Help with recurrent UTIs?

October 13, 2005 9:04 AM

Recurrent urinary tract infections.

I've had four in the last year or so. I know about going to the washroom within 10 minutes after sex, and that condoms with spermicide increase your chances of getting a UTI. I know to stay away from sugar, spicy food, caffeine, citrus, etc., while I have one. I have heard that cranberry juice (without sugar) or cranberry pills can help, and it has helped calm it down in the past, but never actually stop it. I don't want to be on antibiotics this often. Should I be taking a cranberry supplement? Is there anything else I can do to stop them? Should I be concerned about how often I'm getting them?

Pertinent info: 24, female, monogamous straight relationship, Depo-Provera, Toronto.

P.S. I'll ask my doctor about this, but: He called me in 2 weeks after my physical because he thought I had a UTI. I said that it had been 2 weeks and I would have noticed something (perhaps BURNING and BLOOD). So, he inquired if I'm having regular periods (though he gives me the Shot every 3 months), because they "clean you out." I'm not certain that he grasps the disconnect between the urinary tract and menstruation (and I'd think that, if anything, the urinary tract would be unhappy about blood in the general area), and I'd like to know what he thinks my period is supposed to "clean out" other than shedding the uterine lining. I'm switching doctors in January.

posted by heatherann to Health & Fitness (37 answers total)

Are these diagnosed UTIs, or do you just have the symptoms of a UTI?
posted by gramcracker at 9:08 AM on October 13, 2005

Response by poster: Diagnosed.
posted by heatherann at 9:11 AM on October 13, 2005

Get thee to a good urologist.
posted by NucleophilicAttack at 9:11 AM on October 13, 2005

I had a recurrent UTI that required a longer-than-prescribed course of Cipro to fully eliminate. It's possible that you simply aren't killing off all the bacteria each time, and they re-colonize. What specific (antibiotic, dose, length) treatments have you undergone?
posted by trevyn at 9:15 AM on October 13, 2005

Homeopathic remedy 30C cantharis (it's spanish fly!) has helped me with UTI's.
posted by brujita at 9:19 AM on October 13, 2005

Response by poster: Right now, it's apo-sulfatrim (sulfamethoxazole/trimethoprim), one pill twice a day for a week. I'm not sure what the names of the others were, but they were for a week, sometimes two.
posted by heatherann at 9:23 AM on October 13, 2005

FWIW, it's somewhat common to have an asymptomatic UTI. When I had my pre-op tests, the urine test came back positive for a UTI, even though I was completely asymptomatic. None of the nurses were surprised by that.

It's possible that it's not been 4 separate UTIs, just one that's getting beat back but not completely gotten rid of.
posted by jlkr at 9:26 AM on October 13, 2005

1) drink cranberry juice regularly- once you have a UTI it's not as effective. It's more of a preventative thing.

2) if you're taking Pyridium don't drink cranberry juice at the same time- they cancel each other out.

3) in my experience extra lube is more effective than after-sex peeing. ymmv, of course.
posted by small_ruminant at 9:38 AM on October 13, 2005

Do you wear a thong? If so - try switching to some grandma panties. That thin piece of fabric can be an enteric bacteria highway.
I get about one a year - my doc gives me a 3 day course of cipro and it kills the crap out of it.
posted by Wolfie at 9:41 AM on October 13, 2005

I feel your pain.

Sexual positions can make a difference, too. I've gotten them when my partner has slipped out of me accidentally and made contact with my urethra--so now I try to avoid that.
posted by handful of rain at 9:42 AM on October 13, 2005

Your partner may need to be treated. Sorry to say this, but when I had recurrent UTIs, it was because my partner was having sex with someone else. Yes, this was really nonfun.

