Recurrent Bladder Infections
Marja Sprock, MD FACOG
Bladder infections (cystitis) that keep on recurring,
even if they never progress to a kidney infection
(pyelonephritis), or worse an infection of your entire
body (urosepsis), can drag you down.
infection per year is normal for women, up to 3 when we
get older, however not more than that. Not all
bladder infections are symptomatic and not all require
treatment. Also some antibiotics, like
ciprofloxacin, which has been used extensively for
bladder infections in the past, should not be used as a
first line anymore, since the resistance to it is too
is not sent off for culture test every time a bladder
infection is diagnosed. If despite taking antibiotics,
you are not getting better, it may be that the bacteria
which are causing the infection are not sensitive to the
antibiotic you have been taking.
cystitis is an infection of the bladder (lower urinary
tract); it can occur alone or together with
pyelonephritis (infection of the kidney – the upper
urinary tract), and all of them can be called a UTI or
urinary tract infection. Most of the time when the term
UTI is used, it indicates a bladder infection.
Cystitis and pyelonephritis are generally considered to
be uncomplicated in otherwise healthy nonpregnant women.
A complicated urinary tract infection, whether in the
bladder or kidneys, is associated with an underlying
condition that increases the risk of failing therapy,
such as an obstruction, anatomic abnormality, urologic
dysfunction, or bacteria resistant to multiple
Issues related to acute uncomplicated cystitis and
pyelonephritis in women will be reviewed here
one reason the infection "recurs", is if it does not
really get treated. This is why you could get a call
from the doctor’s office to start another antibiotic,
stating that the one you were originally taking is not
sensitive. That does not mean your doctor was wrong, you
get coverage per local guidelines for your UTI. Once the
culture comes back and you are diagnosed with a
resistant bacteria or a totally different one than is
regularly the case, your antibiotic may have to be
changed to be effective. Years ago, you would receive
antibiotics for a longer period than now, medicine has
advanced. The first line recommended antibiotics will be
prescribed for 3 or 5 days, but you can treat cystitis
in one day if needed.
adequate treatment is necessary for cystitis not to
recur, however numerous women get reinfected.
couple of issues can make bladder infections easier to
occur, like thinner tissue in the vagina/ over the
urethra in menopause, providing less resistance against
the bacteria. Local estrogen may increase your
Remember: you were taught to wipe front to back.
There is a reason! Even though bacteria from the bowel
are the most commonly found in an UTI, we should not
"rub it in". If you have fecal incontinence, it is hard
to prevent bladder infections often. Spray bottles in
the toilet may help to stay clean. Remember no soap in
the vagina and wipes are not great either, unless all is
purely used on the anus.
natural vaginal flora has lactobacillus and loss of
these natural bacteria may make it easier for unwanted
ones to enter. Soap use close to the vagina, increases
the pH of the vagina, making it alkaline, and
lactobacillus prefer a slightly acidic environment.
Intercourse can often cause infections, especially in
thin the vaginal/ urethral tissue, as in after
menopause; estrogen or prophylactic antibiotics may
Spermicide use and a new sex partner all increase the
risk of recurrent UTI.
Recurrent infections may not have been adequately
treated or recur.
Genetics, menopause and bladder
prolapse are some of the reasons
for recurrent bladder infections
Reinfection can be caused by retention/ not emptying of
the bladder. The reason for not emptying the bladder can
be a prolapse (the bladder has fallen down in the
vagina) and has caused a bulge. The bladder often
empties better at night, since it will hang down less,
and may keep you from sleeping well.
women have no prolapse, but the bladder muscle does not
contract well, sometimes a neurologic issue or prolonged
overstretching of the bladder, causing retention-not
emptying of the bladder, predisposing to infections.
if you have none of the above, some women have a genetic
propensity to infection, which increases the chance that
E. Coli the most common uropathogen/bacteria will bind
to the cell.
cranberry juice help you to prevent these infections;
well it has been shown to diminish the chance of
adherence of some bacteria to the cell. Prophylactic
antibiotics can help in some situations of retention of
urine or infections after intercourse. Urinating after
sex is not harmful, but not really proven to help.
Abstinence may help, but I would recommend prophylactic
antibiotics to take after intercourse.
Vaginal estrogen as a cream or ring will also
significantly decrease the chance of recurrent
infections in postmenopausal women.
Obviously if retention or not emptying of the bladder is
the reason, emptying needs to be improved, either by
prolapse reduction, catherization or nerve stimulation.
Recurrent bladder infections are a genetic problem for
some, an anatomic problem for others or a problem that
does not arise till after menopause for a lot of women.
However it can be debilitating and discouraging.
are numerous treatment options available, obviously
dependent on the underlying reason. If you are bothered
by recurrent bladder infections, see Dr. Sprock
at Central Florida UroGynecology in Rockledge for a
consultation. Call 321-806-3929 for an
appointment or leave a note