Frequent UTIs in women: What you should know

Urinary tract infections (UTIs) are a common issue. The term UTI typically refers to an infection of the bladder, but it can also mean an infection in another area of the urinary tract, including a more serious infection of the kidneys. Women are 30 times more likely to experience a UTI compared to men. A diagnosis of frequent UTIs means you have more than three UTIs in one year, or more than two UTIs within a six-month time period.

Women are more likely to experience UTIs partly due to the differences between male and female anatomy. The opening of the urethra, the tube that empties urine from the bladder, is shorter in women and physically closer to the rectum, where a multitude of bacteria live. This makes it easier to pass bacteria into the bladder. Escherichia coli (E. coli), the bacteria that most commonly causes a UTI, is abundant in the colon and rectum.

There are various risk factors for the development of frequent UTIs in women:

• Kidney stones or bladder stones. Kidney and bladder stones can make it difficult to empty your bladder, which increases the chances of bacteria spreading in the urinary tract.
• Diabetes. People with diabetes may be more likely to have glucose (sugar) in their urine during times when their blood sugar is running high. Also, certain medicines used to treat diabetes may consequently increase urine glucose levels in the kidneys and bladder, potentially increasing the risk of a UTI.
• Sexual intercourse. Increased bacteria may be found in the bladder after intercourse. Additionally, spermicides can eliminate beneficial bacteria species such as lactobacilli that live in the vagina. A decrease in good bacteria numbers can allow harmful bacteria, such as E. coli, to increase in numbers, possibly leading to a UTI.
• Menopause. Hormonal shifts that often occur with menopause can change the acidity of the vaginal environment. The effect is a decrease in the number of lactobacilli, which can make an infection more likely. It can also be more difficult to empty your bladder, increasing the risk for infection.
• Urinary catheters. A catheter drains urine when you can't empty your bladder on your own, such as following surgery. This may increase the risk of bacteria entering your bladder.

In addition, there may be genetic causes for frequent UTIs. A woman might be more likely to have recurring UTIs if her mother or sister has experienced this issue.

Knowing the risk factors for a UTI can help prevent them in the first place.

Wiping from front to back after urinating is recommended to avoid moving bacteria toward the urinary system. Emptying the bladder before and after sexual intercourse can be helpful as well. If you use spermicides, you may want to talk with your healthcare provider about discontinuing them and opting for other forms of contraception.

After menopause, treatments such as topical estrogen creams may decrease the occurrence of frequent UTIs.

If you have been diagnosed with frequent UTIs, there are some treatment options to consider. Your healthcare provider may first recommend doing tests to identify what is causing your frequent infections. Treatment may include a referral to a specialist, such as a urologist, to explore further possible explanations for recurrent UTIs. Imaging exams such as CT (computerized tomography) scans or ultrasound studies may be ordered to evaluate the anatomy of the urinary tract. In some cases, a cystoscopy may be recommended. This involves the use of a small camera.

Antibiotics, which help the body fight bacteria, can be used to treat and prevent urinary tract infections. Some women may be prescribed an antibiotic to take at the first signs of a UTI or after sexual intercourse. In other cases, a healthcare provider may prescribe daily antibiotics for months at a time to help prevent UTIs. There is some concern, however, that the bacteria causing the infections may become resistant to daily and other antibiotic treatments.

Over-the-counter urinary tract infection products are available. Scientists have investigated cranberry juice and related products as a means to prevent or treat urinary infections. Cranberries may decrease the ability of bacteria to attach to the walls of the urinary system. Studies on these products have shown mixed results, and more research is needed.

If you experience frequent UTIs, discuss options with your healthcare provider or a specialist, as they can advise you on how to best prevent or treat infections.

Published August 2022.