You use the restroom and immediately feel it: that subtle discomfort with a slight burning sensation. You just recovered from a urinary tract infection (UTI) — could you already have another one?
Nearly 7 million people experience a UTI at some point in their lives. For some, the infections keep coming back. This is called recurrent UTI.
What is a recurrent UTI?
A UTI is considered “recurrent” when it happens more than twice within six months, or at least three times a year. These infections can disrupt your life in many ways, with frequent doctor’s visits, antibiotic use and ongoing discomfort.
Why do some UTIs keep coming back?
While both people assigned female at birth (AFAB) and people assigned male at birth (AMAB) can get UTIs, those AFAB are more prone to recurrent infections. People AFAB have shorter urethras, which allow bacteria to enter the bladder more easily.
Hormones can also impact the chances of getting a UTI. One example is during menopause when estrogen levels decrease. Lack of estrogen can thin the vaginal and urethral walls, making infections more likely.
Other factors that increase risk of recurrent UTIs include:
- Medical devices or obstructions: Catheters, bladder stents or urinary tract abnormalities can trap bacteria, leading to recurring infections.
- Sexual activity: Intercourse often introduces bacteria into the urinary tract, increasing the likelihood of infections.
- Unfinished or ineffective treatment: If a UTI isn’t fully treated or bacteria become resistant to antibiotics, infections can return.
- Urinary flow issues: Conditions such as bladder stones, urinary reflux or an enlarged prostate can prevent the bladder from emptying fully, allowing bacteria to flourish.
- Weakened pelvic structures: In people AFAB, issues including pelvic organ prolapse or cystoceles can affect bladder function and increase UTI risk.
Antibiotic treatments for recurrent UTI
Standard treatment for a UTI includes prescription antibiotics, but not all UTIs respond to the same drugs. UTIs may keep coming back if the prescribed antibiotic isn’t effective against the bacteria causing the infections.
Your physician can narrow down the type of bacteria causing the UTI and choose the most effective antibiotic. This process usually involves a urinalysis and culture — testing a urine sample to identify the specific bacteria involved. This information can help your physician prescribe an antibiotic that will reliably target the bacteria.
Nonantibiotic therapies for recurrent UTI
Some people explore nonantibiotic approaches to help break the cycle of recurring infections. Ask your physician if any of the following are right for you:
D-mannose
D-mannose is a sugar that turns the bladder wall into a kind of nonstick surface that prevents bacteria from attaching to and growing on the bladder wall. Research varies, but some studies show that D-mannose is as effective as antibiotics in treating UTIs. Some people also use D-mannose (available over the counter) as a preventive measure to stop UTIs from developing.
Cranberry supplements
Cranberry is well-known for its UTI-fighting abilities. One 2013 meta-analysis found that cranberry juice and tablets helped reduce UTIs in women with recurrent infections compared to a placebo. On the other hand, other research found no effect.
Cranberry also prevents bacteria from sticking to the bladder wall. The risks associated with taking cranberry supplements to prevent UTIs — upset stomach, diarrhea, chance of interaction with blood thinner medications — are manageable, so ask your physician if you should add it to your preventive plan.
Probiotics
Probiotics add good bacteria to the body that can keep harmful bacteria from taking hold in the urinary tract. Some studies suggest that probiotics can reduce the risk of recurrent UTIs in women, while others have found no major effect.
Probiotics don’t work for everyone, but they’re generally safe and can support overall gut and immune health. Your physician can recommend a high-quality supplement. You can also incorporate probiotic-rich foods into your diet, such as:
- Fermented foods such as miso soup, pickles and sauerkraut
- Yogurt with “live and active cultures”
Vaginal estrogen
Since decreasing estrogen levels during menopause increase risk of recurrent UTIs, restoring those levels with vaginal estrogen can help. According to one study's findings, vaginal estrogen may help prevent recurrent UTIs.
Your doctor may recommend vaginal estrogen therapy because it keeps a good balance of beneficial microorganisms in your vaginal microbiome. It also helps restore the flexibility of vaginal tissue. Both outcomes can create an unwelcome home for infection-causing bacteria.
When to see a specialist for recurrent UTI
If you’re struggling with recurrent UTIs, it’s important to get to the bottom of the issue. Untreated UTIs can be life-threatening and lead to dangerous bladder infections, kidney infections, sepsis and even organ failure.
It’s essential to see a doctor if:
- UTIs keep coming back despite preventive measures
- You have a fever, back pain or blood in your urine, which could indicate a kidney infection
- You have underlying conditions that might contribute to frequent UTIs
