Urinary tract infections are a common problem for women of all ages. These infections can be frustrating, especially when they occur frequently. Urinary tract infections are "frequent" when you have had three or more infections in the past year. This interactive tutorial was designed to educate you on the topic as well as to help you find some ways to address this problem. You will be asked some questions to help us provide you with relevant, personalized advice to help address this problem.
It is important to know that this website does not replace a formal medical assessment, and you should still address this problem with your physician.
Please note: This website is meant to address frequent urinary tract infections among adult women. It is not intended for men, children, or women who are pregnant. Patients with neurological diseases, those that are immunosuppressed, those with known abnormalities of their urinary system, and those that regularly use catheters should discuss their infections with a physician, as they are more likely to need to see a specialist to address this problem.
1) There are two different ways to test the urine for infection. One way is to “dip” a test stick in the urine. This is a test done in the doctor's office, and the results are available right away. The second way is to send the urine sample to the laboratory and see if it grows bacteria (this usually takes 1-3 days). Does your doctor send your urine to the laboratory to see what bacteria grows?
Yes: Great, this is an important first step to make sure you truly have bacteria in the urine. While it may not be necessary each time, it is important to do at least once in women with frequent UTIs.
Urine dipsticks
No: A urine dip or "dipstick" is a fast method to quickly test for a urinary tract infection. To do this test, a chemical strip is placed into a cup of urine and may detect white blood cells in urine as a possible sign of infection. The test can also detect “nitrites”, which tells you that certain types of bacteria are in the urine. Although this simple test can usually detect whether or not a patient has a urinary tract infection (UTI), it cannot tell which type of bacteria are causing the infection, and it may not always provide accurate results. Some physicians will choose to treat for a UTI based on this test alone, while others will wait until the urine culture is back in approximately 1-3 days. The urine culture confirms that bacteria are causing the UTI and tells the doctor which antibiotics will work to treat the infection.
When a physician starts an antibiotic immediately after a urine dip stick without doing a urine culture, the physician is making an educated guess as to which antibiotic will be effective in treating the UTI. In other words, this antibiotic may or may not be effective, and there is also a chance that your symptoms may not actually be caused by a UTI.
There are other conditions that may produce the same exact symptoms as a UTI but are actually caused by a bacterial infection of the urinary tract and not treated by antibiotics. Some examples include pelvic floor muscle spasm, vaginal infections, interstitial cystitis/bladder pain syndrome, genital herpes, sexually transmitted diseases, overactive bladder, vaginal changes due to aging, and pelvic inflammatory disease. Talk to your health care provider next time and make sure they send the urine for a culture. If there are no bacteria, ask them to consider some of the conditions listed above.
2) When you start antibiotics for your urinary tract infection, do they make the symptoms go away quickly (for example within 1-3 days)?
Yes: Great, that is what would be expected if your symptoms are due to urinary tract infections from bacteria. Generally, some noticeable change in symptoms is seen in 1-3 days. It may take longer for complete resolution of symptoms.
No, or I am not sure: It is important that a urine culture is done before you start antibiotics. If your symptoms do not resolve, or your treatment requires multiple courses of antibiotics, it could be that the bacteria are resistant to the antibiotics you are taking, or it could be that you don’t actually have a true bacterial urinary tract infection. Instead, you could have another condition that can cause urinary symptoms that feel like an infection such as pelvic floor muscle spasm, vaginal infections, interstitial cystitis/bladder pain syndrome, genital herpes, sexually transmitted diseases, overactive bladder, vaginal changes due to aging, and pelvic inflammatory disease. Talk to your health care provider next time, and please ask them if it would be beneficial to send the urine for a formal culture. If urine cultures aren’t showing bacteria, talk to your doctor about the conditions listed above.
3) Does your doctor test your urine for bacteria even when you don’t feel like you have a urinary tract infection?
Yes, or I am not sure: Some people have bacteria that live in their urine and bladder all the time, but these bacteria are not causing any symptoms or problems. This is called "asymptomatic bacteriuria." Treating asymptomatic bacteriuria can actually cause true urine infections in the future and may cause the bacteria to become resistant to antibiotics.
Asymptomatic bacteriuria is sometimes inappropriately referred to as a “urinary tract infection”. A urinary tract infection is when the bacteria living in the bladder and urine cause inflammation. This can then cause symptoms such as bladder pain, a sense of urgency to go to the bathroom, needing to go to the bathroom to urinate often, and sometimes even fever, nausea, or vomiting. The majority of people with asymptomatic bacteriuria do not need antibiotics. In some cases, such as during pregnancy or before certain surgeries it is appropriate to treat these bacteria in the urine even if they are not bothering you. If you don't have any symptoms from bacteria in your urine, please ask your doctor if you have asymptomatic bateriuria and if you actually need antibiotics.
