A month a year with a UTI is too much!

November 5, 2010 1:37 PM

More help with recurrent UTIs?

For many years now, my 69-year-old mom has had recurrent UTIs. For the past few years she has had several a year. This year she has had four or five already. She keeps going to her regular doctor and has been to a urologist (has another visit with the urologist coming up) but so far no luck. She gets them right about 10 days after she gets a cold, and sometimes she just gets them without any cold. Help! It's excruciating to have my mom go through this.

I read this question, but it was 5 years ago and I'm wondering if there's new science or new experiences/voices within the hive mind.

posted by anonymous to Health & Fitness (13 answers total)

I have a few notes on various articles about UTIs; perhaps some of these will be of use to you. I apologize, the citations aren't perfectly formatted, and you may need access to databases to get to the full article in most cases (your local library may be able to hook you up with this, however).

Google Scholar is a good place to look for articles about this kind of thing as well. A lot of the literature in the UTI realm focuses on UTI incidence as it relates to sexual intercourse; this may or may not apply in your mother's case, which could make searching for relevant information a bit more difficult.

Also, you may consider a cranberry pill or juice regimen. Several studies have shown that cranberry pills (which are much less expensive than juice; this has also been researched [PDF]) are effective at preventing UTIs.

Citations and notes for three articles follow. The last one is probably best, because it recommends a fairly easy regimen to follow at home.

1. "Recurrence of Urinary Tract Infection in a Primary Care Setting: Analysis of a 1-Year Follow-Up of 179 Women," Risto Ikäheimo , Anja Siitonen, Tarja Heiskanen, Ulla Kärkkäinen , Pauli Kuosmanen, Pertti Lipponen and P. Helena Mäkelä. Clinical Infectious Diseases, Vol. 22, No. 1 (Jan., 1996), pp. 91-99. http://www.jstor.org/stable/4459171

Notes:
* Type of treatment (which antibiotic used) had no statistically significant effect on rate of recurrence of infection
* 80% caused by E.Coli
* “Many of the strains causing the index episodes of UTI probably persisted for a long time (up to one year) in patients and caused new episodes from time to time

2. "Recurring urinary tract infection: incidence and risk factors.," Foxman, B. Am J Public Health. 1990 Mar;80(3):331-3. http://www.ncbi.nlm.nih.gov/pubmed/2305919

Notes:
* the risk of a second infection is greater than the first, and that the first "sets the stage" for recurring infection.
* The six-month risk of a second UTI was 26.6 percent; the risk of a third UTI, 2.7 percent.... median time to recurrence was approximately two months (56 days)
* Frequency of sexual intercourse, diaphragm use, and voiding around sexual intercourse were only weakly associated with second infection (Table 1). The trend in decreasing proportion of second infections with voiding after sexual intercourse is of interest (linear regression coefficient: -0.033; SE = 0.033).
* factors observed to be associated with UTI in previous studies-frequency of sexual intercourse, diaphragm use, and voiding after sexual intercourse-did not predict recurrence in the next six months. The strongest predictors were characteristics of the infection itself: the presence of hematuria [red blood cells in the urine] and urgency.
* The strongest predictor of second infection was the presence of hematuria and urgency as symptoms of initial UTI. Future studies should use consider both behavioral and bacterial characteristics as potential determinants of recurring UTIs

3. Adatto K, Doebele KG, Galland L, Granowetter L: Behavioral factors and urinary tract infections. JAMA 1979; 241:2525-2526. http://jama.ama-assn.org/cgi/reprint/241/23/2525

Notes:
* Voluntary retention of urine for more than an hour after experiencing the urge to urinate was present in 61% of the patients (people who had had 3 or more UTIs in the past) and in only 11% of the controls
* There is an association between sporadic coitus (coitus after a period of abstinence) and increased irritation with intercourse, which is stronger within the patient group regimen and those who did not.
* Sixty-five percent of those who reported following the regimen had no UTI (symptomatic or asymptomatic) during the follow-up period, and an additional 19% experienced a reduction in the frequency of reinfection. All but one of the patients who did not report following the regimen continued having infections at a rate comparable with their pre-interview experience.
* Our study disclosed no direct relation between coitus and UTI apart from postcoital voiding.
* REGIMEN: (1) regular urination (about every two hours), (2) postcoital voiding within ten minutes, (3) adequate hydration (at least eight 237-mL glasses of fluid daily), (4) adequate lubrication during coitus, and (5) wiping the perineum front to back after urination.

I hope that some of this information is of value to you, and good luck getting this figured out.
posted by k8lin at 2:02 PM on November 5, 2010 [2 favorites]

Um it's strange she would get them after a cold. Does she do anything different, like take a bath? If so, be aware that bubble bath CAN cause recurrent UTIs. If you know she's in danger of getting UTIs, there are some preventative measures she can take.

1. Pee often- Every four hours AT LEAST. Thoroughly emptying the bladder often will prevent the bacteria from having a fabulous growing environment. (Also is her urologist sure she is emptying her bladder completely? If not, this could explain why bacteria is finding so many ops to grow there.)

2. Keep the urine acidic-cranberry pills are good for this

3. Talk to her urologist about preventative antibiotics-If she's regularly getting UTIs, there are meds that a person can take Macrobid. It's intended to be taken "as needed." I'm not sure why the urologist hasn't brought this up already.

4 Wiping with Betadine-Betadine is an antiseptic that can be diluted. That area, especially in women, is crowded with openings where bacteria can unfortunately creep from one place to another. While E Coli is cool in your rectum, it's not cool when it travels to the urethra. Cleansing the area with a mild betadine wash every time can help reduce the likelihood of contamination.