In addition to cranberry juice as a regular part of your diet, drink lots of fluids, pee often and wipe hygenically, and take vitamin C. It helps make your urinary tract more acid, which the bacteria dislike.
posted by theora55 at 10:01 AM on October 13, 2005

Apparently, D-mannose is the ingredient in cranberry juice that makes it effective for UTI; my wife swears by the stuff.
posted by dpcoffin at 10:03 AM on October 13, 2005

are ther long/longish intervals (say, a several weeks or even more) between, ahem, moments of intimacy? because if you do, that can be one of the factors giving you UTI symptoms -- sex (especially vigorous sex) after a dry spell can trigger the UTIs.
also, careful with anal sex -- switching to vaginal right after anal sex is a big no-no, you are going to move bacteria around, and the same bacteria that live happily in your rectum will really damage your unrinary tract, if they manage to crawl in there


I'm switching doctors in January.

good, he doesn't sound too great, frankly, for the reasons you have pointed out

and by the way, maybe the Mayo doctors have something useful to tell you
posted by matteo at 10:06 AM on October 13, 2005

oh, and I second the thong suggestion -- don't wear them. also, stick to 100% natural fabrics for your panties
posted by matteo at 10:07 AM on October 13, 2005

Make certain the boyf goes along next time. It takes longer for men to show symptoms, he could be your - ahem - vector.
posted by methylsalicylate at 10:19 AM on October 13, 2005

And something I didn't mention in my first answer: the hormonal cycle does seem to affect urinary tract health, so your doc may not be as far off as you seem to think. There's not a complete disconnect between urinary tract health and menstrual cycles.
posted by jlkr at 10:38 AM on October 13, 2005

I have the same exact problem that always occurs after rough, er, "intimacy". I'm now allergic and immune to three of the four types of antibiotics.

Chugging water--at least 48 ounces a day--has helped immensely, but I still have had three infections in the last year. Has anyone had real success with cranberry pills?
posted by sian at 10:41 AM on October 13, 2005

Um, have you had a cystoscopy? Because there might be something wrong in your bladder, including cancer.
posted by aramaic at 10:55 AM on October 13, 2005

During one 2-year relationship, I had frequent UTIs... and after that, very rarely. That guy was faithful to me, by the way.

Maybe the problem isn't with you.
posted by wryly at 10:56 AM on October 13, 2005

Um, have you had a cystoscopy?

I'd recommend a good, long course of a strong antibiotic before resorting to that. I had two cystoscopies, both completely unnecessary, because the doc didn't prescribe enough antibiotics.
posted by trevyn at 11:01 AM on October 13, 2005

Response by poster: Thanks for all this great info, guys. I was unaware that UTIs could be asymptomatic. I'm going to the doctor tomorrow, so I'll talk to him about it and schedule a follow-up test for when I'm done this round of antibiotics. The boyfriend is due for a physical anyways, so perhaps we'll get him tested too.

More water, more lube, less time between sex -- sounds like a plan.

I also received this response by email, for the purpose of anonymity:

Two women close to me have been seriously troubled with this problem for several years.

Two really important lessons from them. First, make sure you get the bladder infection specific pain killer - phenazopyridine I believe, I might be leaving some letters off or something. There is no need to feel the pain once you know what is going on. Second, back in 1990 or so a doctor decided that stretching one woman's urethra would solve her problem. She found this to be useless, EXTREMELY painful, and she may or may not be suffering a little incontinence because of it.

It is apparently quite dependant on your sexual partner, not because of infidelity, just mechanics and personal bacteria - multiple 'once-removed' partners can't be good though. It also seems like stress, sleep and hormone levels have a significant effect on the risk of an occurrence.

Neither woman has found any therapy that actually helped substantially despite trying many cranberry and vitamin C type remedies. However, apparently a yogurt is available that has beneficial bacteria, I don't know anything more about it. I have also heard that there has been some minimal development of a topical treatment, a suppository of some sort I guess. Presumably the drug companies don't see enough profit in solving this health problem properly.

