Why Do I Keep Getting UTIs? 8 Causes of Recurrent UTIs | SELF

Getting a UTI (urinary tract infection) sucks. You know what sucks even more? Getting a sucky UTI and over and over again.

They’re called recurrent UTIs, and they can make you feel like you spend half your life running to the bathroom. If that sounds like you, listen up. There are a few things you should know about what qualifies as a recurrent UTI, why they happen, and what you can do about them.

What is a UTI

Before we talk about the recurring UTI, let’s talk about the one-and-done UTI.

A UTI is an infection in any part of your urinary tract, the Mayo Clinic explains. The infection usually starts when bacteria normally found in your bowels gets into the urethra, where pee exits from. Instead of getting flushed out by urine or fought off by your immune system like it’s supposed to, the bacteria begins to colonize the urinary tract, according to the The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Most UTIs stay in the urethra (called urethritis) and bladder (called cystitis), per the Mayo Clinic. They can cause symptoms like pain or burning with urination, a strong and persistent urge to urinate, frequently peeing small amounts—are you sensing a theme here?—and pressure or discomfort in the pelvic or lower stomach area. A simple UTI, diagnosed with a urinalysis or urinary culture, can typically be easily treated with antibiotics, the Mayo Clinic explains. (If it moves up the tract and results in a kidney infection, causing serious symptoms like a high fever, chills, nausea, vomiting, and flank pain, you may require hospitalization for IV antibiotics, according to the Mayo Clinic.)

Sometimes, a UTI keeps coming back, and we call it a recurrent UTI. “Most people would say a true recurrent UTI is either two within six months or three within a year,” Sandip Vasavada, M.D., Urologic Director, Center for Female Urology and Reconstructive Pelvic Surgery, at Cleveland Clinic within the Glickman Urological Institute, tells SELF.

Here’s everything you need to know about recurrent UTIs, including how to treat and prevent them.

1. Recurrent UTIs are very common for people with vaginas.

Studies estimate that 30 to 44 percent of women who get a UTI will get a second one within six months, according to the American Academy of Family Physicians (AAFP). And most of these people will be healthy individuals that have perfect normal urologic anatomy.

In fact, basic anatomy in itself may be the single biggest risk factor for UTIs, urologist Elodi Dielubanza, M.D., assistant professor of surgery at Harvard Medical School and associate surgeon at Brigham and Women’s Hospital, tells SELF.

The reason why is simple. The majority of UTIs are caused by the bacteria E. coli, which are native to the GI tract (and poop), but can cause an infection if they get to your urinary tract. The genital anatomy of someone with a vagina is conveniently set up in a way that makes this trip very quick and easy for those bacteria. Basically, the distance between the anus and the urethra is extremely short (seriously, have you ever looked?), as is the length of the urethra, which basically acts like a short ladder that the bacteria can climb up into the bladder, Dr. Dielubanza says. In comparison, people with penises tend to have a greater distance between their anus and their urethra, which makes these infections less likely (but still possible).

2. Sex puts you at greater risk of recurrent UTIs.

Being sexually active is a UTI risk factor, and having sex three or more times a week or having new sex partners or multiple partners can especially put you at risk of recurrence, according to the AAFP.

Basically, sex can jostle around the bacteria down there and make it more likely that the wrong guys will end up in the wrong place (your urethra). “Vaginal penetration can push some bacteria around [the anus or vagina] up into the urethral area,” Dr. Vasavada says. But it’s not just vaginal intercourse. Sexual activity involving “fingers, toys, or anything that causes movement of bacteria” can increase the odds you’ll develop a UTI, Sovrin M. Shah, M.D., an assistant professor and attending physician in the Department of Urology at the Icahn School of Medicine at Mount Sinai, tell SELF.

That’s why peeing after sex is such common UTI-prevention advice, in case any bacteria has gotten up there. “If a patient voids after [sexual activity], that can help flush the contaminated urine out,” before bacteria get the chance to colonize, Dr. Vasavada says. (And yes, you can have sex while you have a UTI that’s being treated with antibiotics, although you may not want to if it’s uncomfortable.)

3. Menopause is another risk factor.

Because UTIs are sometimes thought of being a problem for young people with active sex lives, older people are surprised to find they start getting more UTIs after they go through menopause, Dr. Vasavada says. This is thanks to a postmenopausal decline in estrogen. This estrogen deficiency alters the vaginal pH and flora in such a way that make it more hospitable to the kind of bacteria that cause UTIs, according to the AAFP.

Topical estrogen is one option for postmenopausal people to reduce the likelihood of recurrent UTIs, Dr. Vasavada says. So if you’ve gone through menopause and keep battling UTIs, it’s definitely worth talking to your doctor about.

4. Some medical conditions make you more prone to recurrent UTIs.

While there are a “variety of anatomic and functional scenarios that put you at risk,” the most common ones involve urinary retention, or an impaired ability to empty your bladder fully and frequently, Dr. Vasavada says. This results in stagnant urine, which lets infection-causing bacteria linger.

