I can pee clearly now, the pain is gone
August 23, 2016 9:05 AM   Subscribe

How did you get over recurring UTIs? What has helped you?

(Please don't feel that you have to read my entire wall of text before posting about what has worked for you, because it would be good to know what has helped others, even if it's something that hasn't helped me so far.)

I've had six urinary tract infections in five months, confirmed by culture. It's not the same infection every time--sometimes it's E. coli, sometimes it's Enterobacter.

I went to the urologist that my primary care doctor recommended. Coincidentally, I started a new UTI a couple days before my long-awaited appointment. He told me based on the rapid test that I didn't have a UTI, but took a culture, and sure enough, after a few days of torment, they called me to tell me that it was another one.

For prevention, when I saw him, the urologist recommended a particular brand of cranberry supplement and a particular brand of probiotic, to be taken orally, so I carefully complied. After the culture results came back (indicating E. coli with no antibiotic resistance), he prescribed yet another course of nitrofurantoin. I didn't feel better after a week, so he called in another week of nitrofurantoin. Four days after I took the last pill in that prescription, I developed a new UTI. This time it was Enterobacter, resistant only to tetracyclines. Another week of nitrofurantoin, no relief. After that I called in and demanded a different antibiotic; they gave me Augmentin, because I am allergic to Bactrim and Cipro. Still taking the expensive cranberry and probiotic supplements.

The cranberry supplement costs $45 a month at the lowest dosage and is not covered by insurance (I've already met my high medical insurance deductible for this year). The urologist recommended only this specific brand; importantly, he's not selling it, but I'm not impressed by it so far, since I still got another UTI while using it. It claims to be unique in containing 36 milligrams of PAC (proanthocyanidin) per capsule, but as far as I can determine from journal articles, the unsweetened 100% cranberry juice I've been drinking probably contains more than that in a single ounce. So I've been drinking at least two to four ounces of 100% cranberry juice per day, and also taking the recommended cranberry pill at bedtime, for good measure.

I don't have much confidence that the recommended oral probiotic pill can make any difference, especially while taking antibiotics, but I've been diligent in taking it as recommended, on an empty stomach, as many hours as possible from my antibiotic doses. One article I read said that inserting the probiotic vaginally is safe and is more effective, so I've been doing that once per week, as well.

I'm in my mid-fifties and have been in menopause since January. In May (after the first two UTIs in this series), my primary care doctor prescribed Estring, a vaginal ring that releases a small but steady amount of estrogen, hoping that would help prevent further UTIs. No such luck. The urologist said that he likes to prescribe the use of a vaginal estrogen cream, in addition, but I'd already tried Premarin cream, back in January, and it gave me awful vaginitis. I haven't been able to tolerate vaginal anti-yeast creams for years, so this shouldn't have been a surprise. Evidently I'm sensitive to one or more of the inactive ingredients. One of the inactive ingredients in Premarin cream is a detergent, sodium dodecyl sulfate, also known as sodium lauryl sulfate. I haven't been able to use detergents or soap inside my vulva for years without developing a bad case of vaginitis afterwards; I don't think this is uncommon, so why do they even put it into the vaginal creams?! The Estring vaginal ring seemed to be pressing on my aching bladder, so after three months my primary care doctor switched me from that to topical Vagifem 10 mcg tablets, three times a week. The urologist dropped the idea of a cream after I mentioned my problems with Premarin and possibly Estrace, without considering a compounded cream; my primary care doctor says that a custom-compounded cream would be very expensive and probably not covered by insurance.

Sex seems to be a real issue in triggering these. I don't want to give up sex. I can't bear the idea of giving up sex. Of course I always pee before and immediately after sex, like you're supposed to (this requires drinking glass of water immediately before sex). I always wash my bottom with soap after a bowel movement. I have only one sex partner, and he certainly showers frequently enough. We don't use spermicides or condoms; we use a lubricant, S'Liquid H2O, that doesn't cause stinging for me the way other brands do. Someone told me that she was prescribed nitrofurantoin to take every time she has sex. How does that work for people who have sex every night? Someone else told me she found she and her husband had to give up having sex more than one day in a row, that always taking a day off in between helped. I don't like that idea, but it's better than my current situation, in which having sex even once seems to be enough to trigger it. It's not even just intercourse; masturbation seems to do it, too.