No: Testing the urine when you don't feel like you have a urinary tract infection may detect "asymptomatic bacteriuria." Asymptomatic bacteriuria is sometimes inappropriately referred to as a "urinary tract infection." A urinary tract infection is when the bacteria living in the bladder and urine cause inflammation. This can then cause symptoms such as bladder pain, a sense of urgency to go to the bathroom, needing to go to the bathroom to urinate often, and sometimes even fever, nausea, or vomiting. The majority of people with asymptomatic bacteriuria do not need antibiotics. In some cases, such as during pregnancy or before certain surgeries, it is appropriate to treat these bacteria in the urine even if they are not bothering you. If you don't have any symptoms from bacteria in your urine, please ask your doctor if you have asymptomatic bacteriuria and if you actually need antibiotics.
4) The reasons why you get urinary infections changes as you get older. As women age, their estrogen levels fall, and they go through menopause (average age is 51). Please select which group best fits you:
Pre-menopause (usually < 40-45 years of age): There are many reasons why you may be at increased risk for developing a urinary tract infections (UTIs). Some women have a genetic risk for more infections (meaning it was inherited from your parents). If your mother or sister(s) have a history of frequent UTIs, this may be the reason why you are at increased risk. Unfortunately, you can’t change this risk factor!
Some other risk factors include not drinking enough water throughout the day, holding your urine for long periods of time, and not emptying your bladder completely when you urinate. Sexual activity may also increase the risk of UTIs in some women, particularly with the use of contraceptives that contain spermicide. Additionally, constipation (meaning that you do not have a daily bowel movement or have hard stools) can also contribute to the risk of developing a UTI. These risk factors are all things that you can change by drinking more water, urinating regularly, and using stool softeners or laxatives. Using a method of contraception that does not contain spermicides may also reduce your risk.
Peri-menopause (usually 45-55 years of age with symptoms to suggest a change in hormonal function (e.g. irregular periods, hot flashes, mood changes)): There are many reasons why you may be at increased for developing a urinary tract infections (UTIs). Some women have a genetic risk for more infections (meaning it was inherited from your parents). If your mother or sister(s) have a history of frequent UTIs, this may be the reason why you are at increased risk. Unfortunately, you can’t change this risk factor!
As you go through menopause, the estrogen levels in your body fall. This can cause changes in the vagina that make UTIs more likely to occur. Sometimes the addition of estrogen cream/suppositories to/in the vagina can help reverse these changes and reduce your risk of UTIs. You can discuss the use of estrogen with your physician to see if this treatment is appropriate for you.
Some other risk factors include not drinking enough water throughout the day, holding your urine for long periods of time, and not emptying your bladder completely when you urinate. Sexual activity may also increase the risk of UTIs in some women, particularly with the use of contraceptives that contain spermicide. Additionally, constipation (meaning that you do not have a daily bowel movement, or have hard stools) can also contribute to the risk of developing a UTI. These risk factors are all things that you can change by drinking more water, urinating regularly, and using stool softeners or laxatives. Using a method of contraception that does not contain spermicides may also reduce your risk.
Post-menopause (usually > 55 years of age and more than 1 year since your last menstral period): There are many reasons why you may be at increased for developing a urinary tract infections (UTI). Some women have a genetic risk for more infections (meaning it was inherited from your parents). If your mother or sister(s) have a history of frequent UTIs, this may be the reason why you are at increased risk. Unfortunately, you can’t change this risk factor!
After menopause, the estrogen levels in your body fall. This causes changes in the vagina that make UTIs more likely to occur. The addition of estrogen cream/suppositories into the vagina can help reverse these changes and reduce your risk of UTIs. It helps the good bacteria grow in your vagina, and this helps to prevent the bacteria that cause UTIs from getting into your bladder. You can discuss the use of estrogen with your physician to see if this treatment is appropriate for you.
Some other risk factors include not drinking enough water throughout the day, holding your urine for long periods of time, and not emptying your bladder completely when you urinate. Sexual activity may also increase the risk of UTIs in some women. Additionally, constipation (meaning that you do not have a daily bowel movement or hard stools) can also contribute to the risk of developing a UTI. These risk factors are all things that you can change by drinking more water, urinating regularly, and using stool softeners or laxatives.
