Recurrent Urinary Tract Infection

What is urinary tract infection?

Urinary tract infection is an infection at some location alongside the urinary tract. The urinary tract includes the kidney, the ureter and the bladder.

What causes urinary tract infection?

Women are at risk of urinary tract infection, because of the short urethra, in comparison to men. Sexual activity, pregnancy and delivery, the menopause (change) and diabetes mellitus predispose to infection as well.

How does urinary tract infection present?

Patients may not necessarily be aware they have an infection and presentations vary according to the location of infection. Patients with kidney infection may have loin pain whereas patients with bladder infection may feel pain in the pelvis. Urine may smell, sting or become cloudy.

Patients may go to the toilet more often and / or have to rush to the toilet to pass water. Patients may feel unwell, suffer from nausea, vomiting and / or experience fever.

How is the diagnosis made?

The diagnosis is made by taking a sample of water to be tested. Patients will be asked to obtain a clean sample, which is called midstream urine. Patients will be asked to clean the area down below with water, start passing urine and collect urine half way. Urine dipstick, microscopy or culture and sensitivity will then be carried out to check the sample.

How is the condition treated?

Antibiotics are required to clear active infection. The route varies according to the severity of infection. Very unwell patients may need to be admitted to hospital to be given antibiotics through a drip. Most patients however can be treated with oral antibiotics at home. It is important to complete the course of antibiotics to the end, rather than till the features of infection ease, to ensure complete eradication of infection. If you are able to drink, then drinking plenty of water helps flush the infection.

Patients with underlying or contributory cause(s) need these to be addressed. For example, good control of blood sugar is important in diabetic patients and the use of local oestrogen cream after the menopause (change) may help improve vaginal atrophy.

For patients who suffer from recurrent urinary tract infection, the use of low dose daily antibiotic may be required. Cranberry juice may help, as it prevents bacteria from attacking the lining of the urinary tract.

Cranberry juice is also available in tablet form. Both however are better avoided if there is history of stones.

Drinking adequate fluids, 1½ to 2 litres per day, will help. Avoiding bladder irritants, such as spicy food, alcohol and caffeine, may also be beneficial.

Good toilet hygiene is important. For example, washing the area down below with water after passing urine and wiping from front to back help reducing infection.

Some advice cleaning the genital area and passing urine before and after intercourse as well. Avoiding tight underwear and wearing cotton underwear can also help.