has been thoroughly evaluated, measures can be instituted to prevent recurrent infections. Such measures include:

Increasing fluid intake
Increasing frequency of bladder emptying
Pelvic floor relaxation to allow for complete bladder emptying
Replacement of estrogens in post-menopausal women
Voiding after intercourse (in women)
Post-coital antibiotics (in women)
Prophylactic low dose antibiotics

In those patients who have symptoms of cystitis, but in whom urinary tract infection can not be documented, other diagnostic studies may be performed. Initially, a voiding diary will be obtained to determine how frequently and how much the patient voids. This study is useful in determining how much urine a patient makes over the course of the day and will also allow for measurement of bladder capacity. If the cause for the patient's urinary symptoms can not be determined by the voiding diary, the patient may be evaluated by a urodynamic study which measures bladder sensation and bladder pressures as the bladder fills. If a patient is found to have an "overactive" bladder, medical therapy is often successful in improving the patient's symptoms. If the bladder does not empty completely, medications or behavioral training may be successful in improving or eliminating the problem