Management And Prevention Of Recurrent Urinary Tract Infections In Women
Farford B. Management and prevention of recurrent urinary tract infections in women. Consultant. 2018 58:99-103.
An estimated 150 million urinary tract infections occur worldwide each year, approximately 80% of which occur in women, making UTIs one of the most common causes of bacterial infection in women of all ages.1 UTIs have a significant impact on morbidity and account for more than $6 billion in annual direct health care costs in the United States.1
Approximately 20% to 30% of women who develop a UTI will have a recurrence.1,2 Recurrent UTIs lead to increases in the number of office visits, time off from work, the number of urologic evaluations, and the use of antimicrobials.3 Although the evaluation and management of recurrent UTIs are similar to that of single-episode UTIs, there are a number of effective strategies to consider when managing recurrent UTIs.
Definitions
A UTI is generally considered complicated if the patient has an anatomic abnormality, a voiding dysfunction, or an obstructed urinary tract, or if the infection is iatrogenic. Pregnancy, urolithiasis, diabetes, and immunosuppression are also associated with complicated UTIs.4
Pathogenesis
Risk Factors
Diagnosis
Treatment
Prevention
Bryan Farford, DO, is a physician at Mayo Clinic Florida in Jacksonville, Florida.
References:
Risk Factor #1: Sweetened Drinks And Soda
Carbonated drinks are known to increase the occurrence of some lower urinary tract symptoms. Diet sodas alone contain four well-known bladder irritants: acidic carbonation, citric and other acids, caffeine, and artificial sweeteners.
What You Can Do About It
If this is your only reason to give up sweetened and carbonated drinks, youre already doing better than most people. No one needs these drinks. Removing them from your diet will help with more than prevention UTIs. Water is the best replacement.
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How To Feel Better
If your healthcare professional prescribes you antibiotics:
- Take antibiotics exactly as your healthcare professional tells you.
- Do not share your antibiotics with others.
- Do not save antibiotics for later. Talk to your healthcare professional about safely discarding leftover antibiotics.
Drink plenty of water or other fluids. Your healthcare professional might also recommend medicine to help lessen the pain or discomfort. Talk with your healthcare professional if you have any questions about your antibiotics.
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Strengths And Limitations Of This Study
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Recurrent urinary tract infection is one of the most common reasons for long-term antibiotic use in the frail elderly. We systematically reviewed trial evidence to address clinical uncertainties around this practice.
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We did not identify any trials in older men nor any trials in frail care home residents.
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We identified only three small European trials, with follow-up ranging from 6 to 15 months, in older women.
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Only one trial measured the impact of long-term antibiotics on antibiotic resistance.
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Trial evidence suggests long-term antibiotics reduce the risk of UTI recurrence in older women. Many clinical uncertainties remain unaddressed.
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How To Prevent Uti: 23 Tips That Can Help Overcome Recurrent Utis
You may have heard how to prevent UTI with tips like, wipe from front to back, or pee after sex. But there are others its almost certain you havent considered.
So this article will cover the basics as well as some lesser known but potentially highly effective tips about how to prevent UTI.
Jump To Section:
- How to Prevent UTI After Sex > > > >
- Why you should reconsider your body products > > > >
- UTIs and diet, drinking and smoking > > > >
- Habits that may increase your risk of UTI > > > >
- Health signals you shouldnt ignore > > > >
Antiseptic Drug As Good As Antibiotics For Preventing Recurrent Utis
The antiseptic drug methenamine hippurate is as good as antibiotics for preventing recurrent urinary tract infections in women, finds a trial published by The BMJ.
Its use as an alternative to antibiotics may also help tackle the global burden of antibiotic resistance, say the researchers.
Over half of women have at least one urinary tract infection in their lifetime, and recurrence occurs in about a quarter of women who have one episode.
Current guidelines recommend daily low dose antibiotics as the standard preventive treatment for recurrent UTI. But such long term use of antibiotics has been linked to antibiotic resistance, so research into non-antibiotic alternatives is urgently needed.
Methenamine hippurate is a drug that sterilises urine, stopping the growth of certain bacteria. Previous studies have shown that it could be effective in preventing UTIs, but the evidence is inconclusive and further randomised trials are needed.
So a team of UK researchers, led by clinicians and scientists from Newcastle set out to test if methenamine hippurate is an effective alternative to standard antibiotic treatment for preventing recurrent UTI in women. The research was led by Mr Chris Harding, consultant urological surgeon, Newcastle Hospitals NHS Foundation Trust and a senior lecturer at Newcastle University.
The non-inferiority margin, defined after a series of patient focus group meetings, was a difference of one UTI episode per year.
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Risk Factor #: Tampons
What You Can Do About It
If you think this may be a problem for you and you can avoid using tampons, do. If this isnt an option, do your best to find a brand that is manufactured without chemicals. Be sure to wash your hands before changing tampons, and try to empty your bladder completely whenever you feel the urge to urinate. Taking steps to learn how to prevent UTI can seem inconvenient at first, but implementing small changes one at a time can make a big difference.
