Struggling with recurrent UTIs? A nephrologist can help!

Recurrent urinary tract infections (UTIs) refer to multiple infections affecting the urinary syste

The urinary tract is responsible for the production, storage and elimination of urine. It consists of the following parts:

• Kidneys: These small, bean-shaped organs are located at the back of your body, just above your hips. Most people have two kidneys. They filter waste and excess water from your blood, which then becomes urine. Common waste products include urea and creatinine.
• Ureters: These are thin tubes that transport urine from the kidneys to the bladder.
• Bladder: The bladder is a balloon-like organ that holds urine until it is ready to be released from the body.
• Urethra: This tube transports urine from the bladder to the external environment.
• UTIs are a widespread issue, particularly in women. Recurrent UTIs are characterised by having two or more infections within six months or three or more infections within a year.

Types

There are three main types of UTIs, with each type depending on which part of the urinary tract is affected.

• Urethritis: An infection of the urethra
• Cystitis: A bacterial infection in the bladder, often caused by bacteria travelling up from the urethra
• Pyelonephritis: A kidney infection typically caused by an infection that has spread from the lower urinary tract or an obstruction in the urinary tract. The obstruction can cause urine to flow backwards into the ureters and kidneys

Symptoms

Symptoms of UTIs may include:

• Painful or burning urination
• Frequent urination
• Urgency to urinate
• Blood in the urine
• Cloudy or foul-smelling urine
• Lower back pain

Causes

Causes of recurrent UTIs are:

• Bacterial infections: These are the leading cause of UTIs. The most common bacteria responsible for UTIs in women include Escherichia coli (E. coli), Staphylococcus saprophyticus and Klebsiella pneumoniae.
• Anatomy: Women are more prone to UTIs than men due to their shorter urethra and its proximity to the anus. This makes it easier for bacteria to move from the anus to the urethra and reach the bladder.
• Menopause: Women experiencing menopause are at a higher risk of developing UTIs due to a decline in estrogen levels. Estrogen plays a key role in maintaining the health of the urethra lining, helping it stay resistant to infection.
• Diabetes: Individuals with diabetes are at a higher risk of developing UTIs due to elevated sugar levels in their urine. The sugar serves as a food source for bacteria, which can lead to infection.
• Certain medical conditions: Other medical conditions that can raise the risk of UTIs include kidney stones, blockages in the urinary tract and bladder issues.
• Some medications: Certain medications, including steroids and chemotherapy drugs, can elevate the risk of developing UTIs.

Diagnosis

A nephrologist is qualified to diagnose and provide appropriate treatment for UTIs.

To diagnose recurrent UTIs, your healthcare provider will assess your medical history and perform a physical exam. They also order other tests, which may include:

• Urinalysis: Here, urine samples are analysed for the signs of infection.
• Urine culture: Here, urine samples are checked for the growth of the bacteria, which helps the healthcare provider decide on the best treatment option.  
• If your infection does not improve with treatment, your healthcare provider may recommend the following tests to check for urinary infections.
• Ultrasound  
• Computed tomography (CT) scan
• Cystoscopy  

If you keep getting UTIs, your healthcare provider may run tests to check for other health issues, like diabetes or problems with your urinary system, that could be causing the infections.

Treatment

• If you have a UTI, consult a healthcare provider for proper treatment. Follow antibiotic instructions carefully, completing the full course to prevent the infection from returning or becoming harder to treat.
• If you experience recurrent UTIs, your healthcare provider may recommend alternative treatments, which could include:
• Wait and watch: Your provider may recommend a ‘watch and wait’ approach, allowing symptoms to resolve naturally while drinking fluids to flush your system.  
• Intravenous (IV) treatment: In severe cases, IV treatment in a hospital may be needed, followed by oral antibiotics to complete the treatment.

Prevention

Making the following lifestyle changes can help reduce the risk of recurrent UTIs:

• Drinking plenty of water helps flush out bacteria and dilute urine, promoting bladder health.  
• Avoid drinks that irritate the bladder, such as coffee, alcohol and sodas with citrus or caffeine, as they can worsen irritation and urgency.  
• A heating pad on the abdomen can relieve bladder discomfort.  
• Wear loose, breathable clothing and cotton underwear to reduce moisture build-up, which can foster bacterial growth.  
• Tight clothing should be avoided.  
• If you use a diaphragm for birth control, consider discussing alternative methods with your healthcare provider, as it may increase the risk of UTIs.

Conclusion

A UTI can be bothersome or uncomfortable before treatment begins. However, once a healthcare provider determines the bacteria causing the infection and prescribes the right antibiotic, your symptoms should improve rapidly. It is crucial to complete the full course of antibiotics as your healthcare provider prescribes. If you experience recurrent UTIs or if your symptoms are not improving, your provider may test for antibiotic resistance. In cases of resistance, you might need IV antibiotics or alternative treatments.