I keep getting utis

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Keep Bacteria Out of Your System

To say goodbye to burning, frequent urination and other unpleasant symptoms, start with these changes today.

Drink plenty of water, and relieve yourself often. The simplest way to prevent a UTI is to flush bacteria out of the bladder and urinary tract before it can settle in. If you’re well-hydrated, it will be tough to go too long without going to the bathroom.

Wipe from front to back. Bacteria tend to hang around the anus. If you wipe from front to back, especially after a bowel movement, they’re less likely to make it to the urethra.

Wash up before sex, and pee afterward. Use soap and water before sex. This keeps bacteria away from the urethra. And peeing afterward carries any bacteria that entered the urinary tract back out.

Steer clear of irritating feminine products. Skip douches, deodorant sprays, scented powders, and other feminine products with fragrances or chemicals.

Rethink your birth control. A diaphragm, spermicide, or spermicide-lubricated condom can make you more likely to get a UTI because they all can contribute to bacterial growth. If you often get UTIs and use one of these birth control methods, switch to a water-based lubricant for vaginal dryness, and consider trying another birth control method to see if it helps.

Some doctors advise women who get a lot of UTIs to wear cotton underwear, take showers instead of baths, and avoid tight clothes that can trap bacteria near the urethra. While these are simple enough to do, none of them are supported by scientific data.

Why do I keep getting UTIs?

Struggling with recurrent UTIs? You’re not alone. UTIs are the second-most common infection in the United States. Half of all women get UTIs, and 30-40% of women who’ve experienced a UTI will face one again in a few months.

Recurrent UTIs occur when new bacteria enter the urethra, or bacteria from a previous infection remain dormant and later re-enter the bladder, causing a new infection.

Keep reading:

  • What causes recurrent UTIs?
  • Who is most prone to recurrent UTIs?
  • How to prevent recurrent UTIs

Improve urinary tract health with Uqora

The key to breaking the cycle of recurrent UTIs is to kill old bacteria, prevent new bacteria from taking hold, and build up your body’s natural defense mechanisms. At Uqora, we make products that do all three. Take Uqora Control daily to break up biofilm that causes recurring UTIs. Drink Uqora Target after sex or exercise to flush out any new bacteria introduced. And give your body an added boost with Uqora Promote—a probiotic designed to arm your body with healthy bacteria that fight the good fight.

What causes recurrent UTIs?

A recurrent UTI, also called a chronic UTI, is an infection that keeps coming back, even after treatment with antibiotics. These infections can happen anywhere from a couple times a year to multiple times per month. For the person suffering, it’s endlessly frustrating. Each new infection means more pain, visits to the doctor, and rounds of antibiotics.

Once you get one UTI, your likelihood of getting another UTI increases.

The cycle is brutal and tough to break. Despite antibiotic treatment and otherwise good health, 26-44% of women will experience another UTI within six months after their first infection.

Bacteria can survive a course of antibiotics by adhering to the bladder wall and forming biofilm.

Recurring UTIs can occur for a couple reasons:

  1. New bacteria enter the urethra and cause another UTI.
  2. Bacteria from a previous infection hide out in the bladder and later emerge, causing a new infection.

Unfortunately, standard UTI treatments aren’t always effective because bacteria are in a constant arms race with antibiotics and the immune system. They can adhere to the bladder wall and join together to form a protective shield called biofilm. Inside this safehouse, bacteria are hidden from the immune system. Even urine tests can fail to detect them, which is why so many people suffering from recurring UTIs will get false negatives when tested.

Biofilm allows these bacteria to live long periods of time inside our own cells, adapting and multiplying. And when future courses of antibiotics weaken the immune system, bacteria seize the opportunity and create a new infection.

+ What is a urinary tract infection? Urinary tract infections are a common bacterial infection affecting over half of women at least once in their lifetime. Unfortunately, some people continue to have UTIs throughout their life. Infections of the urethra and bladder are the most common forms of UTIs though the term is often used for kidney infections as well.Recurrent UTI prevention is on the minds of anyone suffering from UTIs occurring more than three times a year. + What causes UTIs? Patients often wonder what causes recurrent UTIs. Sometimes the problem may boil down to basic anatomy that allows the bacteria to more easily travel into the urethra from the anus. The most common bacteria that causes UTIs is E. coli that doesn’t normally live within the urinary tract. While the gut does contain some harmless strains, the urinary tract cannot combat the bacteria resulting in pain and discomfort for you. + What are usual UTI symptoms? UTI symptoms are less than stellar, as they start to dictate how your day will play out despite any plans you have. You should consult your doctor as soon as possible if you are experiencing:

  • A painful, burning sensation when you urinate. The pain can spread as the infection moves from the urethra to the bladder and on to the kidney.
  • Dark, bloody, or cloudy urine with a foul smell.
  • An intense and frequent need to urinate.
  • Only being able to squeeze out a few drops when you go to the bathroom.
  • Pain in your sides, pelvic region and lower abdomen.
  • Fever, vomiting, nausea, and chills.

