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Why it seems like you always have a UTI, and what you can do to put an end to it.
Urinary tract infections — or UTIs — are a classic example of how the female anatomy is sometimes uniquely unfair. Because the urethra is much shorter in women than in men, and because the vagina is a nice dark and moist environment where bacteria growth can thrive, UTIs are essentially a plague upon anyone with a vagina. Statistically speaking, men just don't get them nearly as often.
Even if you've only ever had one UTI in your lifetime — and stats show that about half of all women will have at least one at some point — you know how terrible they are. But now imagine if you got them every few months, or even after each time you had sex. According to Dr. Kimberly Ferrante, a urogynecologist with New York University's Langone Medical Center, getting two UTIs within six months, or three or more in 12 months, qualifies as having something called "recurring UTIs," and these infections aren't all that uncommon.
The bad news here is obvious: UTIs are horrific and painful and no one wants one. But there's lots of good news! There are treatment options out there, it's not something most people deal with for their entire lives, and — if this is something you're struggling with – you're absolutely not alone. Ferrante, along with Dr. Craig Comiter, a urologist with the Stanford Center for Female Urology and Neuro Urology, lent their expertise on recurring and persistent UTIs.
Uh, what do you mean "recurring and persistent" UTIs?
There are two designations physicians use to differentiate UTIs that aren't just one-off, occasional infections: Recurring — or new, separate infections of the urinary tract that occur two or more times in a six month period, or three or more times in a 12 month period; and persistent — a single infection caused by a specific kind of bacteria that either doesn't respond to treatment, or keeps coming back after treatment.
Comiter said, of the people who get three or more infections a year, only about two percent of those are dealing with persistent infections. Which is to say they're extremely rare. Those persistent infections are usually caused by a foreign body, like a stone in the urinary tract. He only really suspects a persistent infection versus a recurring one if a patient has a history of stones, has had incontinence surgery or a hysterectomy, or if a woman has a pediatric history of UTIs. Persistent UTIs are typically diagnosed with somewhat invasive measures, like an ultrasound, so he doesn't automatically assume persistance and run through a gamut of tests if a patient doesn't have those risk factors. If you're getting UTIs several times a year, it's almost certainly a new infection each time.
Why would someone get multiple UTIs in a year?
First off, this isn't all that uncommon. The key research on recurring UTIs is a 1990 study on among college women who'd had one infection. The study found that about a quarter of all women who'd had one UTI got another within six months, and about three percent got a third infection within six months. Anecdotally, there are some women who get UTIs essentially every time they have sex. And then of course there are some women out there who never have them.
Comiter said some women are genetically predisposed to get UTIs more easily. To understand why this might be, it helps to know how UTIs are caused.] Buckle up because it's unpleasant, but we are here to learn. "Ninety-five percent of urinary tract infections are from E. coli [bacteria]," Ferrante said. "It's [bacteria] from basically the rectum — in the rectal area, usually — getting pushed into your urethra." The distance between a person's rectum and their urethral and vaginal openings is small, and, in the midst of penetrative sex, the bacteria that lives in and around the rectum has an incredibly easy time traveling to those openings. That bacteria is then able to work its way into a woman's urinary tract for a couple of reasons: The vagina is a beautiful environment (warm, moist, dark) for bacterial growth, and the female urethra is only about four centimeters long. If the bacteria gets into the urinary tract and bladder and there's warm urine (sorry) just sitting in there, it's even easier for it to grow and spread — and that's where you get into infection territory.
"There are receptors on the skin of the vagina that grab onto bacteria, and the bacteria have receptors that grab onto the vagina," Comiter said. "The bacteria evolutionarily want to get into the urinary tract so they can reproduce. They have pili that can adhere to the vaginal wall, set up shop, and get into the urethra. Some people have receptors for these bacteria, and some don't."
So having a proclivity to get UTIs more than others doesn't mean you're "dirty" or "gross" —not at all. It just may mean your body is particularly welcoming to the myriad bacteria that can cause an infection. But that's ok! Because guess what? These infections are totally treatable and curable.
When you're likely to start dealing with recurring UTIs
Both Comiter and Ferrante said the most common reason people get UTIs in the first place is because of sexual activity, and particularly first-time sexual activity. "Younger women are more sexually active in general than older women, not that older women aren't sexually active, but younger tend to be more sexually active," Ferrante said.
For that reason, recurring UTIs usually show up in a person's twenties, or when they start having sex for the first time. And because of something called "honeymoon cystitis," recurring UTIs might flare up again at the beginning of a new relationship. Honeymoon cystitis is just a medical-ish term for inflammation in the female bladder that occurs due to increased sexual activity during the honeymoon phase of a relationship. This explains why a new partner might introduce a UTI — it has nothing to do with any bacteria that might exist on their person, but is related to all the fun, new-partner sex you're having.
Comiter also said recurring UTIs are a problem for women after menopause, when estrogen levels are lower. "Estrogen provides a normal vaginal environment with a normal pH, and when you go through menopause, the skin of the vagina becomes a little thinner and the good bacteria don't live so well in the post-menopausal vagina. That leaves more room for bad bacteria to set up shop and cause infections."
But just as there's a treatment plan for solving recurring UTIs in your twenties (or thirties, or forties, or whenever), there's a plan for putting an end to them after menopause.
How to prevent recurring UTIs, with and without a doctor's help
The reason why doctors call them "recurring" UTIs, versus just saying you get several infections in a year, is that it changes the way you're being treated — so you don't waste money on appointments and medicine, and waste time in pain with an infection. Comiter and Ferrante have similar approaches when it comes to treating recurring UTIs caused by sexual activity (focusing on that, because it's almost always the culprit).
The first thing literally everyone can do to avoid any UTI is make sure you're peeing both before and after sex. But Comiter is sympathetic to the fact that stopping in the middle of foreplay to say, "WAIT GOTTA PEE!" might be a mood-killer, so if all you can manage is peeing after sex, then do that. But do it quickly. If you're peeing before and after sex like it's your job and are still getting UTIs, Comiter and Ferrante said they like to start with natural, homeopathic treatments before prescribing a preventative antibiotic.
"There's not a lot of stuff that's proven other than giving people antibiotics, just I like to try less invasive stuff first," Ferrante said. "I'll tell them to take 1000 milligrams of vitamin C three times a day, just to acidify their urine. Bacteria don't really want to grow in an acidic place. I'll tell them to take cranberry tablets twice a day, the idea is that the cranberry molecule gloms onto bacteria and flushes it out when people urinate. And they can try things like D-Mannose as well, [a health supplement] that mimics the look of the bladder lining to bacteria, so they get flushed out by glomming onto the D-Mannose."
If none of that is working and you're still getting three or more infections in a year, your doctor will either prescribe an extremely low-dose antibiotic to to either every day or after each time you have sex. Research suggests taking a pill after sex is just as effective as taking one every day, and carries the benefit of not having to take antibiotics daily.
But this isn't a lifelong situation — Comiter and Ferrante said most women see an issue with recurring UTIs clear up as they get older. "Honestly you only really try to do the antibiotics for a period of six months or so," Ferrante said, just because there are side effects associated with most antibiotics, and because you don't want to risk any kind of drug resistance.
And there you have it! That's probably more information on UTIs than you ever thought you could know. But when it comes to things like your own health, particularly in the pelvic area, there's truly no such thing as knowing too much. Especially if that means you can put an end to painful UTIs that cause you to run to the bathroom every ten minutes.
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