That includes someone with a spinal cord injury or nerve damage around the bladder who might have trouble emptying their bladder, or someone with a kidney stone that blocks the flow of urine, according to the NIDDK.

Another common example is diabetes, where several factors can make recurrent UTIs more likely, Dr. Vasavada explains. First, nerve damage in the bladder can reduce the sensation of having to go and the ability to fully empty the bladder, per the NIDDK. A weaker immune system makes people generally more susceptible to infections, per the Mayo Clinic. Plus, bacteria can feed on the excess amounts of sugar that spill out into the urine when someone has high blood sugar, Dr. Vasavada explains.

5. Some people are just more prone to recurrent UTIs.

“Even if someone doesn’t have any of these factors, they may just keep getting UTIs,” Dr. Vasavada says. Their increased susceptibility may come down to inherited and genetic factors. For instance, having a first-degree relative with a history of having five or more UTIs is a risk factor for recurrent UTIs, according to the AAFP.

One specific genetic variation occurs in the clinginess of the cells that line your bladder. “Certain people have cells with receptors that bacteria can ‘stick’ to more easily,” Doreen Chung, M.D., a urologist at New York-Presbyterian/Columbia University Medical Center, tells SELF. “In layman’s terms, we say the lining of their bladder and ureter is more like velcro,” Dr. Vasavada says.

Dr. Chung points to a 2009 study published in PLOS One that looked at 1,261 women aged 18 to 49 with recurrent UTIs and kidney infections. The study found that genetic variation in a kind of receptor called Toll-like receptors (TLRs) is associated with an increased risk of both kidney and bladder infections.

6. There are a few preventive measures that might help.

If you’ve even gotten one UTI before, then you’ve probably heard these tips: Drink a lot of water, don’t hold your pee in, and wipe front-to-back. “These are simple measures and maneuvers that may or may not help [prevent your UTIs,]” Dr. Vasavada says. “But we generally recommend them because [they’re] not too onerous and they’re good habits anyway.”

Drinking enough water and emptying your bladder frequently (and after sex) are helpful for preventing bacteria in stagnant urine from colonizing, the NIDDK explains. And wiping from front-to-back helps stop fecal matter (which contain UTI-causing bacteria) from making its way from the anus to the urethra.

7. Repeat after us: Cranberry juice cannot treat UTIs.

According to the National Center for Complementary and Integrative Health (NCCIH), cranberry juice will not treat an existing UTI. However, there is some research suggesting cranberry juice could help prevent UTIs in the first place, according to the NCCIH. An ingredient in cranberry juice and supplements called proanthocyanidins, or PACs, may help prevent bacteria from sticking to the lining of the urinary tract and bladder, Dr. Vasavada says.

But the evidence is a pretty mixed bag. For instance, a meta-analysis of 13 randomized controlled trials (RCTs) including over 1,600 subjects, published in JAMA Internal Medicine in 2012, found evidence of a link between cranberry-containing products and a protective effect against UTIs. However, the authors cautioned that there was significant heterogeneity across the studies, in terms of both variables like the dosages used and the size of the results.

And a 2012 Cochrane review of 24 studies including 4,473 women found that although some smaller studies suggest a preventive effect, particularly in women with recurrent UTIs, the body of evidence as a whole doesn’t suggest a statistically significant difference. “So, it’s sort of up to you. If someone takes it and they think it benefits them, great,” Dr. Vasavada says.

8. You could be a candidate for prophylactic antibiotics.

If you’re basically a walking UTI, you do have options: prophylactic antibiotics, which is a fancy way of saying preventive antibiotics. The idea is to nip any UTI-causing bacteria in the bud before they can even think of colonizing your urinary tract.

“If someone’s had multiple culture-proven infections and we have no other sources or factors we can find, then we will consider prophylactic antibiotics,” in some form, Dr. Vasavada says. There are a few ways to go about this, depending on the doctor and the patient, Dr. Vasavada says.

One option is low-dose antibiotics taken for daily for something like six months, per the Mayo Clinic. However, doctors are increasingly cautious to prescribe routine antibiotics unless all other options are exhausted, because of side effects and the potential for developing antibiotic resistance, Dr. Vasavada says.

Another route is a single dose of the antibioitic that you take every time you have sex. “That’s often time enough to prevent the infection from settling in,” Dr. Vasavada says. Another method is basically self-started or self-directed treatment using a standing prescription. Whenever you think you may have a UTI, you reach out to your doctor, who may want you to drop off a urine sample or may just tell you to go ahead and take the meds if you’ve recently tested positive and are feeling the symptoms again, Dr. Vasavada explains.

So if you’re suffering from recurrent UTIs—and you’ve been suffering—talk to your doctor. There’s hope.

Additional reporting by Laura Adkins.


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