UTI symptoms may present themselves differently in older patients. Other indications to look out for include lack of mobility and appetite, agitation, and confusion. + What is cystitis? Cystitis is the inflammation of the bladder, and is usually referred to as a bladder infection. It is a type of urinary tract infection. Cystitis occurs when bacteria from your gastrointestinal tract such as E.coli are introduced to the opening of your urethra and climb up to your bladder, bind to the bladder walls, and multiply. + What does is mean to have recurrent UTIs? Recurrent UTIs or chronic UTIs are infections that come back even after they have been treated with antibiotics. Recurrent UTIs happen for a number of reasons: age, menopause, diabetes, genetics, and the fact that women have shorter urethras than men. + What are chronic UTIs? Chronic UTIs or recurrent UTIs are infections that do not respond to medicine and keep recurring. They are more common in women due to the fact that a woman’s urethra is within close proximity to the vagina and anus, where UTI-causing bacteria live. Women’s urethras are shorter than men’s, so bacteria have a shorter “ladder” to climb when it comes to colonizing the bladder. + How do I prevent and get rid of recurrent UTIs? When you ask your doctor how to get rid of bacteria that causes UTIs, the most common answer is with an antibiotic prescription. A wide range of antibiotics may be used to treat your UTI depending on how severe the infection is and whether or not it has traveled into the kidneys. Unfortunately, antibiotics can also have negative side effects. Knowing how to prevent UTIs is key If you suffer from chronic UTIs:

  • Post-sex pee: Flush out any bacteria that may have travelled up to your urethra during sex.
  • Always wash between switching from anal to vaginal sex.
  • Stay hydrated.
  • Steer clear of feminine sprays, douches, and spermicidal lube that can throw off your bacterial balance.
  • Consider probiotics.
  • Shower instead of taking a bath.
  • Do not hold your pee over a long period of time, go when your body tells you to.
  • Wear cotton undies and go commando at night to get some air to your area!

For some of us, taking these simple precautions aren’t enough. If you find that you keep getting recurrent UTIs, consider adding Uqora to your routine. Drink Uqora Target after UTI-causing activities to flush out bacteria. Uqora Target has the perfect dose of d mannose for UTI prevention, and other UTI-fighting ingredients to keep you UTI-free.

Who is more prone to recurrent UTIs?

Sometimes gender, age, preexisting conditions, and other unavoidable circumstances put people at higher risk for recurring UTIs. Here are some examples of groups that are more susceptible.

  • Women: It’s probably no surprise that women get UTIs at a much higher rate than men. Roughly one in two women you know will get a UTI at some point in their life, and about one in five women will suffer from recurrent UTIs. Why the difference? Women have a shorter urethra than men, so bacteria that make it into the urethra don’t have to travel far to reach the bladder. Plus, the distance between the urethra and the anus is much shorter in women, so bacteria can travel from the anus to the urethra much more easily.
  • Pregnant women: A woman’s risk of developing a UTI increases further throughout pregnancy. The uterus is located directly above a woman’s bladder, so it’s easily obstructed as her uterus grows. Sometimes that can block drainage, and stagnant urine is an inviting place for bacteria to grow. Plus, hormonal changes during pregnancy allow bacteria to travel up the urinary tract easily. These physical changes make frequent UTIs a common problem during pregnancy.
  • Menopausal & post-menopausal women: Hormones play a key role in the makeup of vaginal bacteria. Estrogen has been shown to protect the vagina and urethra from bacterial growth by making it more difficult for dangerous bacteria to grow and establish themselves. During menopause, estrogen production slows significantly, so E. coli and other bacteria have a better shot at taking hold.
  • Elderly people: As we age, our risk of developing frequent UTIs increases for a few reasons. In general, our immune system weakens over time, making it more difficult for our body to defend itself against harmful bacteria. Another important change is that the muscles around the bladder weaken as we age, making it more difficult to fully expel urine. This leads to incontinence, or an inability to properly empty the bladder, as well as a lessened urinary flow. Incontinence puts people at increased risk for UTIs, because the remaining urine is an inviting place for bacteria to grow. Finally, catheters often introduce bacteria that can cause UTIs, and catheters are more often necessary for elderly patients.
  • People with diabetes: Another group of people more prone to frequent UTIs is people with diabetes. People who have diabetes are at a heightened risk because they may also struggle to fully release the bladder for a variety of reasons, including neural damage and compromised blood flow. People with diabetes also commonly take a medication called Jardiance that works by filtering sugar from the blood and releasing it in the urine. The sugar in the urine can increase their odds of infection for two reasons: 1) Bacteria in the urinary tract can eat this sugar and use it to grow and spread. 2) When urine dries outside the urethra, this can make sugar available for bacteria to spread into the urinary tract. Jardiance has shown to really improve the health of those with diabetes but also comes with the unfortunate side effect of frequent urinary tract infections.

What other factors put you at risk for chronic UTIs?

If you don’t fall into one of the groups above but still experience chronic UTIs, there are a number of other factors that could be at play. In general, some of us are more prone to getting UTIs frequently because of differences in anatomy, lifestyle, habits, and general health.

