Treatment From A Gp For Utis That Keep Coming Back
If your UTI comes back after treatment, you may have a urine test and be prescribed different antibiotics.
Your doctor or nurse will also offer advice on how to prevent UTIs.
If you keep getting UTIs and regularly need treatment, a GP may give you a repeat prescription for antibiotics.
If you have been through the menopause, you may be offered a vaginal cream containing oestrogen.
Why Does It Happen
Vaginas maintain their own balanced mix of yeast and bacteria. A type of bacteria called Lactobacillus keeps the vagina slightly acidic, which isnt welcoming to yeast. This slightly acidic environment keeps the yeast growing in the vagina under control.
Broad-spectrum antibiotics, which you might take for bronchitis or a sinus infection, are like a bomb to your bodys natural balance of bacteria. They wipe out the bad bacteria causing your illness.
Antibiotics also wipe out beneficial bacteria, including Lactobacillus. Without enough Lactobacillus, your vagina becomes less acidic, making it an ideal environment for yeast.
There are several things you can do to reduce your risk of getting a yeast infection after you take antibiotics.
Can Probiotics Prevent Utis
Probiotics are live microorganisms that you can supposedly take for health benefits. The most commonly recommended probiotic for recurrent UTIs is Lactobacillus, a type of bacteria that normally lives in our gut and helps keep it healthy.
The theory is that lactobacilli prevent invaders like E. coli from attaching to cells in vagina and hiding until they cause a reinfection later. Studies have found that women who have recurrent UTIs dont have enough lactobacilli.
Lactobacillus comes in a capsule that you take by mouth or as an intravaginal suppository. In a few studies, it lowered the number of UTIs that women experienced. In another small study, taking Lactobacillus and cranberry supplements together was more effective than taking them separately. However, when multiple studies on Lactobacillus were reviewed, the results were inconsistent. Also, When Lactobacillus was compared to TMP/SMX, the antibiotic worked better than Lactobacillus at reducing UTIs.
Recommending Lactobacillus is also difficult because there are many different strains of the bacteria that havent been studied well. Also, like cranberry supplements, probiotic products are not strictly regulated by the FDA nor have they been approved by the FDA to prevent UTIs.
Lactobacillus is generally safe, though there are some reports of vaginal or abdominal discomfort. It may also be costly to try different strains and products to find one that works best.
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What Does A Uti Feel Like
If you experience a strong urge to go to the bathroom, or a need to urinate more frequently probably, a Urinary Tract Infection could be responsible. Other symptoms like abdominal pressure and discomfort while urinating often accompany a UTI. While the condition can affect anybody, including babies, it mainly occurs in women.
Treatment For Complicated Utis
If your UTI is considered complicated due to extenuating circumstances, your doctor will likely still prescribe an antibiotic, but your course of treatment may be different. For example, while UTIs are common during pregnancy especially in the lower urinary tract pregnant women typically require a longer course of treatment, regardless of which type of antibiotic is used. The antibiotics prescribed vary according to which trimester the expectant mother is in, too. TMP, for instance, isnt used during the first trimester.
In short, if your UTI is informed by extenuating circumstances, expect your physician to take those into account as he or she determines what antibiotics may be the safest and most effective, as well as how long you need to take them.
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Can Vaginal Estrogen Products Prevent Utis
For women near menopause or who have gone through menopause and get 3 or more UTIs per year, vaginal estrogen may be helpful, according to the American Urological Association . Vaginal estrogen comes as a ring , an insert , or a cream . It is both safe and effective for women in this population who are looking to prevent recurrent UTIs.
That said, in a head-to-head trial of vaginal estrogen inserts compared to a daily preventive antibiotic, vaginal estrogen was not as effective as daily antibiotics. More on this below.
Estrogen works by making the vagina more acidic and increasing the number of healthy bacteria in the vagina. This makes it hard for E. coli to live and hide in there, which prevents them from showing up in the urinary tract later.
Some of the more commonly reported side effects of vaginal estrogen include breast tenderness, vaginal bleeding, and vaginal discomfort like itching, burning, and irritation.
If you are being treated for breast cancer or have had breast cancer, vaginal estrogen is considered safe, but you should speak with your oncologist before starting any estrogen-based products.
Other Ways To Prevent Recurring Utis
If you have more than 3 UTIs in 1 year, or 2 UTIs in 6 months, there are other things that may help prevent UTIs.
There is some evidence that women under 65 years old who keep getting UTIs may find it helpful to take:
- a supplement called D-mannose this is not recommended for pregnant women
- cranberry products, such as juice or tablets
Speak to your doctor before taking any of these during pregnancy.
Be aware that D-mannose and cranberry products can contain a lot of sugar.
Page last reviewed: 18 November 2020 Next review due: 18 November 2023
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Key Points About Urinary Tract Infections
- Urinary tract infections are a common health problem that affects millions of people each year. These infections can affect any part of the urinary tract.
- Most UTIs are caused by E. coli bacteria, which normally live in the colon.