Finally, it seems that repeated bladder infections over many years have caused at least one of the women unusual sensitivity in the urethra (nerve problem? who knows...), and hence some sexual dysfunction.

posted by heatherann at 11:03 AM on October 13, 2005

The OTC UTI painkiller is called AZO around here. You can ask any pharmacist or pharmacy tech for "the UTI medicine that makes your pee orange." They will know what you're talking about. It really releives the discomfort, which I know can be insanity in and of itself.

Drink water. Water water water. Being hydrated is helpful. I've also been advised in the past to urinate before sex and afterwards -- so I guess go beforehand, drink a glass of water, and then go afterward. (I, too, dealt with this problem on a recurring basis while dating one guy. I don't know for sure that he wasn't cheating on me, but I doubt it. I think we just had incompatible bacteria.)
posted by Medieval Maven at 11:35 AM on October 13, 2005

Um, how clean is your boyfriend? Does he wear condoms all the time even though you are on Depo-provera?

It may not hurt for him to wash before sex, especially under the foreskin.

IANAD, but my guess is that you have a resistant bacteria strain. Cranberry juice helped a lot, in my case. But you have to drink it regularly. You can find unsweetened, pure cranberry juice at health food store (and really cheap at Trader Joe's, but I don't know if there are any in Toronto). For god's sake, don't drink it straight! Dilute it about 1 part cranberry with 4 parts unsweetened apple juice.
posted by luneray at 11:43 AM on October 13, 2005

I've had problems with recurring UTIs, and while cranberry pills and lots of water are really important, the best thing I've found is a drug called Macrobid. It's an antibiotic that isn't meant to be taken as part of a cycle, but rather as needed. I'm not really sure about the mechanics, but essentially you take a pill after every time you have sex. I went through two refills of the stuff a few years ago, and haven't had a problem since (knock wood!) Ask your doctor for a scrip, maybe.
posted by audrey the bug at 11:51 AM on October 13, 2005

My mom had frequent UTIs, and they finally diagnosed her with Crohn's Disease. The diseased part of her intestine was resting on her bladder, making a hole between them and constantly allowing bacteria in there.

Not trying to freak you out. Just saying - it could be lots of things.
posted by clh at 12:25 PM on October 13, 2005

I think you're on the wrong antibiotic - you're taking a sulfa drug and not Cipro. There are a lot of sulfa resistant UTIS strains out there, as I know from horrid personal experience. A few years ago I went though this exact same thing - recurring UTIs, every few weeks or month, always treated with sulfa. Well, my doctor finally decided that the sulfa had never gotten it all, and put me on Cipro, and blam, 10 days later I was fine and I haven't had one since. They're reluctant to use a strong antibiotic on something as common as a UTI, and you can't blame them, since they want to keep it in reserve if it's ever needed, but I've had UTIs that got up into my kidneys, and you do NOT want that to happen. Demand Cipro.
posted by mygothlaundry at 12:30 PM on October 13, 2005

I feel your pain. Quite literally since I tended to get UTIs way too often myself. Now I keep it mostly at bay, and I can but to sum up what has been said; Find an urologist and get thoroughly tested, same with your boyfriend. Drink lots of water (2-3 liters a day), wear cotton panties (no thongs) and loose trousers (preferably no syntetics).

I also take cranberry pills 2 or 3 times per day all year round, not as a cure, but as an prevention, and it has worked for me. Also, if I feel it sneaking up on me I go to bed with a warm water bottle between my thighs. I think it helps, but I have never heard about anyone else doing it.
posted by mummimamma at 1:29 PM on October 13, 2005

Are they culturing your urine specimens? It's not uncommon when diagnosed with a UTI to have your doctor put you on an antibiotic while the urine culture comes back. Sometimes after the results are in, you need to be switched to a different antibiotic.
posted by 6:1 at 1:59 PM on October 13, 2005

A few years back I experienced a series of UTIs (five within six months). I finally did a really long course of antibiotics that seemed to clear it up.

