Not another bladder infection

By Aoi Mizushima, M.D., family medicine and obstetrics, Providence Medical Group-North Portland

If you've had a bladder infection before, you're well aware of the signs when another one is coming on: the strong, incessant urge to urinate, with very little output; the pain or burning when you go; the cloudiness, pink tint or strong smell to your urine; the feeling of pressure or pain in your lower abdomen. The universal reaction to these returning symptoms is: Ugh - not again.

According to the National Kidney Foundation, about one in five women will have a urinary tract infection, also known as a UTI or bladder infection, at some point in her life. Most will experience only one, but 20 percent will have another one. Once you've had two, you have a 30 percent chance of having a third, and after three, your risk of repeated UTIs rockets to 80 percent.

Women aren't the only ones who get UTIs, but they do get most of them. The main reason is probably anatomical – women have a shorter distance between the rectum, where many bacteria exit the intestinal tract, and the urethra, where bacteria can enter the urinary tract and travel to the bladder. Bacteria most commonly make their way into the urethra during sexual activity, putting young, sexually active women at the highest risk for UTIs. 

But older adults are at risk, too. In postmenopausal women, lower estrogen levels make it easier for bacteria to grow in the urethra. In older men, an enlarged prostate gland may partially block urine flow and prevent the bladder from emptying completely, allowing bacteria more time to settle in and multiply. Bladder leakage from incontinence can raise a UTI risk in older men and women, as well, by creating a moist breeding ground for bacteria.

People with poorly controlled diabetes also are at higher risk of bladder infections due to their weakened immune systems and, in some cases, due to kidney changes. Women with diabetes are at five times greater risk of developing UTIs than women without diabetes.

While all of that explains why some people get more bladder infections, the question most people really want answered is: What can you do about them?

Treating infections

If you feel some burning or other early signs of a UTI, start drinking plenty of fluids and monitoring your symptoms. Dehydration can cause symptoms similar to a mild bladder infection. 

If your symptoms don't improve, visit your doctor for a urine test before you check out the pharmacy for remedies. That's very important, because pyridium - the most commonly taken over-the-counter medicine for UTIs - interferes with the results of urine cultures. That poses a big problem when we're trying to find out which bacteria are causing your infection. Identifying those bacteria is crucial to make sure we prescribe the correct antibiotics to fight them. 

When prescribed and taken correctly, antibiotics are the most effective treatment for bladder infections, bringing improvement within 48 hours, and often clearing up burning sensations within five hours. If that sounds like too long to continue in your uncomfortable condition, it's perfectly fine to take pyridium after you've left your urine sample, and to keep taking it alongside your antibiotics. It can offer some quick relief while you wait for the antibiotics to kick in. Once you start to feel better, don't stop taking your antibiotics – you need to finish the full course to prevent the infection from returning.

Think you can tough it out without treatment? A mild infection could clear up on its own, but monitor your symptoms closely, and see your doctor if things start to get worse. Blood in your urine or pain in your lower abdomen may be signs that the infection has traveled into your kidneys. Kidney infections are very serious. If you have all of the classic signs of a UTI, plus a temperature of 102°F or higher, chills, pain in your flank area, or nausea and vomiting, see a doctor right away.

If you are pregnant and you experience any signs of a bladder infection, alert your doctor immediately. Pregnant women have a 40 percent higher risk of a simple UTI progressing into a kidney infection. 

Preventing repeat performances

To reduce UTI recurrences, try these preventive measures, which have been shown to help prevent bladder infections for many people:
  • Drink lots of water: Stay hydrated and urinate frequently.
  • Empty your bladder: When you urinate, take time to empty your bladder completely.
  • Urinate immediately after intercourse: Although the research is mixed, this has become a mainstay of preventive recommendations. 
  • Practice good hygiene: Wipe from front to back, and wash yourself daily. 
  • Make a contraceptive change: Women who use spermicides with diaphragms are at higher risk of UTIs.
  • Consider estrogen cream: Topical estrogen cream appears to benefit some postmenopausal women, but its benefits should be weighed against its risks.
Two other interventions, while not yet proven, may hold some promise for relief:
  • Cranberry juice: Some people swear by cranberry juice. Yet, while there are good scientific explanations for how and why it might prevent UTIs, there are no quality studies showing that it does. I hope we'll see more research soon. Until then, there's not much harm in trying it. 
  • Probiotics: Some women have benefited from using probiotic vaginal capsules. As with cranberry juice, the scientific connections are there, but more evidence is needed to prove their effectiveness. 

If, despite your best preventive efforts, you still find yourself saying, “Ugh – not again,” one too many times, be extra vigilant about seeing your doctor, testing your urine and documenting which bacteria are the culprits. With this information, your doctor may be able to start you on a program of preventive antibiotics to eliminate future infections. A referral to a urologist also may be in order to rule out anatomical issues that may be contributing to the problem. 

Read more about UTIs in our Health Library.