  • Anatomy: Sometime a simple anatomical difference makes it easier for bacteria to travel throughout the urinary tracts. If a woman’s urethra is particularly short, she can be at higher risk for urinary and bladder infections. In addition, bacteria are often flushed out by the flow of urine. If the urethra is particularly wide or the muscles surrounding the bladder are weak, the flow of urine can be light, making it easier for bacteria to hold on to the urinary tract wall.
  • Genetics: Research has shown that some people have cells that attract bacteria with toll-like receptors. Bacteria can bind to these receptors more easily, which helps explain why some people get more UTIs than others.
  • Sexual activity: Intercourse itself doesn’t cause UTIs. It’s the bacteria that are introduced during the act. Bacteria are easily transferred from the skin to the urethra, which is why the post-sex pee is so important. Urination helps flush out bacteria that may have found their way up your urethra. But if you always pee after the deed and you’re still getting infections, it may be time to introduce products that help prevent a UTI after sex.
  • Hygiene: Certain personal care habits can increase the risk of recurring UTIs. They include wiping back-to-front instead of front-to-back, neglecting to frequently change underwear, wearing underwear that don’t breathe well, or going long periods without bathing.
  • Compromised immune system: Chronic illness can make it more difficult for your body to fight and flush out UTI-causing bacteria. Certain diseases also increase the risk of UTIs, including diabetes and multiple sclerosis.
  • Certain habits: A variety of other behaviors can lead to frequent or recurring urinary tract infections, including not drinking enough water, holding urine for too long, and engaging in prolonged physical activity.
  • Prior UTIs: Remember, your odds of getting another UTI increase once you’ve had one, so even if it was a one-time circumstance that caused your original infection, you may continue experiencing them.

How to prevent recurrent UTIs

The best UTI prevention helps control the growth and production of bacteria within the urinary tract. The prevention methods that help flush out bacteria with good hydration work well. A treatment plan that breaks down the biofilm bacteria use to protect themselves can have long-lasting results in preventing a UTI.

Here are some simple steps you can take to reduce your risk for chronic UTIs:

  • Always pee after sex: This helps wash out the bacteria that may be lingering in your urethra after sex, reducing your chances of infection. In addition to flushing out the bacteria with proper hydration and good hygiene, you can stop UTIs caused by sex when you take a daily capsule for ongoing UTI prevention.
  • Wash between anal and vaginal sex: Switching from anal to vaginal sex without cleaning up in between allows bacteria from the rectum to spread and easily travel up the urethra.
  • Rethink your contraception method: Spermicides and diaphragms are common offenders when it comes to UTIs. They can aggravate the sensitive tissue around the vulva and lead to more frequent UTIs.
  • Drink plenty of water: Frequent hydration leads to frequent urination. The more water you drink, the more bacteria you’ll flush out of your urethra.
  • Rethink your cleaning regimen: Throw away your feminine sprays and douches—they do more harm than good. Spermicidal lube can also disrupt the natural vaginal flora that keep your body in healthy balance.
  • Take probiotics: One of the best ways to fight bad bacteria is with good bacteria. Probiotics like Uqora Promote help boost your body’s infection-fighting bacteria, so you can prevent UTIs naturally.
  • Opt for showers over baths: Skip the soak in favor of the rinse. Showers tend to clean the body more effectively. Plus, baths allow the body to eat up synthetic ingredients in personal care products, which can irritate the urethra and lead to infection.
  • Don’t wait to pee: The longer you hold it, the more likely you are to feel the burn later. Flushing your bladder out frequently is key to UTI prevention. Go as soon as you can.
  • Air it out: Give your nethers some room to breathe. Try wearing cotton underwear during the day and going commando while you sleep.
  • Use preventative products: The best way to combat UTIs is to take a preventative product regularly, especially after sexual activity or exercise. Take control of your UTI prevention to get back to enjoying sexual intercourse.

Why do UTIs come back right after antibiotics?

When UTIs keep coming back, doctors will often prescribe “prophylactic antibiotics,” or a constant, low dose intended to prevent new infections. But that can just lead to bigger problems. Each course of antibiotics puts you at higher risk for developing an antibiotic-resistant infection, which means future treatments may not be effective.

In a recent study, Urinary Tract Infections: Epidemiology, Mechanisms of Infection and Treatment Options, the authors concluded: “Moreover, high rates of recurrent UTIs suggest that antibiotics are not an effective therapy for all UTIs.”

Antibiotic resistance is generally known to be a contributing factor in repeat occurrences of an infection. The World Health Organization has been tracking the rapid growth of bacterial resistance to various antibiotics; after a virtually zero measurable effect in the 1980s, the problem has grown to become widespread and one of great concern.

One of the most common pathogens associated with urinary tract infections is Escherichia coli (E. coli), a bacterial strain which has been attributed to greater than 85% of UTIs worldwide according to the CDC. The antibiotic resistance rate for E. coli is also rising rapidly. Klebsiella pneumoniae and Staphylococcus saprophyticus can also cause urinary tract infections. Like E. coli, these bacterial strains are showing a growing resistance to antibiotics.

As mentioned, bacterial biofilms also play a significant role in the development of chronic UTIs. After treatment, a majority of UTI sufferers tested for the presence of bacteria in their urine were thought to be free of infection after testing showed negative results. Their urinary tract infections, however, returned. Biofilms can be blamed; their presence can result in patients being incorrectly assumed to be free of UTI-causing bacteria.

