Recurrent UTIs: Why They Happen and How to Avoid Them

Content medically reviewed by Patricia Segler, MD

If you have ever had a urinary tract infection (UTI), you know how uncomfortable it can be. More than 50% of women have a UTI at some point during their lives, which means there’s a good chance you have experienced at least one. However, for some women, UTIs occur more frequently. If you have had two within six months or three within a year, you have recurrent UTIs.

The good news is that most UTIs respond well to antibiotics. For some women, UTIs keep coming back. However, you can take steps to help prevent UTIs and avoid the complications they can cause.

What Causes Recurrent UTIs?

All UTIs, whether your first or your fifth, occur when bacteria enter the urinary tract. UTIs can develop anywhere in the urinary system, but a bladder infection is the most common type of UTI. Most UTIs occur when Escherichia coli bacteria, which live in the intestines, enter the urethra (the tube that carries urine from the bladder) and travel up to the bladder.

Women are much more susceptible than men to UTIs because their urethras are shorter, making it easier for bacteria to reach the bladder. The urethral opening is also closer to the anus, which is often the source of infection-causing bacteria.

Recurrent UTIs: Who’s at Risk?

Certain risk factors vary with age, and others may be hereditary. But some are simply more prone to getting UTIs than others, which is why the same risk factors can cause recurrent UTIs for some people.

For women who have not entered menopause, the most common risk factors for UTIs are having sexual intercourse and using spermicides. Sexual activity can increase germs in the urethra, and spermicides destroy beneficial bacteria in the vagina and make it easier for harmful bacteria to get in.

After menopause, the drop in estrogen levels in your body can make UTIs more likely. The number of healthy bacteria in the vagina declines, and vaginal tissue can become thin and dry, making it easier for harmful bacteria to grow.

Some women also have more difficulty completely emptying their bladder after menopause. If bacteria are present in the urine left behind, infections can happen. Weakening urethra muscles also make it easier for bacteria to reach the bladder.Other risk factors include –

• Diabetes. This disease can weaken your immune system as well as cause nerve damage that makes it harder to completely empty your bladder. Poorly controlled diabetes also results in glucose in the urine, and bacteria can feed upon that bacteria and grow—leading to UTIs.
• Heredity. If you have a mother or sister with recurrent UTIs, you are more likely to get them as well.
• Kidney stones. Any condition that blocks urine flow from the kidneys to the bladder can lead to UTIs. A kidney stone can also act as a foreign object to which bacteria may adhere, allowing for urinary tract infection.
• Pregnancy. Hormones during pregnancy cause urinary tract bacteria to change. Pregnant women also frequently have trouble emptying their bladder completely, making them more prone to UTIs.

UTI Symptoms and Treatment

How do you know when you have a UTI? Symptoms might include –

• A burning feeling when urinating
• An urgent need to urinate, but not much comes out when you try
• Pain or pressure in your lower abdomen
• Urine that has a foul odor or looks cloudy
• Blood in your urine (more common in younger women)
• Feeling confused, shaky or weak (more common in older women)
• Fever, which can signal the infection has spread to your kidneys

Don’t wait to see your health care provider if you have any of these symptoms. They will perform a urinalysis by taking a urine sample and testing it for bacteria. This lets your provider know what type of bacteria is present and determine the best way to treat a UTI.

When treated right away, most UTIs clear up with one course of antibiotics. If left untreated, a bladder infection can lead to a kidney infection, which is more serious. In some cases, an infection that begins in the urogenital tract (the urinary and genital tract) can travel to the bloodstream. This is called sepsis and is life-threatening. About 1 in 4 cases of sepsis start in the urogenital tract.

What Can You Do to Prevent Recurrent UTIs?

If you get recurrent UTIs, your provider can help devise a prevention plan. Possible steps include taking a low-dose antibiotic for at least six months or taking a single dose of an antibiotic after sex.

Besides antibiotics, there are other ways you can help prevent UTIs –

• Avoid douching or using feminine hygiene sprays.
• Clean the outer parts of your genitals and your anus every day.
• Drink plenty of fluids. Aim for six to eight glasses per day.
• Empty your bladder before and after having sex.
• Use a birth control method that does not include spermicide.
• Wear cotton underwear and loose-fitting pants and change out of workout clothes or wet bathing suits immediately.
• When you have to urinate, don’t wait. When urine stays in the bladder, bacteria can grow.
• Wipe from front to back to prevent transferring bacteria into the vagina.

For some post-menopausal women, vaginal estrogen therapy is another option for preventing UTIs. This comes in the form of creams, tablets, or rings that are applied directly to the vagina, where they release small amounts of estrogen. It can take a few months for the full benefits to take effect, but your risk of UTIs can then drop by more than 75%.

If recurrent UTIs have been affecting your quality of life, don’t hesitate to talk to your provider. Your provider will help you figure out what could be causing the UTIs and the best ways to stop them from continuing. By staying on top of your symptoms, you can get the right treatment and prevent complications down the road.