Recurrent, or Repeated Urinary Tract Infection (UTI), What are the causes?

How will you know that you have a urinary tract infection (UTI)?

You will have the typical symptoms of UTI, i.e., painful urination, feeling urgent but passing small amounts of urine frequently and a sensation of incomplete bladder emptying.

Your urine may appear cloudy and even bloody.

The causes of UTI are similar to those of recurrent or repeated UTI as listed below.

How do you know that you have recurrent or repeated UTI?

You have recurrent or repeated UTI if you have more than 3 episodes of UTI in a year but it must be confirmed by urine tests showing:

• more than 10⁵ organisms (bacteria or germs) per ml of a single organism.
• with more than 10 white blood (pus) cells per ml.

How common is it?

• About 5% of women 15 – 65 years of age have significant amount of bacteria (>105) in their urine.
• 25% of women experience at least 1 proven recurrence of UTI within 6 months of the 1st attack.

What are the causes?

• Not drinking enough fluids
• Dehydration from e.g., sports, outdoors in hot weather, food poisoning (vomiting and diarrhoea).
• Passing urine infrequently because of e.g., your job (does not allow you to visit the toilet), fear of dirty toilets, long distance travel with infrequent toilet breaks.
• After painful sex in younger women, e.g., after just beginning sexual intercourse or too frequent coitus (“honeymoon cystitis”).
• After painful sex in more matured women, from infrequent coitus or too frequent sex over a short period of time, e.g., when husband comes home from working abroad.
• Menopause.
• Unhygienic toileting habits, e.g., wiping or cleaning from back to front
• Difficulty in passing urine, e.g., after vaginal delivery, pelvic organ prolapse, after prolapse and or incontinence surgery.
• Kidney and/or bladder stone, tumour; foreign body in bladder.

What will your doctor find when he/she examines you?

• High and/or tight, painful and tender (pain on examination) posterior fourchette (the entrance of the lower part of the vagina), especially on parting the vagina.
• Pain and/or tenderness of the bladder (lower part of the tummy and/or top of the vagina).
• Pelvic organ prolapse, especially of the bladder (cystocoele) and/or uterus (womb).
• Menopausal changes: narrowing, dryness, thinning and paler colouration of the inside of the vulva and vagina.

What tests are done?

• Urine tests to check for urinary tract infection.
• Bladder scan to check the amount of urine still left inside the bladder after you have voided- to exclude a high residual urine which is common in voiding difficulty.
• Kidney and bladder scan to check for stones, tumours, foreign body, e.g., tapes or meshes.
• Cystoscopy: Inserting a medical telescope to inspect inside your bladder and urine pipe.

What can be done?

Treat the causes:

• Drink adequately: at least 1.5-2.5 L of fluids per day (7-8 cups or glasses).
• Avoid dehydration.
• Pass urine regularly (every 2-3 hourly).
• Pass urine before and after sex and to drink more in the next 1-2 days after sex.
• Use lubrication if necessary, practise foreplay to reduce vaginal dryness and painful sex.
• Experiment’ by trial and error to find out which sexual positions suit you and your partner best, causing the least discomfort and pain during sex.
• Wipe or clean from front to back after opening your bowels.
• Treat urinary tract infection (UTI) initially with broad spectrum antibiotics which may need to be changed to the appropriate antibiotic after the return of the urine culture and sensitivity result.
• Treat post-menopausal changes with local Premarin (oestrogen) cream and vaginal Vagifem (oestradiol) tablets to prevent vaginal dryness, painful sex and recurrent UTI.
• Treat pelvic organ prolapse with pessary or surgery.
• Refer patients with kidney and/or bladder stones, tumours and foreign bodies to our Urological colleagues.
• Treat a high and/or tight, painful and tender lower part of the entrance of the vagina with surgery by a minor procedure called Fenton perineoplasty.