DEAR DOCTOR K:
I’m in my 30s and fairly healthy. However, I keep getting urinary tract infections. My husband and I want to know what I can do to prevent them.
Many women know well the symptoms of a urinary tract infection (UTI). You might feel a frequent urge to urinate, yet pass little urine when you go. It may hurt when you urinate. Your urine might be cloudy, blood-tinged and strong-smelling. Furthermore, many women have a tendency to get repeated UTIs.
UTIs are usually caused by bacteria that live in the gut and are present on the skin around the rectum. There, these “bad” bacteria compete for food with “good” bacteria called Lactobacilli. If the bacteria are carried from the rectum to the vagina, they can enter the urethra (the tube that carries urine from the bladder) and infect the bladder.
Some women inherit a condition that makes it easier for the bad bacteria to stick to the lining of the urethra. That, in turn, makes it easier for the bacteria to cause an infection of the urethra and bladder. That’s why a tendency to have recurrent UTIs tends to run in the family.
Risk factors for UTI vary with age. Before menopause, the most common risk factors are sexual intercourse and use of spermicides. Sex can push bacteria up the urethra and into the bladder. And spermicides may kill off beneficial good bacteria in the vagina, making it easier for the bad bacteria to multiply.
After menopause, the numbers of protective Lactobacilli in the vagina naturally decline. It also becomes more difficult to empty the bladder completely. Both of these factors increase the likelihood of getting UTIs after entering menopause.
The most reliable way to prevent recurrences is to take a low dose of an antibiotic used to treat UTIs. There’s some room to experiment here. If you have frequent UTIs, ask your doctor about the following strategies and which one might work best for you:
- take a low dose daily for six months or longer;
- take a dose only after you have sex, particularly if the recurrent UTIs tend to follow having sex;
- keep a supply of antibiotics in the medicine cabinet, and take them at the very first symptoms of a UTI to shorten the duration of symptoms.
If you would like to avoid taking antibiotics, there are two “natural” alternatives. Probiotic vaginal suppositories containing Lactobacilli have had promising results in premenopausal women like you. What about cranberry juice? The evidence that it can reduce the number of recurrent UTIs is weak. Furthermore, you have to drink 8 ounces of it a day for six months to a year. There is a lot of sugar (and calories) in that much cranberry juice.
It may require some experimentation with different alternatives, but you should be able to find a treatment that reduces the frequency and severity of your recurrent UTIs.