I drink a lot of water. I am careful to completely empty my bladder each time (if, after finishing, you stand up and stretch and walk a step or two then try to urinate again, it often turns out you can urinate more). I don't have any urine leakage. I did have two children, but I had a c-section each time for unavoidable reasons. Like a lot of women my age, I have uterine fibroids, but the gynecologist I saw told me that he does not recommend surgical removal of uterine fibroids, instead preferring to treat them with a hysterectomy, and I very strongly do not want to have a hysterectomy.

I told the urologist's nurse on the phone that I was very interested in taking preventative antibiotics for a while, but she said that they worry about lung damage caused by a low daily doses of nitrofurantoin in the elderly, not that I am elderly, so I'd have to see him again in order to discuss the pros and cons. Never mind that I've been taking nitrofurantoin at the higher dose for much of this summer. I moved up my next appointment with the urologist to as soon as possible, but there's no appointment available before late September. I need to gather all the information I can before then, so as not to waste that appointment. If I had any really good ideas, I could take them to my primary care doctor much sooner.

I'm going to see a infectious diseases specialist about this later this month. I hope maybe she'll have something to offer. I don't know what.

Please tell me that there will be an end to this. This is really getting me down.
posted by artistic verisimilitude to Health & Fitness (32 answers total) 15 users marked this as a favorite
Best answer: As someone who is prone to UTIs, I have found something that I *think* is working for me, now that I have not had one in over a year. I take D Mannose tablets, which are somewhat pricey and can be found at whole foods or online. I take 3 after having relations, and 3 again within a few hours. If I feel a "twinge" I take more and drink lots of water. So far so good for me.
posted by peach23 at 9:08 AM on August 23, 2016 [3 favorites]

Best answer: D Mannose worked for me too! Had years of chronic UTIs after heavy antibiotics. They were the only thing to help. I used the loose powder (mixed into water) and taken quite liberally while having an active infection. Then, you can take it preventatively once or twice a day. It works amazingly well without any side effects.

My UTI problem has since resolved but I did notice while taking oral probiotics for yeast issues (FemDolphius brand by Jarrow), I haven't gotten even a twinge of another UTI. I don't know if that would have worked on its own without the D Mannose though.
posted by neematoad at 9:17 AM on August 23, 2016 [1 favorite]

D Mannose is great, and I suspect that was the supplement you are already taking.

Hey! I think the problem is a severe change in the healthy bacteria and such that usually keeps this sort of thing in check. Antibiotics are not helping for this reason. I'm not sure how you repopulate yourself with the "good" stuff, but I kinda do. I know women use yogurt, diluted vinegar. You could drink lots more kombucha and kefir. I know these are "folk" remedies. They do work. Nettle tea helps, I forget why.

You want some sort of topically applied (inserted?) pro-pre-biotics, if I had to guess, in the short term. Longterm, change your diet to add fiber (psyllium will do it) + lots of fermented foods like sauerkraut, yogurt, kefir, kombucha.

Google using raw apple cider vinegar in a drink, and possibly highly diluted as a rinse. Maybe? IANAD. I use lots of supplements and herbs when stuff like this happens, it always works out better longterm for me, even if it takes longer to resolve.

Anyway, don't take antibiotics without taking pro/prebiotic supplements. Ditto Ibuprofen. They really screw up your internal flora.

Hope that helps.
posted by jbenben at 9:32 AM on August 23, 2016 [1 favorite]

Wash after sex - not talking full-on shower/bath, just a warm soapy washcloth.

