Urinary Tract Infection (UTI): How to Prevent Recurrence

1. Wipe the groin area from front to back to prevent bacteria from spreading from the rectal area to the vagina and ascending to the bladder.

2. Avoid potential irritants such as vaginal deodorants, vaginal douching agents and bubble baths.

3. Wash the genital area often with water and normal soap during showers. Voiding (or urinating) after intercourse is encouraged.

4. Avoid use of diaphgrams and spermicide by considering other forms of contraception.

5. Drink plenty of water. Target to drink 2-3 litres daily. This does not apply if the person is on fluid restriction regimes for other medical conditions such as congestive heart failure.

6. Empty your bladder fully to prevent bacteria from multiplying in the bladder.

7. Seek prompt treatment for vaginal / lower genital tract infection to prevent it from spreading. Drinking cranberry juice has possible but limited benefits of preventing UTI (find out more in the article here).

8. Probiotics (live culture yogurt) have also been shown to reduce the chance of getting UTI as "good" live bacteria is introduced into the bowels of patients and reduces the chance of the "bad" bacteria in bowels spreading and causing UTI.

9. A once-daily dose of an appropriate antibiotic (usually taken for a minimum duration of three months) may be indicated in patients with a history of multiple episodes of UTI to minimise the risk of recurrence of infection.

10. Seek proper treatment promptly for any vaginal/lower genital tract infection as such infections can spread to the urinary tract.

Early recognition and adequate treatment of UTI is necessary to prevent complications. Signs to look out for include:

• Pain on passing urine (dysuria), often described as a burning sensation
• Urinary urgency
• Passing urine more frequently than usual
• Passing foul-smelling urine or cloudy urine
• Sensation of bladder fullness or lower abdominal discomfort
• Fever
• Blood in the urine (haematuria)
  
• Flank pain and tenderness over the lower back area next to the spine (may suggest involvement of the upper urinary tract)

It is advisable to seek treatment if the infection doesn’t clear up in a few days. The infection is normally confined to the bladder, but may spread to the kidneys, which is serious and may cause permanent damage.

Additionally, you should consult a doctor if:

• Symptoms do not improve after a few days of home treatment or prescribed antibiotics
• You experience recurrent UTIs (two or more UTIs within 6 months)
• You have fever or chills, which may indicate that the infection has spread to the kidneys
• You are pregnant and suspect a UTI, as untreated infections can lead to complications for both mother and baby
• You have underlying health conditions, such as diabetes or kidney problems, that could increase the risk of complications

Some factors that increase a women’s risk of developing UTI include:

• Age: The rate of UTIs in women gradually increases with age.

• Incomplete bladder emptying, which allows the residual urine to be rapidly infected by bacteria present. Causes include:

  • Pregnancy – about 15 per cent of pregnant women will experience a UTI

  • Bladder, uterine or any other pelvic organ prolapse

• Sexual intercourse, which seems to trigger a UTI infection in many women, although the reason for this is unclear.

• Use of diaphragm and condoms with spermicidal foam as contraceptives

• Immunosuppression with certain medications or drugs

• Diabetes

• Menopause with the attendant loss of oestrogen

• Abnormalities of the urinary tract, such as kidney or renal stones, which act as a focus for infection

• Instrumentation of the urinary tract (e.g. catheterisation, cystoscopy)

• Medical conditions (e.g., diabetes). Diabetes leading to glycosuria (sugar in the urine) makes for a fertile breeding ground for bacteria. A study showed that 9.4% of patients with type 2 diabetes had a UTI compared to only 5.7% of people without diabetes.
  
  
• Co-existing diseases involving the pelvis (e.g., tumours, inflammatory bowel disease).

Diagnosis of UTI can be obtained from a well-taken history and physical examination. Specific tests to confirm UTI include a urine dipstick, urine analysis and urine culture.

The main treatment prescribed for urinary tract infections is usually empirical antibiotics. Alternative antibiotics may be prescribed after the urine culture results are available if the initial antibiotic is found to be ineffective against the infection.

The duration of treatment of the UTI depends on the antibiotic in use. Some common first-choice agents for the treatment of uncomplicated cystitis in women include nitrofurantoin, Bactrim or beta-lactams such as Cephalexin.

You may also be given medication to make the urine more alkaline and asked to drink more water.

Most patients can be treated on an outpatient basis. However, hospital admission for management of complicated UTIs may be indicated in some patients.

Complicating factors include the presence of structural abnormalities (e.g., stones, indwelling catheters), metabolic disease (e.g., diabetes, pre-existing kidney disease) or patients who are immunosuppressed and therefore more prone to serious infections (e.g., HIV, patients on chemotherapy).

Urinary tract infections may be classified by where the infection occurs in the urinary tract or its severity (uncomplicated versus complicated). 

• Cystitis (bladder infection): This is the most common type of UTI which occurs when bacteria infects the bladder.

• Urethritis (urethra infection): This type of UTI affects the urethra, the tube that carries urine out of the body.
  

• Pyelonephritis (kidney infection): A more severe UTI that affects the kidneys.

If UTI is left untreated...

The infection can spread upwards to the kidneys leading to complications such as infection of the kidneys and even renal failure. It can also spread via the blood stream (septicaemia) to affect the body in general, which can be fatal.