Post-menopausal because I had my ovaries removed surgically: There are many reasons why you may be at increased for developing a urinary tract infections (UTI). Some women have a genetic risk for more infections (meaning it was inherited from your parents). If your mother or sister(s) have a history of frequent UTIs, this may be the reason why you are at increased risk. Unfortunately, you can’t change this risk factor!
After menopause, the estrogen levels in your body fall. This causes changes in the vagina that make UTIs more likely to occur. The addition of estrogen cream/suppositories into the vagina can help reverse these changes and reduce your risk of UTIs. It helps the good bacteria grow in your vagina, and this helps to prevent the bacteria that cause UTIs from getting into your bladder. You can discuss the use of estrogen with your physician to see if this treatment is appropriate for you.
Some other risk factors include not drinking enough water throughout the day, holding your urine for long periods of time, and not emptying your bladder completely when you urinate. Sexual activity may also increase the risk of UTIs in some women. Additionally, constipation (meaning that you do not have a daily bowel movement or hard stools) can also contribute to the risk of developing a UTI. These risk factors are all things that you can change by drinking more water, urinating regularly, and using stool softeners or laxatives.
6) Which supplements or over the counter options are you interested in getting more information about? Please check all that apply.
Cranberry
Cranberries have been long studied as a potential agent to prevent urinary tract infections (UTIs). The active ingredient in cranberry is called “proanthocyanidins” or PACs, and scientists believe PACs help prevent bacteria from attaching to the bladder lining. PACs are found in different concentrations depending on the type of cranberry supplement. Cranberry juice may also be helpful, but to drink enough PACs, you also have to drink a lot of unwanted sugar and calories. Some types of cranberry tablets may not have PACs, or enough PACs, so not all cranberry supplements are considered equal. Scientists believe that cranberry supplementation needs to have 36 mg of PACs to be effective for reducing recurrent UTIs. Check the label of your cranberry tablet to see if it includes 36 mg or more of PACs. If it does not, it may not be effective enough to help you reduce UTIs. Cranberry tablets can be taken daily as a preventative measure or after sexual activity if this is one of your main triggers for a UTI. Daily cranberry tablets may be expensive. You should consider if this additional cost is actually decreasing the frequency and/or intensity of your UTIs. In patients who have less than 3 UTIs per year or whose UTI symptoms are easily managed, it may not be worth it take a cranberry pill every day. Please discuss this with your physician.
D-Mannose
Bacteria, particularly “E. coli”, attach to the urinary tract by clinging with their arms (“fimbria”) to the bladder lining. D-mannose prevents this by blocking the attachment the bacteria use. D-mannose is a natural sugar that is normally present in the urine in a small amount, but you can increase this by taking a supplement (usually it is a powder that is mixed in water). It is generally well tolerated with few side-effects. It is also found in high concentrations in many fruits and vegetables like apples, pineapple, green beans and cabbage. There have not been a lot of studies on D-mannose, but in one clinical trial it did reduce repeated UTIs in women who used it regularly.
Probiotics
There is not much proof that probiotics can prevent urinary tract infections. Probiotics may help healthy bacteria grow in the body. They are thought to potentially block the ability of bad bacteria to attach to the body. They may also help stimulate the production of chemicals in the body that can get rid of harmful bacteria. The most common probiotics include Lactobacillus, taken by mouth or placed directly in the vagina. Lactobacillus naturally lives in the vagina, and can be found in pill form as well as in yogurts. Good bacteria, such as lactobacillus, help change the vagina so that the unwanted bacteria (that cause UTIs) cannot get into the bladder. Other examples of common probiotics include B. lactis and L. reuteri. Probiotics have become increasingly popular as a non-antibiotic method to prevent UTIs. They however have not been scientifically well studied, and we don’t know how actually helpful they are.
Anti-inflammatories (NSAIDS, such as ibuprofen, naproxen)
In more than half of women with straight forward UTIs (those without fever or abnormal urinary systems), the symptoms can go away in several days without antibiotic treatment. To help with the uncomfortable symptoms of a UTI, such as burning with urination and needing to urinate frequently, medicines like ibuprofen (a NSAID type drug) can be effective. Unfortunately, UTIs can worsen if only taking anti-inflammatory drugs; therefore, treatment of frequent urinary tract infections should be managed on an individual basis. If you are generally healthy, your doctor may suggest that you try using NSAIDs for a few days to see if the UTI will go away before starting antibiotics. This approach requires patients to closely monitor their symptoms and to call their doctor right away if symptoms worsen, or they experience a fever.