Another UTI??? How to deal with frequent bladder infections.
Most women have had at least one UTI and the feeling is unforgettable - you have to pee all the time, but it hurts to pee even just a little bit. Then you give into the pressue - and almost nothing comes out. It’s unpleasant to say the least. Most women are lucky and this is a rare occurence. You have a UTI once in your teens/early 20s, maybe once in pregnancy and once around menopause. However, for some women, this is more of a monthly sort of problem. Ladies, if that’s you, then this post is for you.
What causes recurrent UTIs? There are a number of things that are responsible and assuming you have good wiping hygeine - front to back and don’t have a sudden onset change in anatomy in your 40s (it’s not impossible - that’s when urethral diverticulums which hold infection form), then the most common reason for recurrent UTIs is that you don’t have strong defense systems. The female urethra is short and thus not particularly difficult to attack. In your younger years, you typically have a pit of acid (the vagina) between the urethra and the anus and that keeps most things away. If that pH protection gets disrupted - sex, bubble baths, beach time - then you can get an opportunity for infection to form.
One note here. If you feel like you are getting frequent UTIs, it’s important to get a urine culture for two reasons. One is to make sure this isn’t just a single poorly treated infection recurring and the other is to make sure that there isn’t a different underlying condition like interstitial cystitis that’s not being effectively managed while also continuously knocking out your gut flora. So, it may be easy to call the online doc, but it’s a good idea that if you have more than one UTI a year that you get it checked.
How do we build stronger defenses? I have two major suggestions. The first is boric acid vaginal suppositories, which are available over the counter at most drug stores/grocery stores/amazon. Just make sure you put them in the vagina and not in your mouth. My second suggestion is a good probiotic. I have no brand recommendations, because I think ideally the best probiotic is living food - anything that is fermented. You just have to make sure that after the food was fermented, it wasn’t pasteurized. Sauer kraut is a good example. Most of what you find at the store - in a jar or a plastic pouch was fermented, but then it was pasteurized and sealed. You want the stuff in the refridgerated section in the special bag that won’t explode. Or, hit up your local Korean restaurant for some kim-chi if they make it in house. Other good examples are kombucha, yogurt (go for low sugar), real pickles and the like. You can also make these things at home - sauer kraut is cabbage+salt+time. I just hope your comes out better than my under the counter experiments have gone.
If building stronger defenses doesn’t work, then I would consider bringing in additional soldiers to man the weak spot. The most common way we do this is using macrobid for supression. Macrobid is an antibiotic that, when taken orally, is rapidly cleared from the blood by the kidney and deposited in the bladder. It won’t affect any other part of your body, but id will do good things in the bladder. Typicallying the suppression dose is less than the treatment dose and because it can’t affect anything other than the bladder, it won’t wreak habit on the GI tract. You can also add pyridium to the mix, which helps to futher acidify the urine. With both of these treatments, we either do them as often as you have a triggering event - say sex - or for people who don’t know their triggers, or who encounter their triggering event every day - say daily sex (and good for you) - then we do the prophylactic dose daily. Both pyridium and macrobid require a prescription.
If you are postmenopausal and suddenly start getting UTIs, you need estrogen. Luckily vaginal estrogen is safe for almost every person on the planet, so … 1 gm vaginally 1-3 times per week will make all the infections disappear. This one thing could save Medicare millions of dollars per year (and countless women’s lives) and it’s an absolute travesty that a core safety measure (like the one I had making sure everyone whose BMI was over 28 knew they were fat) has never been starting vaginal estrogen in a woman after she’s had an episode of urosepsis. Instead, we just see them back for another round of hospitalization and intensive IV antibiotic therapy in 6 months.
Can you both strengthen the defenses and get more troops? Of course. I think that for people who fail defense building alone, it will probably still be more beneficial if we continue the defensive strategy while adding the other medications.
When should you see a doc? If you are getting more than one UTI a year, it’s worth at least working on defense building and I’d see a doc to get the urine culture. At our office, an established patient can stop in during business hours without an appointment to get this test. If you are getting 4 or more UTIs per year, you both qualify for supressive therapy and need to see a doctor to rule out any underlying anatomic or physiologic problem. I’d say that any doctor in the women’s healthcare space could and should recognize and treat this, but I’ve sadly learned that this is unlikely. So, you may need a gynecologist, PCP, urogyn or urologist. Just don’t stop pushing until you get someone who takes you seriously.