The deceptiveness of bacterial biofilms

Free-floating microorganisms, such as E. coli, can attach themselves to a surface. In the case of urinary tract infections, the surface can be the bladder wall. After the first few microorganisms adhere to the attachment surface, they can be joined by others in a process termed dispersal. At this stage, the bacterial colony can spread on the bladder wall and increase in size.

The process eventually becomes irreversible and the colony begins to develop a protective external covering around itself. This is the biofilm, and it allows the bacterial colony to exist undetected and remain protected from the effects of medications. Because the bacterial colony remains encased within a protective shell, the body’s immune system is less likely to become aware of its presence and respond.

Only free-floating bacteria can be detected by standard microbiological urine testing. Negative test results will be obtained when no free-floating bacteria are present in urine, even if biofilm colonies remain attached to the bladder wall. When these undetected biofilm colonies eventually release bacteria, the body’s immune system will react and the acute and distressing symptoms of a urinary tract infection will once again begin to appear.

Biofilms are also formed by fungal microorganisms, but bacterial biofilm infections are the more common factor in UTI causes. The National Institute of Health has estimated that bacterial biofilms account for about 80 percent of human infections. Combined with the rise of antibiotic resistance, biofilms account for a great deal of the suffering that women with recurrent UTIs are forced to endure. The best approach to end the suffering can be found in taking preventive steps that will help to avoid both first-time and recurring UTIs.

Take a proactive approach with Uqora

Understanding why your UTIs keep coming back can help you prevent them. If you struggle with chronic UTIs and are sick of antibiotics, try Uqora. We make effective, safe products using ingredients found in nature to help women take control of their urinary tract health.

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“I suffered from CHRONIC UTIs and have had some pretty serious repercussions from taking mass amounts of antibiotics. I have not had a UTI since I started taking uqora. I drink it after things that are my triggers (sex in particular) and it stops it in it’s tracks!”
Lacey, Uqora customer

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Recurrent Urinary Tract Infections

Recurrent UTIs at a glance

  • A urinary tract infection (UTI) is a bacterial infection in the urethra, bladder, ureters, and/or kidneys.
  • UTIs are considered recurrent if they occur two or more times in six months, or three or more times in a year.
  • Common symptoms include a strong urge to urinate, and frequent urination in small amounts, often accompanied by a burning sensation.
  • UTIs are predominately treated by primary care physicians or urologists; treatment commonly includes preventive antibiotics, either taken continuously in low doses or as needed when UTI symptoms or triggers are presents.
  • More severe UTIs may require hospital treatment, particularly in the case of an infection that travels to the kidneys.

Causes of recurrent UTIs

Recurrent UTIs are a painful, inconvenient problem that affects 20 percent to 30 percent of all women. UTIs occur when bacteria in the gastrointestinal tract move from the anus to the urethra and into the urinary tract, potentially infecting the urethra, bladder, ureters, or kidneys.

Women who experience two or more UTIs in a six-month period, or those who have three or more UTIs in the course of a year are diagnosed with recurrent UTIs.

Sexual intercourse is a common cause of UTIs in women. People who use catheters (small tubes that are placed into the bladder through the urethra) are also at increased risk of developing recurrent UTIs.

After experiencing six or more UTIs a year, Marie knew there was a bigger problem. Learn how she finally found an answer at CU Urogynecology.
Read Her Success Story

Symptoms of recurrent UTIs

UTIs cause a range of symptoms, which can vary depending on which part of the urinary tract is affected.

Common symptoms include:

  • A feeling of pain or burning during urination
  • Pain or pressure in the pelvic area
  • A strong urge to urinate
  • Frequent urination in small amounts
  • Urine that is cloudy
  • Urine that is colored slightly red, pink, or brown
  • Urine with a strong, unpleasant odor

A UTI that has spread to the kidneys is a potentially serious infection that requires immediate medical attention. Contact your physician right away if you have a UTI along with nausea, vomiting, fever, chills, and/or back pain below your ribs on one side.

Treatment of recurrent UTIs

Most UTIs go away with a short course of antibiotics. UTIs may be treated with antibiotics in addition to home remedies such as drinking large amounts of water, frequent urination and completely emptying the bladder, and taking cranberry supplements.

However, women with recurrent UTIs often require preventive antibiotics, depending on the frequency or triggers of their infections.

Women who regularly develop UTIs following sexual intercourse may benefit from a dose of antibiotics that is taken after sex. For women who have less than three UTIs per year, a physician may provide a prescription for antibiotics that can be filled whenever symptoms start to appear.

For women whose recurrent UTIs occur more than three times per year, another treatment option is to take a regular, low dose of antibiotics to help prevent infections.

Other women with recurrent UTIs that may benefit from preventive antibiotics include women who have spinal cord injuries or other complex conditions involving the nervous system, such as multiple sclerosis or diabetes.

Recurring urinary tract infections may be a side effect of a more serious condition. If you are concerned, take our “Do I need a Urogynecologist?” self-assessment.