5. When she gets a UTI, take the full regimen-Some people stop taking the drugs after the symptoms go away. This can foster the development of superbugs.
posted by miss-lapin at 2:06 PM on November 5, 2010

Have her take some probiotics. Don't just go down to the grocery store and get some yogurt - go to a health food store and get some of the pills that need to be kept in the refrigerator.

I find dried cranberries to be more effective than cranberry juice or pills. YMMV. But be aware that they usually have added sugar.

What kind of soap does she use? Although I'm generally a big fan of handcrafted soap rather than commercial soap, if she's prone to UTI's then she should make sure that she's not washing with glycerin soap. (Glycerin is basically sugar.) Most commercial soaps have the glycerin removed, unless it's specifically called glycerin soap. Handmade soap, even if it isn't specifically called glycerin soap, is generally going to have glycerin in it because it's created during the saponification process.

If you live in a damp climate, or even if you don't, make sure her towel completely dries out between uses. Better yet, use a fresh towel every day for a while, and/or throw the towel in the dryer after each use.

Don't use scented toilet paper. The chemicals could be causing irritation.
posted by MexicanYenta at 2:29 PM on November 5, 2010 [1 favorite]

I had similar recurring infections until I started taking 500mg of Vitamin C and cranberry tablets every day. I can take them as infrequently as every-other day and still be OK, but if I miss more than 3-4 days in a row, I'm just asking for trouble.
posted by samthemander at 2:36 PM on November 5, 2010 [1 favorite]

Nthing cranberry tablets.
posted by cyndigo at 2:53 PM on November 5, 2010

It's possible that when she has a cold she's not drinking much and is choosing to stay in bed or relax rather than empty her bladder regularly. Stasis and dehydration are big causes of repeated UTI in the older population. Fluids, fluids, fluids are the key here. She should be drinking enough water so that her pee is clear or light-straw colored on a daily basis.

If she's getting the UTIs constantly, her doctor or uro may prescribe a low-dose daily antibiotic. Yeah, in general it's better to avoid this, but if it'll prevent her from getting repeat infections (which could, in the worst case, spread to her kidneys) then it might be worthwhile.
posted by tetralix at 3:06 PM on November 5, 2010

Are they doing urine tests and finding infections each time or is she just having UTI symptoms? Because if she's having symptoms but her tests are coming up clean or inconclusive, have they discussed interstitial cystitis with her?
posted by crankylex at 3:10 PM on November 5, 2010

YMMV, but D-Mannose has always knocked out a UTI within 48 hours for me. Taken daily, it has helped friends with histories of recurrent UTIs stay infection-free indefinitely. It can be found in the supplements section at Whole Foods or other health food stores.
posted by tanuki.gao at 5:35 PM on November 5, 2010 [1 favorite]

Another thing worth investigating is an actual immunization against UTIs. I am not sure what they would be called in the US or UK, but in Germany doctors either prescribe StroVac (3 x injections) or alternatively Uro-Vaxom (tablets). Could be worth a try?

Check with her if she had pain as the bladder fills up and feels better when it's being emptied - if that's the case, it could actually point towards interstital cystitis. If it hurts passing urine, that more likely a UTI and bacteria could be the cause.

I found this book worth a read: Coping with Cystitis.
posted by jp021272 at 5:48 PM on November 5, 2010

Cranberry juice/pills and water, lots of water, every day.

She should also be eating yogurt daily. If she needs abx to knock this infection out, the daily dose of yogurt will help see her through that without getting a yeast infection.

Does she drink a lot of pop or sweetened coffee or tea? Sugar is not helpful for UTIs, and liquid sugar is the worst.

If she using something like babywipes or colored or scented TP in the bathroom, that needs to stop. Lots of places will tell you to wipe front to back, but I have never been able to make that work. A peri bottle and little flannel cloth wipes is the least irritating way to get clean. (For flannel wipes, check out cloth diapering sites. They aren't very expensive. And a peri bottle is like a dollar.)

Good luck.
posted by Leta at 7:09 PM on November 5, 2010

I'll nth cranberry pills. I find they are FAR more effective than the juice. Even the pure, no sugar added organic juice. Not too mention far cheaper...
posted by whoaali at 7:51 PM on November 5, 2010

It might be a good idea to have her kidney function checked. It decreases a bit with age and that many infections could cause some damage. Not trying to scare you. It's just a friend's mom had tons of infections and found out she had a congenital birth defect in her kidneys that didn't cause problems until she got older.
posted by stray thoughts at 10:58 PM on November 5, 2010

Proper hand hygiene is one of the best defenses we have against preventing infections. It sounds counter-intuitive, but she may want to wash prior to using the restroom to ensure she's not spreading bacteria from her hands to her urethra while wiping. (Of course, she'll still want to wash them after voiding, too.)

If she uses enemas, this may also be a cause - bacteria can spread from the anus to the urethra and cause UTIs. She'll want to be extra careful to practice proper hygiene and thoroughly clean the anal and vaginal area after using the enema.

Finally, if she's sexually active, this may also be causing the UTIs. It can help to void shortly after intercourse; bacteria that have been spread to the opening of the urethra are usually flushed out with the urine.

I realize none of these explains the cold/UTI link. It could be a coincidence, or it could be that her immune system is busy fighting the cold, so to speak, and more susceptible to other infections.
posted by pecanpies at 9:13 AM on November 6, 2010