Data Synthesis And Analysis
For analysis, included studies were classified into 3 main groups: placebo-controlled studies , head-to-head studies , and continuous vs intermittent approaches . One study differed from all other studies in terms of design and is therefore discussed individually.
The meta-analysis of the PC studies was based on a comparison of pooled risk ratios in the 2 arms. As microbial recurrences are now considered to be of minor relevance, a subanalysis restricted to reported clinical recurrences in the included studies was performed.
HH prophylaxis comparisons were based on the number of infections per person-year, also in terms of an RR calculation. Heterogeneity was evaluated using the Q and I2 statistics and considered to be significant if the P value using the chi-square test was < .1 for Q and to be high if the I2 value was 75%. Confidence intervals for I2 were based on the Higgins and Thomson calculation . All meta-analyses were performed using the statistical package OpenMetaAnalyst utilizing the meta and metafor packages in R , based on random- and fixed-effects models. Where appropriate, the absolute risk reduction was used to calculate the number needed to treat .
Publication bias was investigated using funnel plots and the arcsine test . A sensitivity analysis was added to investigate the potential effects of publication bias based on the trim and fill method and the Copas selection model and using the metasens package in R.
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Are Otc Urinary Tract Infection Drugs Safe
Over-the-counter drugs for urinary tract infections are generally safe for most people. However, if you have certain medical conditions or are pregnant or nursing, you may not be able to take these medications. Always read the warnings printed on the packaging. Consult your primary care physician if youre unsure about taking any OTC drug.
Urinary tract infections are some of the most frequent clinical bacterial infections in women, accounting for nearly 25 percent of all infections. More than 50 percent of women will develop a UTI and UTI symptoms in their lifetimes, and because antibiotics are the most common conventional treatment for UTIs, bacteria have become antibiotic-resistant and recurring infections are a major concern. For this reason, its important to use home remedies for UTIs that eliminate bacteria completely and reduce the risk of developing recurrent urinary tract infections.
Some of the best home remedies for UTI include drinking plenty of fluids, staying clean and dry, and consuming things like cranberries, probiotics, vitamin C and using essential oils. Read on for all 12 of my top home remedies for UTI.
How Is A Chronic Urinary Tract Infection Diagnosed
If you have a chronic UTI, you probably had a UTI in the past.
Performing lab tests on a sample of urine is the most common method doctors use to diagnose UTIs. A medical professional will examine the sample of urine under a microscope, looking for signs of bacteria.
In a urine culture test, a technician places a urine sample in a tube to encourage the growth of bacteria. After one to three days, theyll look at the bacteria to determine the best treatment.
If your doctor suspects kidney damage, they may order X-rays and kidney scans. These imaging devices take pictures of parts inside your body.
If you have recurring UTIs, your doctor may want to perform a cystoscopy. In this procedure, theyll use a cystoscope. Its a long, thin tube with a lens at the end used to look inside your urethra and bladder. Your doctor will look for any abnormalities or issues that could cause the UTI to keep coming back.
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How Can Parents Help
At home, these things can help prevent recurrent UTIs in kids:
Drinking Fluids Encourage kids to drink 810 glasses of water and other fluids each day. Cranberry juice and cranberry extract are often suggested because they may prevent E. coli from attaching to the walls of the bladder. Always ask your doctor, though, if your child should drink cranberry juice or cranberry extract, because they can affect some medicines.
Good Bathroom Habits Peeing often and preventing constipation can help to prevent recurrent infections.
No Bubble Baths Kids should avoid bubble baths and perfumed soaps because they can irritate the urethra.
Frequent Diaper Changes Kids in diapers should be changed often. If poop stays in the genital area for a long time, it can lead to bacteria moving up the urethra and into the bladder.
Proper Wiping Girls should wipe from front to back after using the toilet to reduce exposure of the urethra to UTI-causing bacteria in poop.
Cotton Underwear Breathable cotton underwear is less likely to encourage bacterial growth near the urethra than nylon or other fabrics.
Regular Bathroom Visits Some kids may not like to use the school bathroom or may become so engrossed in a project that they delay peeing. Kids with UTIs should pee at least every 3 to 4 hours to help flush bacteria from the urinary tract.
Risk Factor #1: Diet And Utis
Highly acidic or alkaline foods can cause further irritation and inflammation in an already fragile urinary tract. Foods high in histamine are also known to cause bladder discomfort.
What You Can Do About It
Because food-related symptoms vary by person, its a good idea to monitor your diet and any irritation that follows ingesting certain foods. For some people, it can help to avoid chocolate, citrus fruits, vitamin C and acids like vinegar. In the case of vitamin C, a bladder-friendly, buffered vitamin C may be kinder on the bladder.
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When Should I Call The Doctor
As soon as you think that your child has a UTI, call your doctor. The doctor may recommend another urine test after treatment to be sure that the infection has cleared.