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Recurrent urinary tract infections are common in women. A urinary tract infection is considered recurrent in women who have been adequately treated for an infection and then it returns after symptoms have resolved. Women who have more than 2 urinary tract infections in 6 months or more than 3 urinary tract infections in a year should seek medical help.

What causes recurrent urinary tract infections?

The anatomy of the female urinary tract is in close proximity to the anal opening. Fecal bacteria can colonize the vagina and distal urethra (end of the urethra). The bacteria can then ascend into the urinary bladder causing an infection.

However, if you are experiencing recurrent infections, other medical causes need to be excluded.

A full evaluation for recurrent urinary tract infections will include a detailed medical history and focused genitourinary examination. Based on your consultation, other diagnostic tests may need to be performed. For instance, a bladder ultrasound to evaluate residual urine volume may be performed as well as cystoscopy (evaluation of the bladder with a camera).

What to bring with you to your appointment:

You should bring any documented urine cultures to your office visit. In addition, it is helpful if you have a list of the antibiotics that have been used to treat your infections.

What treatments are available?

All symptomatic, culture proven urinary tract infections need to be treated with antibiotics. Your urologist may request a second follow-up culture to prove the infection has been eradicated.

There are a variety of treatments available for the prevention of recurrent urinary tract infections, including oral medications and supplements. Together with your UCLA urologist, we will choose the regimen that is best for you.

Urinary Tract Infections

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Overview

What Is It?
Most urinary tract infections are caused by a variety of bacteria, including Escherichia coli (E. coli), found in feces. Because the openings of the bowel, vagina and urethra are close together, it’s easy for the bacteria to spread to the urethra and travel up the urinary tract into the bladder and sometimes the kidneys.

Urinary tract infections result in eight to 10 million doctors’ office visits each year in the United States, and at least 50 percent of women will have at least one urinary tract infection at some point in their lives.

Luckily, most urinary tract infections are not serious and can be easily treated with antibiotic medications. The symptoms of a urinary tract infection can be stubborn and can persist after treatment. Sometimes an infection recurs a few weeks after treatment. Nearly 20 percent of women who have a urinary tract infection will have another, and 30 percent of those who have had two will have a third. About 80 percent of those who have had three will have a fourth. If left untreated, urinary tract infections can lead to other more complicated health problems so they should not be ignored.

How the Urinary Tract Works

Your urinary tract includes two kidneys, two ureters, the bladder and the urethra. Your kidneys remove waste and water from your blood to produce urine. Urine travels through muscular tubes, called the ureters, to the bladder. The bladder is a balloon-like organ composed of muscle, connective tissue and nerves that swells as it fills with urine. Urine is stored in the bladder until it is released from the body through another tube, called the urethra. Two muscle groups, the pelvic floor muscles and the urinary sphincters, control the activity of the urethra and bladder neck. These muscles must work together to hold urine in the bladder most of the time and allow the bladder to empty when appropriate.

Cause of Urinary Tract Infection: Bacteria

Most urinary tract infections are caused by a variety of bacteria, including Escherichia coli (E. coli), found in feces. Because the openings of the bowel, vagina and urethra are very close together, it’s easy for the bacteria to spread to the urethra and travel up the urinary tract into the bladder and sometimes up to the kidneys.

Untreated Urinary Tract Infections: Bladder & Kidney Infections

Infection occurs when the bacteria cling to the opening of the urethra and multiply, producing an infection of the urethra, called urethritis. The bacteria often spread up to the bladder, causing a bladder infection, called cystitis. Untreated, the infection can continue spreading up the urinary tract, causing infection in the kidneys, called pyelonephritis. Pyelonephritis can also occur without a preceding bladder infection.

A kidney infection that is not treated can result in the bacteria entering the bloodstream (this is known as urosepsis), which can be a life-threatening infection requiring hospitalization and intravenous antibiotics.

The first sign of a bladder infection may be a strong urge to urinate or a painful burning sensation when you urinate. You may feel the urge to go frequently, with little urine eliminated each time. At times, the urge to urinate may be hard to control and you may have urinary leakage. You may also have soreness in your lower abdomen, in your back or in the sides of your body. Your urine may look cloudy or have a reddish tinge from blood. It may smell foul or strong. You also may feel tired, shaky and washed out.

If the infection has spread to the kidneys, you may have fever, chills, nausea, vomiting and back pain, in addition to the frequent urge to urinate and painful urination.

Common Causes of UTIs

Some women are more prone to urinary tract infections than others because the cells in their vaginal areas and in their urethras are more easily invaded by bacteria. Women with mothers or sisters who have recurring urinary tract infections also tend to be more susceptible. Your risk of urinary tract infection also is greater if you’re past menopause. Thinning of the tissues of the vagina, bladder and urethra, as well as change in the vaginal environment after menopause, may make these areas less resistant to bacteria and cause more frequent urinary tract infections.

Irritation or injury to the vagina or urethra caused by sexual intercourse, douching, tampons or feminine deodorants can give bacteria a chance to invade. Using a diaphragm can cause irritation and can interfere with the bladder’s ability to empty, giving bacteria a place to grow.