- The most common symptoms of UTIs include changes in urination such as frequency, pain, or burning urine looks dark, cloudy, or red and smells bad back or side pain nausea/vomiting and fever.
- Antibiotics are used to treat UTIs. Other treatments may include pain relievers, and drinking plenty of water to help wash bacteria out of the urinary tract.
- Other things that can be done may help reduce the likelihood of developing UTIs.
Wipe From Front To Back
According to the National Institute of Diabetes and Digestive and Kidney Diseases , UTIs can develop when bacteria from the rectum or feces gain access to the urethra. This small channel allows urine to flow out of the body.
Once bacteria are in the urethra, they can travel up into other urinary tract organs, where they can lead to infections.
After urinating, wipe in a way that prevents bacteria from coming into contact with the genitals. Use separate pieces of toilet paper to wipe the genitals and anus.
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Ways To Avoid Urinary Tract Infections
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Stay hydrated. Drink plenty of water, which increases urination, thereby flushing out bladder bacteria. How much should you drink? Enough to keep your urine looking clear.
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Wipe properly. Women should wipe from front to back after using the toilet. Wiping from back to front may increase the risk of getting UTIs.
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Use topical estrogen creams. These creams may help postmenopausal women who have vaginal dryness and struggle with recurrent urinary tract infections.
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Don’t rely on cranberry juice. The evidence about whether it helps prevent UTIs is mixed. And the juice has lots of sugar and calories.
Take With Or Without Food
Check the label on your antibiotics. Does it recommend taking them with food or on an empty stomach?
In either case, follow the directions. Some antibiotics are better absorbed on an empty stomach, so you dont want to limit their effectiveness. But if the label says, Take with food, taking your pills with a meal might help ease stomach issues.
Beyond the specifics above, good old-fashioned advice for treating diarrhea still applies. Drink plenty of water to avoid dehydration, and use rehydrating beverages high in electrolytes if needed. Avoid alcohol and caffeine if theyre making your diarrhea worse. Keep in mind alcohol may actually cause severe reactions while you are taking certain antibiotics, so check the label for that information, as well. Eat a more bland diet than you might normally eat.
Its better to use caution than get hit with unpleasant side effects.
Common sense would say you are going to disturb the natural balance with antibiotics, Dr. Rabovsky says, so anything else that causes you GI symptoms could make side effects even worse.
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What Are Urinary Tract Infection Risk Factors
There are many risk factors for UTIs. In general, any interruption or impedance of the usual flow of urine is a risk factor for a UTI. For example, kidney stones, urethral strictures, an enlarged prostate, or any anatomical abnormalities in the urinary tract increases infection risk. This is due in part to the flushing or washout effect of flowing urine in effect, the pathogens have to “go against flow” because the majority of pathogens enter through the urethra and have to go retrograde to reach the bladder, ureters, and eventually the kidneys. Many investigators suggest that women are far more susceptible than men to UTIs because their urethra is short and its exit is close to the anus and vagina, which can be sources of pathogens.
People who require catheters have an increased risk as the catheter has none of the protective immune systems to eliminate bacteria and offers a direct connection to the bladder. Catheters that are designed to reduce the incidence of catheter-related infections are available , but are not used by many clinicians because of short-termed effectiveness, cost, and concern about antibiotic resistancedevelopment in bacteria.
Contact Doctor Within 24 Hours
- Blood in urine and new onset since starting antibiotic
- Taking antibiotic more than 24 hours, and pain with passing urine is severe.
- Taking antibiotic more than 48 hours and fever still there or comes back
- Taking antibiotic more than 3 days and pain not better
- You think your child needs to be seen, but the problem is not urgent
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Uti Diagnosis And Treatment
Think you may have a UTI? The standard way to diagnose one is a urine culture. Most doctors will ask for a clean catch sample, where you pee into a cup midstream after carefully wiping your outer vaginal area.
If you are diagnosed with a UTI, your doctor will likely provide a pregnancy-safe antibiotic for seven to 14 days to get rid of all of the bacteria. Be sure to take the recommended full course, even if you start to feel better midway through treatment, and drink plenty of water.
If the infection has reached your kidneys, your practitioner may suggest staying in the hospital, where you can receive IV antibiotics.
Keep in mind: Some women have a UTI with no symptoms at all. Because an untreated infection can lead to complications including kidney infection and, potentially, an increased risk of fetal growth restriction, preeclampsia and preterm birth notify your provider immediately if you have any UTI-like symptoms.
Likewise, the urine tests at your regular prenatal visits are really important.
Why Do Women Get Urinary Tract Infections More Often Than Men
Women tend to get urinary tract infections more often than men because bacteria can reach the bladder more easily in women. The urethra is shorter in women than in men, so bacteria have a shorter distance to travel.
The urethra is located near the rectum in women. Bacteria from the rectum can easily travel up the urethra and cause infections. Bacteria from the rectum is more likely to get into the urethra if you wipe from back to front after a bowel movement. Be sure to teach children how to wipe correctly.
Having sex may also cause urinary tract infections in women because bacteria can be pushed into the urethra. Using a diaphragm can lead to infections because diaphragms push against the urethra and make it harder to completely empty your bladder. The urine that stays in the bladder is more likely to grow bacteria and cause infections.