Also, consider using those cleansing wipes (you can buy near the menstrual-goods aisle) as a general bathroom tool every time you wipe anything. Maybe not a long-term necessity, but it might be an interesting diagnostic to see whether over-cleanliness would help.
posted by aimedwander at 9:34 AM on August 23, 2016

Similary, your partner should get on the same diet. I suspect this is another aspect of the issue and him having a healthy biome can only help your recovery.

The right brand of non-latex condoms are undetectable, you should use them until this clears up.

Coconut oil as lube for sex, you're not worried about pregnancy so no worries about the interaction whether you use condoms or not. But yeah, use non-latex condoms until this clears up.
posted by jbenben at 9:36 AM on August 23, 2016

Best answer: Counter-intuitive, but I found that too much cranberry juice actually irritated my bladder and made things worse; nettle tea, on the other hand, was extremely helpful (and scratched the I'm-doing-something mental itch in the same way).

Also, avoiding coffee and alcohol until the cycle is broken. I didn't have to give them up permanently, and I'm not going to pretend the month I spent without either was exactly fun, but it did help a lot.
posted by dizziest at 9:38 AM on August 23, 2016

I used to be very prone to UTIs. 7 years ago I went vegetarian, then vegan, and coincidentally noticed I never got a UTI again after that, though that obviously wasn't the reason why I stopped eating animal products - I didn't suspect any connection between the two at that time. Later, I saw an article linking UTIs and chicken consumption. Random, but if you're at the end your rope, maybe try cutting out chicken? One article (but when I googled now, saw there are tons on that link these days): http://www.foodsafetynews.com/2012/03/study-suggests-chicken-is-contributing-to-urinary-tract-infections/#.V7x9YCgrI2w
posted by srrh at 9:44 AM on August 23, 2016

Best answer: I looked up the lube you mentioned, and the amazon image looks like a simple flip top. I feel like I read somewhere that these are prone to getting contaminated somehow... I recommend this stuff. Also water based, works well ;) and has a fancy pump top that somehow prevents any contamination of the lube inside the bottle.
posted by Drosera at 9:57 AM on August 23, 2016 [1 favorite]

I know someone who had recurrent UTIs until an older hippyish friend recommended Goldenseal. She took that for a few weeks (like 6?) and they stopped.

Sex seems to be a real issue in triggering these. I don't want to give up sex. I can't bear the idea of giving up sex.

He may be carrying whatever causes you problems. He might need to be treated in some way. Same acquaintance who took Goldenseal had recurrent yeast infections that didn't stop until she and the BF were both treated for it at the same time.
posted by Michele in California at 9:58 AM on August 23, 2016 [2 favorites]

Try having sex with condoms for a few months and see if that helps -- it could be that your partner is either carrying bacteria or that the, um, end result is imbalancing your pH to the point where bacteria from other sources can take hold.
posted by ananci at 10:19 AM on August 23, 2016 [1 favorite]

It sounds like yours might be caused by a confluence of factors. Others have addressed some nutrition and other approaches; I will say that my chronic UTIs (and bacterial vaginosis, which is just the best) cleared up after I became monogamous with someone who is very strict about having a clean (freshly showered) bum before we have sex. Because he enjoys that level of cleanliness, I do, too--even if it's a quick rubdown with a soapy washcloth just prior to initiating the business.

E. coli literally only comes from fecal matter, and I think we tend to underestimate how much of it is floating around us all the time. Even if we wipe really well and wash our hands, it takes only small amounts to cause an infection.

