Experiencing Recurrent Urinary Tract Infections? Consult a Nephrologist

What are Recurrent UTIs?

Recurrent Urinary Tract Infections (UTIs) are a series of infections that affect the urinary system, comprising the kidneys, bladder, ureters, prostate and urethra. Unlike a single episode of UTI, Recurrent UTIs occur multiple times, posing a greater risk to your overall health. While Recurrent UTIs in females are more prevalent, they can also affect men and children.

Types of UTIs

Urinary Tract Infections can be categorised into several types, each affecting a different part of the urinary system:

Cystitis: This is the most common type of UTI and affects the bladder. Symptoms often include frequent urination, discomfort or pain while urinating, and cloudy or strong-smelling urine.

Urethritis: This type of UTI affects the urethra, the tube that carries urine from the bladder out of the body. Symptoms may include a burning sensation during urination and discharge.

Pyelonephritis: This is a kidney infection and is generally more severe than other types of UTIs. It can be caused by bacteria moving from the bladder to the kidneys. Symptoms may include fever, chills, and back or side pain.

Prostatitis: This is an infection or inflammation of the prostate gland in men of different age groups usually associated with transient elevation of PSA (Prostate specific antigen) levels.

Causes of Recurrent Urinary Infections

Some common reasons for Recurrent UTI include:

Lack of Correct Treatment

One significant reason behind recurring UTIs is failure to complete a prescribed course of antibiotics during a prior infection, which allows specific bacteria to survive and multiply, significantly increasing the likelihood of another UTI. In addition, the choice of antibiotics and the duration of the antibiotic course also play crucial roles in preventing recurrent UTIs.

Bacterial Persistence

Certain types of bacteria, such as Escherichia coli (E. Coli), have the ability to attach to the lining of the urinary tract and form protective biofilms. These biofilms can be highly resistant to antibiotics, posing a challenge in completely eradicating the infection.

Anatomical Factors

Anatomical abnormalities within the urinary tract can create conditions conducive to bacterial entry and multiplication. Examples of such abnormalities include the presence of kidney stones, urethral strictures, and urinary retention.

Sexual Activity

Sexual intercourse, particularly in women, can introduce bacteria into the urinary tract, a phenomenon sometimes referred to as “honeymoon cystitis”. This can increase the risk of UTIs following sexual activity.

Urological/Gynaecological Interventions

Recent/repeated urological interventions such as urinary catheter placement, external catheter placement, cystoscopic examination, urodynamics study, and surgery on the urinary tract may be essential factors.

Hormonal Changes

Changes in hormonal levels, as observed during pregnancy and menopause, can impact the urinary tract, rendering it more susceptible to infections.

What Conditions Are Related to Recurrent UTIs?

Some conditions can lead to the recurrence of UTIs by facilitating the introduction of bacteria into the upper urinary tract.

Recurrent Urinary Infections with Vesicoureteral Reflux (VUR)

Vesicoureteral reflux (VUR) is a medical condition characterised by the backward flow of urine from the bladder into one or both ureters and sometimes even the kidneys. This regurgitation of urine can create a pathway for bacteria from the bladder to enter the upper urinary tract, significantly elevating the risk of recurrent UTIs.

Recurrent Urinary Infections with Hydronephrosis

Hydronephrosis is the enlargement or swelling of one or both kidneys due to the accumulation of urine caused by an obstruction or reflux. This condition can also contribute to the recurrence of UTIs, as the stagnant urine can serve as a breeding ground for bacteria. Understanding how hydronephrosis relates to recurrent UTIs is crucial in managing and addressing this medical concern.

Recurrent UTI Symptoms

Recurrent Urinary Infections (UTIs) can manifest with various symptoms. While some individuals may not experience any noticeable signs, others may have one or more of the following:

• Frequent Urge to Urinate: A person might constantly need to urinate, even when the bladder isn't full.
• Burning Sensation: A burning or painful sensation during urination is a typical symptom of a UTI.
• Increased Urination: UTIs can lead to increased frequency of urination, often resulting in passing only small amounts of urine each time.
• Cloudy Urine: UTIs can cause your urine to appear cloudy, a visual indicator of the infection.
• Blood in Urine: The presence of red, bright pink, or cola-coloured urine can be a sign of blood in your urine, often associated with UTIs.
• Strong Odour: UTIs can give your urine a particularly strong or unpleasant odour.