Any abnormality of the urinary tract that blocks the flow of urine, such as a kidney stone or significant prolapse of the uterus or vagina, also can lead to an infection or recurrent infections. Illnesses that affect the immune system, such as diabetes, AIDS and chronic kidney diseases, increase the risk of urinary tract infections. A weak bladder can also make it difficult to empty completely, allowing bacteria to grow. Lengthy use of an indwelling catheter, a soft tube inserted through the urethra into the bladder to drain urine, is a common source of urinary tract infections. Intermittent catheterization (where a person empties the bladder several times a day but the catheter is removed immediately) actually is used to prevent recurrent infections in some patients.

Because the uterus sits directly on the bladder during pregnancy and can block the drainage of urine from the bladder, UTIs are more common in pregnant women. And when women develop urinary tract infections during pregnancy, the bacteria are more likely to affect the kidneys. Hormonal changes and repositioning of the urinary tract during pregnancy may make it easier for bacteria to invade the kidneys. Such infections in pregnant women can lead to urosepsis, kidney damage, high blood pressure and premature delivery of the baby. All pregnant women should have their urine tested periodically during pregnancy. Pregnant women with a history of frequent urinary tract infections should have their urine tested often.

Most antibiotic medications are safe to take during pregnancy, but your health care professional will consider the drug’s effectiveness, how far your pregnancy has progressed and the potential side effects on the fetus when determining which medication is right for you and how long you should take it.

Diagnosis

Your health care professional will determine whether you have a urinary tract infection based on your symptoms, a physical examination and the result of a laboratory test of your urine. You will be asked to urinate into a small cup. The urine will be examined under a microscope for bacteria and for a large amount of white blood cells, which fight infection. A urine culture may be done in which the bacteria in the urine are encouraged to grow. The bacteria can then be identified and may be tested to see which antibiotic best kills them.

If you are having recurrent symptoms of infections despite treatment, it is important that your urine be cultured before you are placed on antibiotics. Repeated treatment of presumed infections without urine culture should be avoided.

Some bacteria, such as chlamydia, can only be found with special urine cultures. A health care professional may suspect these infections when a woman has urinary tract infection symptoms, but a standard culture doesn’t grow the bacteria.

If you have recurring urinary tract infections, your health care professional may suggest other tests to look for obstructions or other problems that might trap urine in the tract and cause infection:

  • Intravenous pyelogram (IVP) is an X-ray exam of the urinary tract using a dye that is injected into a vein and then enters the kidneys, ureters and bladder. This test is not commonly used alone anymore.

  • A computed tomography scan (CT scan), also known as a CT urography, is a type of X-ray test used to capture images of different structures in the body. The CT scan is usually given with an intravenous dye similar to that used in an IVP (see above). The dye allows your doctor to better see your kidneys, ureters and bladder. Newer CT scanners use much less radiation.

  • Ultrasound uses sound waves to produce images of the urinary tract. No radiation is involved in this test.

  • Cystoscopy is a test using a thin telescope-like instrument that allows your health care professional to see inside the urethra and bladder and examine them for problems.

4 Reasons Why Antibiotics Did Not Resolve Your UTI Symptoms

“I took antibiotics for UTI but symptoms are still there”, it’s a common complaint among chronic UTI sufferers but it could mean a lot of different things. I asked Dr. Lisa Hawes a urologist at Chesapeake Urology to help to navigate different case scenarios and discuss what they could potentially mean. However, do not attempt to self-treat based on this information only.

This post should rather serve you as a guide for a conversation with your doctor. When you know what to mention during your doctor visit, you have higher chances to get better care.

Option #1: Bacterial Antibiotic Resistance

Have you taken all prescribed antibiotics but your symptoms are only getting worse? It could be that your bacteria are resistant to this type of drugs.

You might have heard about superbug bacteria that withstand all available antibiotics. Well, increasingly, bacterial resistance is a real-life problem that physicians facing more often than before.

Here are the main signs that could signal that your bacteria are resistant to the prescribed medication:

  • You are feeling worse, while you’ve been taking antibiotics diligently for over 48 hours.
  • You are experiencing fever or nausea (must see a physician right away).

“Realistically, you should feel much better by the third day of an antibiotic treatment, bacterial load should be lowered, and therefore symptoms should subside”, says Dr. Lisa Hawes “even if not all symptoms resolved, you definitely should not have cloudiness, odor, or blood in your urine 48 hours after starting antibiotics”.

Signs that UTI is not responding to antibiotics

What if you feel lower back pain? Is this a sure sign that infection is progressing to the kidneys and antibiotics are not working?

“While lower back pain could be an important sign of kidney infection, in many cases low back pain alone is not a sure sign that bacteria ascended to the kidneys, it could be just pain radiating from the bladder due to UTI,” clarifies Dr. Hawes. However, if you are experiencing fever (102 -103 F) and/or nausea, these are very serious symptoms and you should seek immediate medical attention.

This is when the chances are higher to get sick with an infection caused by antibiotic-resistant bacteria:

  • You underwent multiple UTI treatments in your lifetime
  • If you have been using the same antibiotic for previous infections
  • Stopped taking antibiotics and didn’t finish all the pills that your doctor prescribed you
  • If you are guilty of keeping a stash of antibiotics and self-treating UTIs, cold, travel diarrhea, etc.
  • You’ve been recently hospitalized
  • If you are immunosuppressed or have any serious chronic health issues, for example, uncontrolled diabetes.

