Chronic UTI

Urinary tract infections (abbreviated ‘UTI’) account for over 7 million visits to health care providers annually and cost the US healthcare system 1 billion dollars annually. Nearly fifty percent of women will develop a urinary tract infection during their lifetime. Eighty percent of these women will subsequently develop another UTI within the ensuing 18 months. Women with recurrent UTIs typically experience two to three infections per year. Although it is not always possible to prevent recurrent UTIs, the following information can help women devise a program to manage recurrent urinary tract infections.

Definition:

The urinary tract consists of the kidneys, ureters (tubes that carry urine from the kidneys), bladder, and urethra (tube that carries urine from the bladder to the outside). Normally urine is sterile (free of infection). Urinary tract infections occur when small microscopic organisms called bacteria invade the urinary tract. A urinary tract infection is called pyelonephritis when it occurs in the kidney, cystitis when it occurs in the bladder and urethritis when it occurs in the urethra.

Finally, UTIs are subdivided into complicated and uncomplicated varieties. Urinary tract infections are classified as complicated when there is a history of hematuria (blood in the urine), neurogenic bladder (e.g., spinal cord injury), recent urinary tract surgery or catheterization, unusual types of bacteria (e.g. Klebsiella, Pseudomonas, or Proteus species), diabetes, compromised immune system (e.g., chronic steroid use, AIDS), UTIs that fail to respond to initial treatment, and renal failure. Other types of urinary tract infections are considered uncomplicated.

Etiology:

Over 80% of UTIs are caused by bacteria called e.coli. The bacteria originally come from the bowel and then make their way into the vagina. Bacteria such as lactobacteria are normally present in vagina and help maintain a healthy environment and prevent yeast overgrowth. It’s not unusual for bacteria to get massaged into the urethra and bladder during intercourse, but a protective lining inside the urinary tract prevents the bacteria from sticking to the surface until they get flushed out during urination. On the other hand, the protective barrier doesn’t work as well in women with recurrent UTIs; therefore, bacteria stick more easily.

In addition, certain types of bacteria are more virulent; they secrete chemicals that help them evade the immune system and sport special hair-like projections called ‘pili’that help them cling to the urinary tract lining.

Although rare, other factors that predispose women to recurrent urinary tract infections include infected kidney stones and a pocket of pus located beneath the urethra called a urethral diverticulum. These two conditions occur in women with persistent UTIs; that is, infections initially respond to antibiotic therapy and then reoccur once the medication is stopped. Special tests can help diagnose these conditions and surgery can correct the problem.

If you are experiencing recurring urinary tract infections and have already been seen by a urologist to rule out an abnormality that needs correction, perhaps there are some steps you can take to prevent future infections. Our doctors have outlined simple precautions that if followed consistently, may make the difference for you.

FOLLOW PROPER HYGIENE TECHNIQUES

Always wipe from front to back using plain white toilet tissue after having a bowel movement or after urination. This is to avoid spreading bacteria from the anal area to the vagina or urethra. If possible, use a hand held shower to wash the genital area daily.

INCREASE YOUR INTAKE OF FLUIDS

You should drink fluids in the form of water or natural juices, without chemicals, at room temperature. Drink enough so that your urine is almost clear when collected in a clear transparent plastic cup. You should check to see if your urine is clear using this method once a week. 8 – 10 glasses measuring 8 ounces per glass per day might meet your requirements. You should urinate at least 2 liters/24 hours.

EMPTY YOUR BLADDER FREQUENTLY

Whenever you feel the desire to urinate, do not wait. Failure to promptly empty your bladder may be one of the causes of recurring Urinary Tract Infections.

IF YOU ARE SEXUALLY ACTIVE

Empty your bladder before sex and immediately after sex. Before sexual activity make sure that you are adequately lubricated and that you assume a comfortable position to avoid injury to the urethra.

TRY TRIPLE VOIDING

Triple voiding means attempting to urinate three times. After you have finished passing urine for the first time, you should wait for 10 seconds and try to pass urine the second time. Wait for another 10 seconds and try to pass urine the third time. The second and third try should be dry ones and done without pushing hard. The reason for triple voiding is to make certain that after urination no drops of urine are left behind as a place for the bacteria to multiply in the bladder and cause an infection.

EMPTY YOUR BLADDER EVERY TWO HOURS

Even if you do not have the desire to urinate. Every two hours when you are awake you should empty your bladder by triple voiding. The reason for this is to prevent the bacteria from significantly multiplying in the bladder and resulting in infection.

TAKE HIGH POTENCY B-COMPLEX VITAMINS

B-Complex vitamins can help compensate for the loss of minerals when you have increased your fluid intake to flush out bacteria from the bladder. Maintaining adequate nutrition and getting sufficient sleep are important contributing factors that increase the body’s resistance to infections and prevent recurring urinary tract infections.

WEAR COMFORTABLE CLOTHING

Refrain from wearing tight jeans and nylon pantyhose for long periods of time because they place indirect pressure on the urethra. Nylon pantyhose are not absorbent. Use 100% cotton undergarments because trapped perspiration acts as a conduit for bacteria to grow and the constant moisture is irritating to that part of the body.