Why Do You Keep Getting UTIs?

You may have read that most people — and especially women — suffer at least one urinary tract infection in their lives. If that seemed awfully low to you, because you're plagued by UTIs all the time, you may wonder why you have to be afflicted with this common ailement so often, and what you can do to break that cycle of recurrent UTis.

The urinary tract consists of the kidneys, the ureters, the urinary bladder and the urethra. Any infection of this tract is called a urinary tract infection (UTI). The urinary bladder is most commonly involved in a UTI and a bladder infection is generally not medically serious when it is treated right away. However, if the treatment is delayed, the pathogens that cause the infection may ascend to the kidneys and infect them, leading to a kidney infection. An infection of the kidneys is a serious condition tthat may lead to permanent damage.

Unlike other infections, urinary tract infections tend to recur. A person is said to be suffering from a recurrent UTI if she or he (because yes, urinary tract infections affect men, too) has two episodes of UTI within 6 months or three episodes within a year.

• 80 percent of all UTIs are caused by Escherichia coli bacteria
• 10 to 15 percent of the cases are caused by Staphylococcus saprophyticus.
• Enterococcus, Klebsiella, Enterobacter, and Proteus species are also implicated in certain cases.

Common symptoms of UTI

Common symptoms of UTI include pain and burning during micturition (urination), a strong and frequent urge to urinate, passing a small amount of urine, heaviness or bloating in the lower abdomen, a change in the color or odor of urine, blood in the urine, pain in the side of the back under the ribs, nausea and vomiting, and fever associated with chills.

People more prone to develop UTIs: The risk factors

Although anybody can suffer from a UTI, people suffering from any sort of spinal cord injury or damage to nerves innervating the urinary bladder, are more prone to develop UTIs. This is because of the stasis of urine in the bladder for a long time allowing bacteria to multiply. Similarly, any obstruction in the normal passage of the urine caused by a kidney or ureteric stone, an enlarged prostate gland or any other growth, can lead to the development of a UTI.

People who suffer from diabetes or any other chronic medical condition which lowers the body’s natural defense mechanism (immune system) are more likely to suffer from a UTI, too.

The presence of catheters or any other tubes in the urethra or the bladder interfere with the body’s innate ability to flush out microbes. In certain cases, catheters may themselves be a source of infection. That is why the Infectious Diseases Society of America advocates the use of catheters for the shortest duration of time possible.

Recurrent urinary tract infections in men usually occur because the bacteria hide deep inside the prostate tissue and multiply there. However, women are far more prone to develop recurrent UTIs than men. While men have a 1 in 20 lifetime risk of developing a UTI, in women the risk is as high as 1 in 3.

Women Are More Prone To Develop Recurrent UTIs

The likelihood of women developing recurrent UTI is very high.

Of all the women who develop at least one UTI in their young age, at least 20 percent will have a recurrent infection. And with every subsequent attack of UTI, her chances of having another episode increase further.

As much as 30 percent of women who have had two bouts of UTI will be plagued by a urinary tract infection a third time, while 80 percent of women who went through three episodes of UTI will have a fourth episode.  And four of these women will have another episode of UTI within 18 months of the fourth one.

In the majority of cases, the UTI is caused when bacteria from the digestive tract gain an entry into the urethra and travel up to reach the urinary bladder. Bacteria and other pathogens can also travel from the vagina to the urethra during sexual intercourse. As the length of urethra in women is quite short compared to that in men, these microorganisms can easily reach the bladder and cause a UTI.

Certain women are more sensitive to spermicides. These spermicides, which can be present within certain condoms or bought alone, can irritate the skin and this, in turn, can facilitate the entry of bacteria into surrounding tissue. The use of a diaphragm hampers the flow of the urine and gives time to the bacteria present in urine to multiply, as well. Similarly, the use of douching, tampons and feminine deodorants can also cause irritation of the skin and give a chance to bacteria to invade the tissues around the reproductive organs.

In postmenopausal women, the tissue surrounding the urinary tract thins out. This natural weakening of the body’s defense mechanism can increase the risk of a bacterial infection.

Although the chances of getting a UTI in a pregnant woman are similar to those in other women, the likelihood of a UTI to involve the kidneys is higher during pregnancy. Scientists blame the shift in position of the urinary tract and the difference in the level of hormones during pregnancy for facilitating the ascending movement of the bacteria. That is why pregnant women are regularly screened for UTI during the first trimester.

Researchers have been trying to analyze the reason behind recurrent urinary tract infections

One study, funded by the National Institutes of Health (NIH), found that bacteria are able to form a protective film on the inner lining of the bladder in mice. If the same is found to be true in case of humans too, it could lead to new ways of treating or preventing recurrent UTIs. Researchers have opined that recurrent UTIs result due to the ability of bacteria to attach to the inner membrane of the urinary tract.

Some researchers have found that women who are non-secretors of specific blood group antigens are more likely to suffer from recurrent urinary tract infections. Non-secretors are persons who do not secrete the normal antigens that are associated with their blood type in the bodily fluids they excrete. The urinary bladder wall is also lined by protective body fluids. In case of non-secretors, the absence of antigens allows bacteria to attach more easily to the bladder wall, a fact that can in turn result in recurrent urinary tract infections.

How to prevent recurrent urinary tract infections

Experts suggest that people, and especially women, take a variety of proactive steps to prevent recurrent urinary tract infections. These include:

• Drinking plenty of liquids so that pathogens can be flushed out easily through the bladder
• Urinate whenever you feel the urge. Holding urine in for prolonged period results in its stagnation in the bladder, allowing time for bacteria to multiply and cause infection.
• Wipe from front to back after a bowel movement to prevent fecal bacteria from contaminating the urethral opening.
• Pass urine after intercourse, as soon as possible.
• Change to some other method of birth control in case of recurrent UTIs to prevent irritation of the skin.
• Wear loose fitting cotton underwear to allow circulation of air and keep the urethral opening dry.

Treatment of recurrent UTIs

• Experts from NIH suggest low doses of prescribed antibiotics daily for 6 months or more, preferably at bedtime.
• A single dose of antibiotic following intercourse.
• A short course of antibiotics for two to three days whenever symptoms appear.