Dr. Hawes highlights that it is important to request a urine culture test before deciding on a type of antibiotics. If you are taking multiple antibiotics without checking bacterial drug sensitivity, it’s a guessing game that only increases your chances to develop a resistant bacteria.

Read how to revert antibiotic resistance with diet.

Option #2: After antibiotics, UTI symptoms still linger? Maybe it’s not a UTI.

Guess what, UTI is not the only diagnosis responsible for UTI-like symptoms.

Unfortunately, this scenario happens way too often: you have had many well-diagnosed UTIs in the past, so when you complained of UTI-like symptoms, your doctor prescribed you antibiotics right away.

Sometimes, after you take antibiotics you could even feel better but then you notice that some symptoms (urgency or bladder pain) still remained. This could be confusing, especially if antibiotics did bring you a slight relief.

Per Dr. Hawes, if you never had blood in your urine, cloudy urine or funny smelling urine in the first place, if your only symptoms were bladder pain and slight burning with urination, then chances are high that it was not a UTI.

As Dr. Lisa Hawes explains ”After multiple UTIs the bladder lining is damaged and inflamed. When the protective GAG bladder layer is damaged, the acidic urine can easily irritate the bladder and cause pain”.

If you noticed that drinking lots of water help with your condition, it is because you are simply diluting the urine and making it less irritating to your bladder walls.

Medications and supplements that help to coat the lining of the bladder (similar to how Pepto Bismol can protect stomach lining) could greatly reduce these symptoms.

Took antibiotics, some UTI symptoms resolved, other symptoms still linger

So why if it wasn’t a UTI, the prescribed antibiotics worked and you did feel a relief? Well, there could be at least three reasons:

  1. It could be that you are lucky to experience the famous placebo effect. It means that your body healed itself when you are given an irrelevant medication or even a sugar pill. This phenomenon affects up to 75% of patients in controlled groups (depending on a disease) and while it is still not well understood, it’s a real thing.
  2. Another option is a test failure. No tests are 100% accurate. There is always a room for human error, too. So it could be that there was, indeed, an infection in your sample but the lab wasn’t able to culture it. The chances for a mistake are higher when urine is too diluted with water that you were drinking excessively prior to the urine test. It could also be that a certain type of bacteria is more irritating to the bladder even with a lower count.
  3. Moreover, Dr. Hawes encountered many patients in her practice that claim that specifically, Cipro helps them with their UTI-like symptoms even when a lab finds no bacteria in their urine.

Dr. Hawes hypothesizes that it could be due to some sort of a side-effect from Cipro: perhaps, the medicine does something else to the body besides killing bacteria that could indeed reduce UTI-like symptoms.

Bacteria in my poop could…

  • Cause UTI
  • Prevent UTI
  • Both!

Why Your UTI Test May Be Negative Even When You Have Symptoms

How about the study that looked at bacterial DNA in the urine of women with UTI-like symptoms who also had a negative culture test?

To summarize, the researchers looked at urine samples of women without symptoms and a group with UTI-like symptoms. They performed two tests: a culture test and a DNA-sequencing test that allows identifying if there is any bacterial DNA in the urine.

According to the study, 90.5% of symptomatic women with a negative urine culture tested positive for Escherichia coli bacteria with molecular methods compared to about 5.3% of women without symptoms.

This allowed the researchers to conclude that culture tests might not be sufficiently accurate and if a patient complains of urinary tract infection symptoms, she might as well be treated for an acute UTI.

The findings are gaining traction among chronic UTI sufferers who feel that the study finally gives more credibility to their complaints.

“However”, argues Dr. Hawes “the significance of finding bacterial DNA may be different than the significance of finding live growing bacteria. Does the DNA stay around after an infection? If so, for how long? How do you determine antibiotic sensitivity based on DNA findings rather than live growth?”.

If you’ve seen any criminal movies in which the action is taking place after the mid-80s, you expect that police will do a DNA test to confirm who was at the crime scene. However, there is a difference between establishing that a suspect was at the crime scene at some point in time versus finding out where is the suspect now.

As Dr. Hawes concludes, “We don’t yet understand the clinical significance of this data”. In other words, do not dismiss the results of your culture test because of this study.

Discuss with your doctor if some of your UTI symptoms persist after antibiotics

Here are several questions that you should think about prior to your doctor visit to help your physician with the right information:

  • Are your symptoms stronger when the bladder is full and you feel better after urination?
  • Does a certain position (sitting versus standing) trigger bladder pain?
  • Do you feel that your symptoms stay the same over the course of days and even weeks?
  • Is there blood in your urine, foul smell, or is your urine cloudy?
  • If you’d like more help on how to discuss your UTI with your provider and how to make the most out of your patient-doctor relationships, check out my Actionable Guide here.

Option #3: Persistent UTI Symptoms After Treatment

Here is another option: they sent your urine sample to a lab and later told you that according to the test you have a UTI. However, antibiotics resolved some symptoms (such as blood in urine), but urge to urinate or pain in lower abdomen remained.

