Plagued With Recurring Urinary Bladder Infections?

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Anyone who has a urinary tract infection (UTI) is familiar with that miserable "gotta go" feeling. This is accompanied by knife-like pain followed by the terrifying sight of pee that looks like cranberry juice. The only thing more distressing than a bladder infection is when it happens again, and again, and again.

Recurrent urinary tract infection is defined as more than two infections in six months or more than three infections in one year. As a practicing ob-gyn, not a day goes by that I don’t see at least one patient with a UTI.

Even though recurrent UTIs can happen at any age, there’s a specific reason why it is more common in the post-menopause crowd. Just like the vulva and vagina, the urinary tract is loaded with estrogen receptors. Post menopause, the tissue along the urethra and bladder becomes much more prone to infection.

And it doesn’t help that when there is no estrogen, healthy vaginal lactobacilli get wiped out, allowing the bad bacteria to take up residence in the urethra which in turn, makes the urinary tract even more prone to infection.

If there is a UTI, it needs to be correctly treated — and the sooner the better since an untreated UTI can result in the bacteria traveling all the way up to your kidneys. If you only get infections once in a blue moon, it’s fine to get a prescription over the phone without a culture. But if you are getting recurrent infections, it’s important, really important, to identify the bacteria to make sure you are treated with the right antibiotic.

A 2021 World Health Organization study found that women were given the wrong treatment for urinary tract infections in up to half of all cases. No wonder so many women get treated again and again with the same antibiotic and end up with a relapse of the original infection! A new antibiotic, pivmecillinam, to treat uncomplicated UTIs, was recently FDA approved and hopefully will reduce failures, but in the case of recurrent infection, a culture is still recommended.

Getting to the doctor to get that urine culture is not always feasible. One innovative solution is MyUTI. You purchase a “Just in Case” kit from MyUTI to have on hand. When bladder symptoms hit, even if it’s 2 a.m., even if it’s a Sunday, you collect the urine in your own bathroom and ship it overnight. The MyUTI lab uses PCR technology (the same technology used for rapid COVID testing) to quickly determine if a UTI is present along with a rapid analysis of which antibiotics will work.

Once you determine you are a member of the recurrent UTI club, it’s time to go into prevention mode. Despite what your mother, your friend, Dr. Google or even your actual doctor has told you, scientific studies have not shown that frequent urination or peeing immediately after intercourse makes a difference. Drink cranberry juice if you like it, but it probably won't decrease infections.

When it comes to the prevention of recurrent urinary tract infections post-menopause, the number one thing that may prevent frequent UTIs is the use of a local vaginal estrogen. I cannot emphasize this enough. Even if vaginal dryness or painful sex is not an issue, for most women, supplying a little estrogen may reduce, or even eliminate, recurrent infections.

In addition to improving the health of the tissue, estrogen assures a healthy microbiome so that good bacteria, instead of problematic bacteria, are hanging around. Topical estrogen comes in the form of a cream, a long-acting vaginal ring, a vaginal insert or a vaginal tablet. Non-estrogen options to treat vaginal dryness such as vaginal DHEA and oral ospemifene also will work.

What about if you have symptoms of an infection, but every urine culture is negative? It’s a common scenario for older women to tell me that they have constant urgency and feel like there is an infection. But when I send a culture it comes back with no abnormal bacteria.

In that case, it’s not an infection causing the symptoms. Hormonal changes in the urinary tract can be responsible for the constant “gotta go” feeling, burning and frequent urination even when there is no infection. And for some reason, the urge to pee most commonly hits at night.

So, if hot flashes and achy joints weren’t enough to keep you from getting a decent night’s sleep, up to 77 percent of post-menopause women wake up one or more times a night to pee. If that is the issue, you don’t need antibiotics: what you need is vaginal estrogen.

So, just to be clear, a lack of estrogen after menopause, increases both the risk of recurrent urinary tract infections and the risk of urinary symptoms such as urgency and discomfort with urination, even when there is no infection.

A local vaginal estrogen is one of the most underutilized and life-changing things a woman can do. And, it continues to mystify me how many gynecologists, internists, family doctors and even urologists do not automatically make this recommendation. Most women are not given that information and continue to needlessly suffer. And yes, vaginal estrogen is safe for everyone including women with a breast cancer diagnosis, though it is always best to check with your oncologist.

So, when you apply your estrogen cream, put it inside your vagina, slather it around the opening, but then go north and put some on your urethra. While you are at it, apply a dab to your clitoris. Vaginal estrogen has the side bonus of giving a nice boost to your sex life. Not only will you not be spending half your life running to the toilet, but you also will be restoring vaginal lubrication and increasing your ability to orgasm.

And don’t stop using your vaginal estrogen. If you do, I promise that in most cases the recurrent bladder infections will come back!

 
Do any of you suffer from frequent UTIs? How do you cope? Let us know in the comments below.