Diagnosing Recurrent UTIs

Diagnosing Recurrent Urinary Tract Infections (UTIs) is a critical process that involves a comprehensive evaluation by a healthcare provider to determine the underlying causes and contributing factors. This diagnostic process typically includes the following steps:

Medical History and Symptom Assessment

At the outset, the healthcare provider conducts a detailed assessment of the patient's medical history. This includes exploring the patient's history of UTIs, any underlying medical conditions, and recent urinary symptoms.

Physical Examination

A thorough physical examination may be performed to detect signs of infection or underlying conditions that could contribute to recurrent UTIs.

Urinalysis

One of the key diagnostic tests is urinalysis. During this test, a urine sample is carefully analysed for the presence of:

• White blood cells
• Red blood cells
• Bacteria
• Other abnormalities

Elevated levels of white blood cells and the presence of bacteria in the urine indicate infection.

Urine Culture and Sensitivity

A crucial step involves conducting a urine culture to pinpoint the specific type of bacteria causing the infection. This determination guides the selection of the most effective antibiotic treatment.

Imaging Studies

In certain cases, imaging studies become necessary to assess the structure and function of the urinary tract. This helps in identifying anatomical abnormalities or conditions such as vesicoureteral reflux (VUR) or hydronephrosis. Common imaging methods include ultrasound, CT scans, or intravenous pyelography (IVP).

Cystoscopy

Cystoscopy is a procedure that involves inserting a thin, flexible tube equipped with a camera (cystoscope) into the urethra and up into the bladder. This procedure allows the healthcare provider to visualise the inside of the bladder and urethra, aiding in identifying any abnormalities or structural issues.

Recurrent UTI Treatment 

Urinary Tract Infections (UTIs) are commonly treated with antibiotics as the primary course of action. The choice of antibiotic and the duration of treatment depend on various factors, including the patient's health condition and the specific type of bacteria identified in the urine

Preventing Recurrent Urinary Tract Infections

• Maintaining meticulous personal hygiene, especially in the perineal area, is essential to minimise the risk of bacterial transfer. For expert guidance on personal hygiene and urinary tract health, consult with the best nephrologist in India, often associated with top kidney hospitals in Delhi or anywhere.
• Regular assessment and timely intervention for abscess drainage are crucial, as this procedure facilitates better antibiotic penetration and minimises the risk of infection spread.
• In women, a thorough evaluation should look for untreated vaginal infections, pelvic inflammatory disease, recent gynaecological interventions or pap smears, and prolapse of the bladder, uterus, or rectum. Additionally, the use of an intrauterine contraceptive device should be checked.
• For men, it is important to be checked for prostatitis, balanitis, epididymo-orchitis, inguinal hernia, and hydrocele.
• Individuals should consider using protective measures, like absorbent pads or incontinence products, to create a barrier between faecal matter and the urinary tract. Seek advice from the best nephrologist in India for personalised recommendations, available at leading kidney hospitals in Delhi.
• Regular check-ups and medication are vital for patients managing conditions such as poorly controlled diabetes, immunosuppressant use, or chemotherapy. 
• Seeking advice with a urologist or specialist to discuss and plan for removing obstructing stones is essential. This procedure can significantly reduce the recurrence of UTIs.
• Patients who cannot use antibiotics for prevention should consult healthcare providers to explore alternative preventive measures, including hygiene enhancements and lifestyle adjustments

Frequently Asked Questions

There are many reasons behind recurrent infections of the urinary tract in adults. Dr. Alka Bhasin, Senior Director – Nephrology, Max Smart Super Speciality Hospital, Saket, gives some questions, which could help you identify the problem and seek immediate medical intervention.

• Is the urinary microbe the same in each instance or varying?
• Is the microbe causing the urinary infection truly identified by the laboratory and significant?
• Is there urinary incontinence? As this can promote infection or be a consequence of the infection.
• Are there accompanying symptoms of burning in the urine, voiding very frequently, urgency, pain over the kidneys, fever? Are there accompanying pus cells in the urine?
• Any accompanying visible blood in urine? – This could be due to cystitis, a stone in the urinary system, prostate enlargement, trauma of the urethral passage, sloughed dead tissue passing out from the kidney.