I recommend evaluating everything you do "down there" and comparing it to when you have flare-ups. In my case, I would get UTIs right after my period. I stopped using tampons for a couple of years and have recently started using them again but I make sure to remove the tampon before I pee. Seems I wasn't getting rid of everything with the tampon in. That may not be it for you, but as with any recurring medical issue, keeping a journal is a good idea.

(FWIW, the doctor told me there was no way I could be getting them from my guy.)
posted by wallaby at 2:32 PM on October 13, 2005

I'm a microbiology graduate student and I recently read a report about how certain types of bacteria that cause UTIs can actually "hide out" inside your own cells. These intracellular bacteria can persist for months undected, until they eventaully bust out and cause a new infection. Hence, recurrent infections. So that may be an explanation, but unfortunately, there isn't much you can do about it aside from taking the full antibiotic course when you do have infection, as to kill all the little buggers before they go hiding again.
posted by emd3737 at 3:14 PM on October 13, 2005

In my experience condoms make it worse, I'm not sure why. Maybe because they make everything drier, maybe a sensitivity to latex- who knows?
posted by small_ruminant at 4:02 PM on October 13, 2005

I second the people who've mentioned that your partner could be a factor. I used to get UTIs constantly, like every couple of months - then at one stage my long-term partner was diagnosed with one as well. After he was treated I think I only ever had one other infection.

Also, don't just go to the bathroom after sex - drink a HUGE glass of water and then wee, that helps. And wipe front to back. There's also a urine alkalizer you can buy - here in Australia it's called Ural. It doesn't clear the infection but it can help a bit with the pain.
posted by andraste at 6:28 PM on October 13, 2005

what about a yeast infection? the treatment would be way different than antibiotics as they work against bacteria. maybe some fluconazole would work, an anti-fungal that is taken orally and works great against yeast. actually, too much antibiotics can cause a yeast infection.
posted by brandz at 6:41 PM on October 13, 2005

I haven't had UTIs (or yeast infections) in three years since I started having a cup of yogurt with live cultures *and* a glass of unsweetened cranberry juice (mixed with other juices), every day. This has tested effective as a preventative. For cranberry to help while you're having a UTI you have drink a lot of it. (I believe it's something like 3 oz. of pure cranberry juice a day to prevent it but 33 oz. a day while infected to help get rid of it, and even then it's not the best cure.)

Also, only wear cotton underwear, or no underwear at bedtime; make sure you wipe front to back or both areas separately with separate wads of toilet paper; and have your boyfriend checked since he could have one that's asymptomatic and just be reinfecting you over and over.
posted by Melinika at 6:52 PM on October 13, 2005

When you wipe your ass, wipe from behind, away from your urethra. (I'm a guy; I have no idea how chicks do stuff.)

Rather than a cystoscopy, an IVP (intravenous pyelogram, an x-ray) should be done. It's noninvasive and more likely to find something.

Regular use of cranberry juice often works, and I believe it's the acidity, not the sugar, that does it.

Be sure to ask about cultures and whether the bugs that grow/grew out were sensitive to the antiobiotics you took.
posted by neuron at 7:32 PM on October 13, 2005

re: cranberry juice: the acidity helps but it also has some compounds that keep bacteria from being able to stick around- sort of UT teflon. If it were just the acidity that prevented UTIs then any acid fruit could do the trick.
posted by small_ruminant at 10:10 AM on October 14, 2005

Since no one mentioned it, a lot of people with recurrent UTIs have residual urine. Sometimes from scar tissue, I was told. When you void your bladder, push several more times after you think it's empty, and keep pushing until you haven't gotten a drop for several pushes. (That's Valsalva's maneuver, if you're keeping track of the details.) This suggestion does not take the place and expensive and perhaps uncomfortable tests (I've had most of them, 35 years ago), but it won't hurt you and if you do have it, makes a lot more difference than you'd think. I haven't had a bladder infection in 35 years, since someone told me I had it.
posted by unrepentanthippie at 8:42 AM on October 15, 2005