Urinary tract infections (UTIs) are a very common reason for women to visit the doctor. Many women, additionally, suffer from recurrent UTIs, that is, more than 2 infections in a 12 month period. Often, they get sent to us ID doctors, in the hope of having their UTIs eradicated once and for all.
Why is it that women are so prone to recurrent UTIs? Below are 4 reasons.
1 – Structural abnormalities of the urinary bladder Women are more prone to having bladder abnormalities, particularly because of child birth. With pregnancy and child birth, the muscles of the pelvis get weakened. Because of this weakness, the support of the bladder is compromised and so the bladder can practically “fall through” the pelvic floor, and bulge, or prolapse, through the vagina (called cystocele). There are various degrees of severity of this problem. The prolapse can be partial where there is a slight bulge through the vagina, or almost complete, where the bladder actually hangs out of the vagina.
The part of the bladder bulging through the vagina, does not get completely emptied of urine. Thus the urine stagnates in this pocket of the bladder, and bacteria can brew, eventually causing an infection.
2 – Low estrogen levels This is a problem with older women after menopause, although younger women who had their ovaries surgically removed, will also experience this problem. Decreased estrogen leads to vaginal dryness. Additionally, there is decrease in suppleness of the tissues around the urethra (the tube draining urine out of the bladder). Dry tissues are more easily irritated. It is easier for bacteria to penetrate irritated tissues. Therefore the tendency towards a UTI is higher.
3 – Increased vaginal pH A high vaginal pH is a more favorable environment for bacteria to thrive. Causes of high vaginal pH include decreased estrogen levels (menopause), pregnancy, and douching. At higher pH levels there is less of the good bacteria Lactobacillus species.
4 – Anatomy Women have a much shorter urethra (the tube that leads urine out of the bladder) than men. As a result, there is a shorter distance between the urethra and the anus. That increases the chance of soiling of the urethral opening. This is a particular problem in older women who have difficulty caring for themselves.
Evaluation of recurrent UTIs includes looking for the above problems. Sometimes the assistance of a Urologist, or a Gynecologist, is needed. Most of these problems can be taken care of in some way or other, whether with surgery, hormone replacement, or probiotic (Lactobacillus) supplements.
Try as we might, unfortunately there are some cases where we can’t seem to put an end to the recurrent UTIs. In some of these cases, we resort to giving low doses of an antibiotic daily, to preventive the infections.