Another upside of being freshly washed is I don't have to get up right away to pee since there's nearly nothing to flush out from the urethra. But I only started to get cavalier about that after a few years of no UTIs. Honestly, it feels like a miracle.
posted by witchen at 10:27 AM on August 23, 2016 [2 favorites]

I have had chronic UTIs my whole life. D Mannose did not help me. I take a prophylactic dose of nitrofurantin after sex, take AZO for the pain as needed. The unorthodox thing that helps me immensely is cutting back on sugar. I have no idea why this helps, but it really does. I am so sorry for you -- UTIs are miserable.
posted by Threeve at 10:27 AM on August 23, 2016

One more thing: if you find yourself getting other types of infections, like pinkeye or styes, then the culprit is almost certainly fecal matter. And I can't speak to the nutrition aspect, but I understand there are some symptoms of food allergy/sensitivity that manifest as gynecological unpleasantness.
posted by witchen at 10:38 AM on August 23, 2016

Sex seems to be a real issue in triggering these.

Has your partner been tested/treated for a possible sub-clinical UTI?

It's not even just intercourse; masturbation seems to do it, too.

Is it possible that a minor reinfection from Partner is being made to flare up by masturbation related moisture/inflammation?

If I were in your situation, I'd continue on the previously medically indicated course while also taking preventative measures based on the possibility of reinfection from partner. The cheapest way to do this is probably to try condoms for a couple months. The prospect of this might be enough to warrant making clinic visits for Partner more of a priority.
posted by sparklemotion at 10:54 AM on August 23, 2016 [1 favorite]

I have some ideas which I hope will help. Both you and he should wash before sex. Both your genitals and anus (in that order) must be scrubbed with soapy washcloth; preferably one washcloth dedicated to the anus. I have learned most people don't actually wash their crack well so I feel this needs to be mentioned. Your hands should also be washed immediately before.

Are you washing your bed sheets, towels, and wash cloths regularly?

Drink more water; your urine should be almost clear always. You'll probably have to get up in the middle of the night to pee and drink more water if you are drinking enough.

Cutting carbohydrate intake, especially sugar, should also provide less food for the bacteria.
posted by flimflam at 10:55 AM on August 23, 2016 [2 favorites]

Is there a urogynecologist in your area that you could see? Someone who specializes in the female urinary system may be able to help you.
posted by mchorn at 11:16 AM on August 23, 2016

" The unorthodox thing that helps me immensely is cutting back on sugar. I have no idea why this helps, but it really does. I am so sorry for you -- UTIs are miserable."

This is because bacteria thrive on sugar. Nthing cutting your sugar and carb intake. And get your partner tested. And use condoms. And change your lube/put fresh lube in a new container.
posted by jbenben at 11:18 AM on August 23, 2016 [1 favorite]

Someone I know had recurrent UTIs and part of her solution involved stopping all dark liquids- no coffee, red wine, colored liquors, dark soda. She does still drink tea.
posted by sulaine at 11:19 AM on August 23, 2016

1) Make sure your partner is clean before sex. It can be kinda sexy like "Hey, you wanna wash up - wink wink"
2) Always wipe front to back after using the restroom (I'm assuming you do but just checking.)
3) Wear cotton regular underwear - no synthetics or thongs.
4) Maybe try another lube - must be water soluble! (I think the sliquid h20 is water soluable from my search - as in it rinses clean with only water. But I use Slippery Stuff Liquid and have never had a problem.)
5) When you pee after sex use as much force as possible with your muscles to eliminate your bladder. Continue to drink water after don't just focus on peeing immediately after sex.

Also: Find a new doctor.

When I had recurrent UTIs my urologist said that if they didn't go away after trying some things that they'd do a scope. Sometimes you can have scar tissue or other blockages in your bladder or urethras. In fact the nurse (lady probably around your age) at my university clinic who got to know me - since I was in there so often with UTIs said she had the same problem when she was younger. The UTIs had caused scar tissue which was broken up during her scope and she didn't have another problem after that.

Luckily after changing my habits around, eliminating every lube but slippery stuff, making sure my partner was clean, and drinking more water, they eventually went away. I had them about every month for at least 6 months and two kidney infections.