If your child has from recurrent UTIs, consult a pediatric urologist, who can do a thorough evaluation and order tests for urinary system abnormalities. In the meantime, follow your doctor’s instructions for treating a UTI.
Implications For Research And Practice
Based on the data we analysed, a pragmatic approach is required when considering prescribing long-term antibiotics in older patients with recurrent UTI. Although long-term antibiotics may reduce the risk of UTI recurrence in women, this benefit diminishes on cessation of treatment. Little is known about optimal prophylaxis period, long-term effects on health, risk of antibiotic resistant infections, effect in older men, effect in frail care home residents or impact on important patient-centred outcomes. These unknowns must be balanced against benefits and patient preferences.
Future research efforts on recurrent UTI should focus on improving the design and reporting of trials and developing a core set of outcomes to allow better synthesis of trial data. Antibiotic prophylaxis should be compared with non-antibiotic prophylaxis with some evidence of efficacy rather than those with little or poor evidence of efficacy. Researchers should address unanswered questions regarding long-term effects, duration of use, adverse effects and antibiotic resistance.
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What Is The Urinary Tract
Urine is one of the body’s liquid waste products, and the urinary tract makes and stores it. The following are the parts of the urinary tract:
Kidneys: These small organs are situated slightly above the hips on the back of your body. They serve as the body’s filters, removing waste and water from the blood. This waste turns into urine.
Ureters: The ureters are thin tubes that transfer urine from your kidneys to your bladder.
Bladder: The bladder is a sac-like container that stores urine before it leaves your body.
Urethra: The tube that transports urine from your bladder to the outside of your body.
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What Is The Long
Urinary tract infections are uncomfortable and painful. Most chronic UTIs will resolve with a prolonged course of antibiotics, but monitoring for further symptoms is important since the chronic UTIs usually recur. People with UTIs should monitor their bodies and seek immediate treatment with the onset of a new infection. Early treatment of infection decreases your risk for more serious, long-term complications.
If youre susceptible to recurring UTIs, make sure to:
- urinate as often as needed
- wipe front to back after urinating
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What Does The Science Say About How To Prevent Uti
Research does support many of the tips on how to prevent UTI covered below. The scientific evidence linking recurrent UTIs to others like wiping patterns, douching, or wearing of tight undergarments is varied and in some cases the evidence is weak, so we share certain tips with that in mind.
We also know, after interviewing many members of our community, that regardless of scientific evidence, a combination of health, diet and lifestyle changes can mean the end of recurrent UTIs for some.
We listened to their stories, collated their suggestions, looked for supporting evidence, and we present what we found out below.
It never hurts to have a quick run through the list to see how your own habits measure up.
If your recurrent UTIs are caused by an embedded infection in your bladder, its unlikely changing one of these habits alone will result in a cure. However, the right changes could support your treatment and help your body recover faster.
Possible Preventive Strategies For Utis
While the research is still out on the preventative strategies below, prospects are promising.
- Probiotics The probiotic strain Lactobacillus, found in fermented milk products, has been shown to prevent urinary tract infections in laboratory testing. Theres also promising research that shows the strains L. rhamnosus gr-1 and L. fermentum rc-14 could prevent UTIs as well.
- Cranberry Juice Cranberries contain polyphenols called proanthocyanidins, which may help prevent E. coli from causing urinary tract infections in women, but data is conflicting about the effectiveness. While a meta-analysis published in the journal JAMA Internal Medicine showed a decrease in UTI rates in those who consumed daily cranberry tablets, a subsequent review published in the Cochrane Database found insufficient evidence to recommend routine use of cranberry. The American Urological Association does recommend cranberry extract as a preventive measure for UTIs Ellura is a brand of cranberry extract capsules.
- Diet Adjustment Research has shown that urine with higher pH levels and higher levels of certain metabolites formed by gut microbes are better able to resist recurrent UTIs. Its thought that one can improve these levels through diet. For instance, calcium supplements raise urinary pH levels. In addition, consuming foods rich in antioxidants, like tea and colorful berries, may encourage growth of metabolites.
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Diagnosis Of Recurrent Urinary Tract Infection In Dogs
As in any other case, the vet will start with a full body examination and take your dogs history. The vet will probably ask questions like:
- When did you first notice changes in your dogs urinating patterns?
- What are the exact urinary patterns you noticed?
- Are there other accompanying symptoms?
- Does your dog have any underlying or chronic issues?
- Is your dog receiving any new drugs or supplements?
Then, based on the initial findings, the vet will proceed with some more specific diagnostic tests and procedures. Following are several diagnostic procedures for diagnosing urinary tract infections.
General Measures To Prevent Recurrent Urinary Tract Infection
Some of the general measures recommended to reduce the rate of recurrent urinary tract infections in women include:
- Having sufficient fluid intake.
- Excessive fluid intake on a regular basis has not been shown to reduce the rate of recurrent UTIs
Dr. Karen McKertich
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