I'm frequently asked, for a woman how many urinary tract infections are too many.
Um oftentimes my answer is well if you're the one getting a urinary tract infection I would say
probably one UTI is too many, but what they're really asking in all seriousness is about when
should I be worried about the frequency of urinary tract infections, and for that reason we use a
definition of frequent urinary tract infections or we use the word recurrent urinary tract
infections, and we actually use a very specific definition of three or more infections in a year,
or two or more urinary tract infections in six months. It's important to remember that when
we talk about urinary tract infections, what we're talking about are symptomatic urinary
tract infections. Meaning, a urinary tract infection is having bacteria in the bladder,
while having symptoms like burning or pain with urination or much more frequent urination,
but when a patient has these symptomatic urinary tract infections, three or more times in a year,
or two more times in six months, they're said to be recurrent urinary tract infections and
we actually evaluate patients with recurrent UTIs a little differently than patients who have less
frequent infections. Oftentimes we want to check and see is there some kind of underlying cause.
So in some instances we might actually look at kidney function, oftentimes that can be done with
an ultrasound or even sometimes a CT scan to check out the kidneys to make sure that they're draining
effectively, that we don't have any abnormalities of the kidneys or stones in the kidneys. In some
cases we'll even take a look into the bladder with a small scope called a cystoscope. This is often
done for women who may have very very frequent infections that are sort of stacked one on top of
another, or for women who have a previous pelvic surgery that might be leading to the infections,
but in both of these instances, it can be very helpful to see if there's an underlying
cause. Interestingly enough even in recurrent urinary tract infections most of the time we
actually don't find an abnormality of the kidneys or an abnormality of the bladder,
and it turns out that it might be that one of the most frequent contributors to urinary
tract infections are actually the antibiotics that we take to treat urinary tract infections.
What I mean by that is that it is normal and healthy for a woman to have certain types of
bacteria in the vagina, and certain types of bacteria in the bladder, and furthermore we find
that if something happens to these normal healthy colonies of bacteria it can actually negatively
impact bladder symptoms and may even lead to more frequent urinary tract infections,
and so it might be that while we have to take an antibiotic sometimes to treat an infection,
just taking that antibiotic may make it more likely that we get another urinary tract
infection. So you can imagine how a woman would sort of get into a cycle where she would get an
infection and take an antibiotic that would lead to the next infection for which she would
have to take an antibiotic again, and this can be a really really frustrating
cycle for a lot of women. Luckily there are a lot of things that we can do to help to
break this cycle that don't always involve antibiotics. There's some over-the-counter
medications one medication that's been studied as d-mannose. Again, an over-the-counter medication
that can be taken that can really decrease the likelihood of getting an infection. There have
been other studies on probiotics and this may help to restore those normal healthy bacteria.
Some women in conversation with their healthcare provider, it turns out that they have thinning of
the vaginal tissue that can occur as a result of menopause, and so some women will be prescribed a
vaginal estrogen cream and that can help to reduce infections. Every now and then we have to resort
to placing patients on a low dose of an antibiotic for some amount of time, but the problem is that's
not really a very good sustainable therapy long term, but just to summarize we normally think of
recurrent urinary tract infections or those that are happening three more times a year
two or more times in six months, those are the patients that may need a more formal
evaluation to look at the kidneys and look at the bladder and oftentimes there are a lot of
things that we can do that would reduce the risk of having that next infection.