Now that was about 4 or 5 years ago? I've only had one or two in that time period - which is pretty standard. Also while I do make sure to ask my partner to clean up if he's been sweaty or something - most of the time it's been fine now that I've been rid of the UTIs for a while. I still make sure I'm extra clean and drink plenty of water.
posted by Crystalinne at 11:40 AM on August 23, 2016

Best answer: My mother used to get terrible UTIs for years - and she tried a lot of what you have tried. Strangely, they went away when she stopped taking vitamins with vitamin C, and stopped with cranberry juice and capsules, and apple and orange juice, etc. No idea if this will help, but I'll throw it out there.
posted by umwhat at 1:17 PM on August 23, 2016

Seconding finding a urogynecologist who by their nature focus on the female urethra. Your run-of-the-mill urologist treats middle-aged men with enlarged prostates more than rucurrant UTIs in women.
posted by eglenner at 1:39 PM on August 23, 2016 [2 favorites]

Washing before sex is critical for me. Washing after makes almost no difference. I also learned a trick from a nurse who used to get chronic UTIs. After washing before sex, take a small blob of petroleum jelly and cover your urethra. The idea is to create a little jelly plug to stop bacteria from getting forced up there during sex. When you take your post-sex pee, you'll pee it back out.

I also took lots of cranberry extract pills and D-mannose for a year (brand didn't matter, but I looked for ones that were on the stronger/higher dosage side). I maintained the regimen of good sex hygiene and cranberry supplementation for a year even after I stopped having chronic UTIs. Now, for whatever reason, my body doesn't get UTIs easily at all even with no special regimens in place.
posted by quince at 2:30 PM on August 23, 2016 [2 favorites]

Seconding all the partner's-health-related advice, and adding: make sure you're laundering anything that touches your genital area (so, washcloths, underwear, body towels, bed linens) in hot water.
posted by Iris Gambol at 3:18 PM on August 23, 2016

Are you constipated? My MIL was prone to recurrent UTIs as well. She even underwent a VCUG to determine if there was some anatomical reason for her UTIs. It showed no issues. However, since the last year she's been UTI free and started eating a much better fiber-rich diet. My 3 year old daughter has also had numerous UTIs (some of which have progressed to full on infections) and the first question her pediatrician and the pediatric urologist asked was: is she constipated? Here's some literature on the link between them.

PS: your title made me LOL. Thank you for the needed chuckle.
posted by tafetta, darling! at 3:33 PM on August 23, 2016

Best answer: My old urologist ended up prescribing me six months of very strong antibiotics. Unfortunately I don't remember which type.
posted by Jacqueline at 5:47 PM on August 23, 2016

Best answer: I suspect that overenthusiastic cleaning after sex has triggered them in me, and while I do still pee and clean up with a wet washcloth after sex I now do not let soap or soapy anything near my urethra. Not sure if the soap sets up some irritation that lets bacteria get established or what, though. And just a wild chance, not from my own experience and not really confirmed, but do you take bubblebaths?
posted by sockasm at 7:21 PM on August 23, 2016

Have you considered having sex in the shower? Can't get much cleaner than that...
posted by Toddles at 9:19 PM on August 23, 2016

Best answer: Oh I, too, have suffered terribly from UTI misery, especially after sex, but also sometimes just when I dont get out of bed early enough in the morning to use the bathroom, which allows the bacteria to concentrate. So I am unaware of the exact cultures I had, and different strains likely thrive in different environments, but I heard that having a very acidic diet (which I definitely have), really encourages bacterial flourishing in the urinary tract. So in my last bout with a UTI, I tried alkalizing with some baking soda diluted in water and I definitely felt better for a few days at a time but then would feel burny again. Cranberry pills did nothing good for me, in fact I always felt symptoms more strongly when I took them in the middle of a UTI (they have an acidifying effect on the urine).