As you could imagine, there could be a scenario when not only you have a full-blown UTI, but also an inflamed bladder lining is causing additional symptoms, as discussed above.

In this case, you, most likely, will see a reduction in pain, and your urine will become clear. However, pain in the bladder area and slight irritation after urination might still linger.

Moreover, when patients mention they feel burning in the urethra rather than the bladder, it’s quite normal. In fact, the urethra has more nerve endings that could be easily irritated due to underlying inflammation.

Option #4: UTI Symptoms Return After Antibiotics?

Another story is when your urine test did show a UTI. You then took antibiotics, felt completely fine, but several days later woke up with the same nasty UTI symptoms.

“Here two options are possible: we were unable to eliminate the infection completely or it is reinfection”, says Dr. Hawes “if only 2-3 days elapsed since treatment and symptoms recurred, most likely we were not able to clear the infection. However, if you get an infection 2-3 weeks after your last antibiotic treatment, count it as reinfection”.

Bacteria hide in your bladder lining

One interesting fact from Dr. Hawes: during bladder cystoscopy of chronic UTI patients she frequently sees “pimples” on their bladder surface. The correct medical term is Cystitis cystica, which is a benign lesion of the bladder as a result of chronic inflammation.

These “pimples” are “thought to be caused by chronic irritation of the urothelium because of infection, calculi, obstruction, or tumor”.

Per Dr. Hawes, a biopsy of these pimples typically comes back with results of bacterial contamination. Basically, bacteria comfortably reside inside of these “pimples” on a bladder wall. The worst thing, they can reappear from time to time to cause yet another infection. That’s why you notice that UTI symptoms come back after antibiotics.

If that’s the case, Dr. Hawes’ identifies the type of bacteria via a culture test and which antibiotic bacteria are susceptive to. After that, she combines a short-term intensive antibiotic therapy with a long-term (1-3 month) low dose antibiotics. This normally kills bacteria that keep reappearing out of the cysts into your bladder.

Many thanks to Dr. Lisa Hawes who took the time off her weekend to share these insights. We hope this information will help you when discussing a treatment plan with your urologist. And if you are happened to be in Maryland, here is contact information for Dr. Hawes’ practice.

What Else Can You Do When Antibiotics Fail?

When it comes to the best treatment for recurrent chronic UTIs there are two main camps.

Some physicians prefer a long-term antibiotic treatment protocol, frequently prescribing a variety of antibiotics over the course of several months (or even years).

Others advocate for the mindful use of antibiotics and focus on correcting underlying dysbiosis as the main reason for recurrent UTIs. In fact, we are still learning about the human microbiome and the effect bacteria have on our health and it seems less and less probable that antibiotics alone could solve chronic issues.

Moreover, antibiotics were developed when we thought that a healthy bladder is sterile which we now know is far from the truth.

What is the best approach to cure a chronic UTI? Here is a selection of posts that can help you to get up to speed:

  1. A holistic approach to UTI treatment
  2. Best UTI treatment is systemic
  3. And don’t waste your money on re-packaged D-Mannose or attempt to prevent UTI with Vitamin C.

When Urinary Tract Infections Keep Coming Back

  • Being in a nursing home or hospital
  • Diabetes
  • Kidney or bladder stones
  • Having a catheter
  • Previous urinary tract surgery
  • Sexual activity
  • Having an infected or enlarged prostate
  • Being born with an abnormality of the urinary tract

How Is a Recurrent UTI treated?

If you have recurrent UTIs, your doctor may send you to a urologist who specializes in diseases of the urinary system. Some of the ways that recurrent UTIs are evaluated and treated include:

  • Testing. The doctor will want to take a urine sample to test for bacteria and white blood cells. It may be necessary to do special X-ray studies to see if there is an obstruction or stones in the urinary tract. A urologist may look into your bladder by passing a special scope through the opening into your bladder. This exam is called cystoscopy.
  • Antibiotics for treatment. Normally UTIs responds very well to antibiotics, and you may only need to take medication for a few days. For recurrent UTIs, antibiotics may be needed for 10 days or more.
  • Surgery. In some cases of prostate disease, stones, or other obstruction of the urinary system, surgery may be done to restore normal flow of urine and help clear up infections.
  • Antibiotics for prevention. Some strategies to prevent recurrent UTIs with antibiotics include taking low-dose antibiotics for six months or taking antibiotics after sexual intercourse.
  • Frequent urine testing. Women who have recurrent UTIs may benefit from testing their urine frequently with a dipstick that warns of any bacteria in the urine.
  • UTI vaccine. Research shows that some women and children who get recurrent UTIs are lacking some proteins they need to fight infections. A vaccine may soon be available to help those people improve their ability to fight UTIs naturally.

Recurrent UTIs are common and there are many effective treatments available. Some simple things you can do to help prevent UTIs include drinking lots of fluids, keeping the genital area clean, wearing cotton underwear, and wiping from front to back after a bowel movement or urination. Drinking cranberry juice and taking vitamin C supplements can also help by making your urine more acidic, which decreases the growth of bacteria.

Urinary tract infections, especially recurrent UTIs, can be a serious health problem. If you know the symptoms, you can always get in touch with your doctor if you think you have a UTI.

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