A urinary infection that keeps coming back

A urinary infection starts with burning when passing urine and frequent trips to the toilet, and usually ends with one course of medicine. But some people get the same problem again a few weeks or months later. If you are one of them, know that you are not alone and there are ways to look into it.

What are the symptoms of a urinary infection?

The NHS lists: pain or burning when passing urine, needing to go often or urgently (even at night), cloudy or bloody urine, pain low in the tummy, pain in the back under the ribs, fever or shivering, and tiredness. In older people and people with a catheter there may be confusion, worsening incontinence or new shivering. Dark or strong-smelling urine on its own may be just a sign of dehydration.

What does “recurrent” mean?

The NHS calls an infection that comes back after treatment, or two infections in six months (or three in twelve months), “recurrent”. If that is the case, be sure to tell a doctor, and do not take medicine yourself each time.

Why does it come back?

The reasons differ and are found only through investigation. The NHS does not give a list of causes, but it makes a few points: the doctor may suggest tests or a referral to a specialist, and a urine test does not always show an infection. If symptoms stay after treatment, ask for a referral to a specialist.

Remember that an antibiotic is only for a bacterial infection. The CDC counts urinary infection among the conditions antibiotics help, but giving antibiotics when they are not needed contributes to antimicrobial resistance. That is why it is better for the doctor to decide each time, not you.

Who should be seen sooner?

The NHS says that in these cases you should get a same-day or quick appointment, or call 111 (in Iran, this means an urgent appointment):

• aged 65 or over, or a child aged 15 or under
• being a man
• diabetes, a weak immune system or a urinary catheter
• pregnancy
• blood in the urine, or pain low in the tummy or in the back
• a very high or very low temperature, or shivering
• symptoms that get worse quickly or do not improve within 48 hours
• repeated infections

If you are confused, drowsy or have trouble speaking, call 115 (Iran’s emergency number). Pain under the ribs and fever with shivering may be a sign of a kidney infection, which can lead to sepsis if untreated (NHS).

What does treatment look like?

It differs with your situation. The NHS lists options the doctor may consider: a different antibiotic, taking an antibiotic for a long period under a doctor’s supervision, vaginal oestrogen for women around or after the menopause, and referral to a specialist. These do not replace a doctor’s opinion and should not be started without a prescription.

What helps prevent it?

From the NHS list:

• Wipe from front to back after using the toilet.
• Keep the genital area clean and dry.
• Drink plenty of fluids, especially water.
• Do not hold urine in, and empty your bladder completely.
• Change dirty nappies or pads promptly.
• Wash the area with water before and after sex, and pass urine after sex.
• Wear cotton underwear and avoid scented soap on the genital area.
• Do not take in too much sugar or alcohol.

On supplements such as cranberry and D-mannose, the NHS says there is some evidence they may help stop it coming back, but no evidence that they treat an infection that has started. Some contain a lot of sugar, and people taking warfarin should avoid cranberry. Talk to your doctor before using them, especially in pregnancy.

In short

Recurrent urinary infection can usually be investigated and controlled. Do not put off the investigation, do not take antibiotics on your own, and take the warning signs (confusion, shivering, back pain and fever) seriously. The cause and the right treatment for you are for the doctor to decide after an examination and tests.