So on an internet recommendation I tried the D Mannose powder sold at Whole Foods and immediately lost the burning feeling. After a few days of use, I felt completely back to right and have stayed that way. So another enthusiastic send up of the D mannose from me! I understand that it is just a sugar that the body does not digest so it immediately gets eliminated, but on its way out it picks up bacteria that stick to it and then it all gets flushed out. Worth trying if you haven't already-- it's about $25 for the 85 gram bottle at Whole Foods.
posted by cristalina at 9:22 PM on August 23, 2016

Best answer: I started seeing a urologist last fall for the exact same reason. Here was the upshot of the appointment:
A prescription of METHENAMINE HIPP 1 GM (hiprex) to be taken twice a day, every day, for about a year.
Take probiotics every day. Antibiotics kill off the good bacteria not just in your gut, but in your urethra as well, so after repeated courses you are less able to naturally fight off infections.

I only take the Hiprex once a day, so I'm taking half of the dose I'm supposed to be taking. (It's a little hard on the stomach I can't take it first thing in the morning.) If you want to test the theory by taking the OTC version of Hiprex, go to the CVS and get Cystex. Make sure it's the one with methenamine. It's the same ingredient as Hiprex, but a much smaller dosage (162 mg vs 1 gram) so take a few a day.

I also take D-Mannose as well. If I do these two things, (hiprex and d-mannose) I don't get infections. If I stop the Hiprex for a couple of weeks, I start getting them again. I admit I am not great about taking the probiotics, which ultimately is what will help get things more in balance. I'm not thrilled about taking Hiprex for the rest of my life, but I'm ok taking the d-mannose and probiotics forever if it prevents them.

Also: I think nitrofurantoin is completely useless as an antibiotic. The only times I've gotten UTI's on a recurring, monthly/6-weeks basis (in 2012 I had SEVEN, and this year I have had FIVE so far) was when I kept getting nitrofurantoin to cure them. After the fifth one this year, they gave me MONUROL 3 GM SACHET, which is an antibiotic that is specifically indicated for UTI's. Why in hell I'd never been given it before is beyond me, but it freaking well worked.

Good luck, and let us know how things turn out.
posted by 8dot3 at 5:43 AM on August 24, 2016 [3 favorites]

I run into the same issue as you. I am going to give the above mentioned ideas a go. I noticed coconut oil as lube and I can't recommend it highly enough.
posted by OkTwigs at 8:43 PM on August 24, 2016

Response by poster: What turned out to be the answer: three weeks of the right antibiotic. According to the Infectious Diseases specialist I consulted next, nitrofurantoin is not sufficiently effective against Enterobacter infections, even if the antibiotic susceptibility panel indicates it is not resistant, so apparently I was never quite getting well. Three weeks of Augmentin did the job. It's been two whole months now since I had a UTI, and I am feeling less fragile, and cautiously optimistic.

The urologist tells me to continue with all preventive measures and visit him again in six months, assuming I stay well that long. He thinks that preventative measures will be more effective now that I've taken the Augmentin long enough to get well. Although he had not mentioned D-mannose to me, he agrees with the posters who suggested that it is a good idea. I've been taking three 500-milligram capsules, three times a day, since reading about it here. This is in addition to the expensive Ellura brand cranberry supplement and the Florajen brand probiotic. He had advised me to take Florajen orally every day, but I read a journal article that concluded that using probiotics as a vaginal suppository works better and is safe; he agrees that this is a good idea, but says I should keep taking the probiotic orally every day, as well.

As sockasm posted above, it is very important to avoid using soap on the urethra. Scrubbing one's genitals before sex, as another poster suggested above, is the worst advice ever for someone who is troubled by UTIs! My first UTIs, at the age of seven, were caused by bubble bath.

I was very favorably impressed by the Infectious Diseases specialist I saw. Those people are great! She listened intently and knew just what to do. I saw another Infectious Diseases specialist before twenty-five years ago for a different reason, and he was able to fix what several doctors had failed to help me with.

Thank you all for all the suggestions, and for giving me hope of getting through this.
posted by artistic verisimilitude at 12:33 PM on October 25, 2016 [3 favorites]

Oh, fantastic news. Thank you for the update!
posted by 8dot3 at 5:06 AM on October 27, 2016

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