Frequent urinary tract infections may be caused by changes in the bacteria in the vagina. Antibacterial vaginal douches, spermicides, and certain oral antibiotics may cause changes in vaginal bacteria. Avoid using these items, if possible. Menopause can also cause changes in vaginal bacteria that increase your risk for urinary tract infection. Taking estrogen usually corrects this problem but may not be for everyone.
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How Are Urinary Tract Infections Treated
Your health care provider will figure out the best treatment based on:
- How old you are
Treatment for UTIs may include:
- Antibiotics
- Other medications to ease pain
- Heat to ease pain
You may also need to make lifestyle changes such as:
- Drinking plenty of water to help wash bacteria out of the urinary tract
- Avoiding coffee, alcohol, and spicy foods
- Quitting smoking
Do Cranberries Prevent Utis
Research on whether or not cranberries can prevent UTIs is inconsistent. Some studies show a benefit while others show very little or no benefit. Some researchers think that cranberries work because they have a component called proanthocyanidin that makes it hard for E. coli to move around and attach to the urinary tract.
There are no clinical recommendations for an exact dose or product to use. Small clinical studies suggest that 150 mL to 750 mL of cranberry juice every day might be helpful. Other small studies have shown that dried cranberries and cranberry tablets might work. The FDA also does not regulate cranberry products like they do medications.
Cranberries are generally considered to be safe. However, too much can cause stomach irritation and weight gain . Cranberries can also affect how medications behave, so be sure to consult your provider if you are considering taking them at the same time. Also keep in mind, cranberries are not as effective as antibiotics a 2011 clinical trial showed TMP/SMX led to fewer UTIs per year than cranberry capsules .
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The Power Of Probiotics
It may seem strange: Youre taking antibiotics, so wouldnt probiotics undo the good your treatment is doing?
However, probiotics add helpful bacteria to your digestive system not the bacteria that cause infections. They dont have any effect on the antibiotic treatment. They only treat the side effects.
The thing that has really been shown to help the most with preventing diarrhea is taking probiotics when taking antibiotics, Dr. Rabovsky says. He notes that reviews of studies suggest probiotics are effective both for regular antibiotic-associated diarrhea and for diarrhea related to C. diff. They also seem to help with side effects such as cramping and gas.
Probiotics come in several varieties. The most commonly studied for antibiotic-associated diarrhea are Lactobacillus rhamnosus-based and Saccharomyces boulardii-based probiotics. Probiotics come in capsules, tablets, powders and even liquid form.
With so many options, be sure to ask your doctor for advice before taking any probiotics, as you should for any type of supplement. Probiotics could possibly be harmful for people with immune deficiencies or those who are severely debilitated.
Does Taking An Antibiotic After Sex Prevent Utis
According to the American Academy of Family Physicians, having sex three or more times a week increases your risk for recurrent UTIs. Your risk is also increased if you use a diaphragm or spermicide products, regardless of the frequency of sexual activity. If you experience recurrent UTIs, changing your method of contraception should be the first thing you consider.
If you continue to suffer from UTIs and they are getting in the way of living a normal life, taking a preventive antibiotic could be an option. Taking regular antibiotics is not a risk-free treatment though, so have a conversation with your provider about whether this is right for you. Taking an antibiotic before or after sex can prevent recurrent UTIs especially if UTIs repeatedly show up 24 hours after intercourse.
During sex, bacteria can get into the urinary tract and cause infections. Antibiotics work by fighting these bacteria. E. coli is the most common bacteria that causes UTIs. Common antibiotics used to treat UTIs are nitrofurantoin, cephalexin, or trimethoprim/sulfamethoxazole .
A clinical trial showed that only 2 out of 16 women who took TMP/SMX right after sex had recurrent UTIs compared to 9 out of 11 women who had a sugar pill. The results were the same regardless of how often the women had sex.
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Should I Take Antibiotics To Prevent Uti
Not usually. Antibiotics are medicines used to kill bacteria that cause infection. When you take an antibiotic to kill bacteria, the bacteria can change or adapt in a way that it becomes resistant to the antibiotic being used. This means that the antibiotic can no longer kill the bacteria. It takes a stronger antibiotic to then kill the bacteria in the future. There are a limited number of antibiotics that can kill bacteria, so its best to use antibiotics only when needed to avoid reaching the point when the bacteria are resistant to all antibiotics.
Here are a few recommendations for using antibiotics and better avoiding antibiotic resistance.
- Do not take antibiotics that are not prescribed to you.
- Do not take antibiotics for conditions that do not require them. For example, dont take antibiotics to treat viruses like the cold or flu.
- Do not take antibiotics simply because your urine has bacteria. It is very common for people with SCI to have bacteria in their urine, so you usually only need to take an antibiotic to treat a UTI when you begin to you have signs and symptoms.
- Antibiotics may be used to prevent infection in some situations. For example, women with SCI are often prescribed antibiotics to prevent UTI during pregnancy.
