"I urinate all the time. It burns when I go to the bathroom. I feel pressure down there. Could I have a urinary tract infection?"
Urinary tract infection is a significant problem in 1 out of every 5 women in the United States. Bacteria can be found in the urine in 4% of women by young adulthood, and then an additional 1 to 2% per decade of age. The older a woman is, the more likely she is to have a recurrent urinary tract infection.
Urinary tract infections are caused by bacteria. The most common bacteria involved are the E. coli bacteria, accounting for about 75% of all cases. The second most common bacteria in young women are the Staph. saprophyticus bacteria, organisms that usually live on the skin.
Why do women get urinary tract infections? Bacteria that normally live in the bowels get into the vaginal area by adhering, or sticking, to the skin cells lining the vagina. These bacteria eventually make their way to the urethra, which is the passageway out from the bladder, and then move up into the bladder. In the bladder, bacteria can adhere to the cells lining the inside of the bladder, multiply, and a urinary tract infection results.
Why do some women seem prone to repeated infections? Women with recurrent infections have a greater incidence of bacteria in the vagina and also have a greater number of bacteria lining the vagina. There is a biologic change in the cells lining both the vagina and the bladder that allows bacteria to adhere to the lining cells much more easily than in women who do not get repeated urinary tract infections.
The probability of recurrent urinary tract infection increases with the number of previous infections. If a woman gets a urinary tract infection and then experiences a second one within the next 6 months, there is a 66% chance of getting another urinary tract infection within the next 6 months.
What can a woman do about recurrent urinary tract infections? The goals of treatment are:
Treatment for recurrent urinary tract infections consists of two steps. We first eliminate the infection and sterilize the urine by prescribing a 10 day course of antibiotics. Then, only after the urine is sterile, we place the patient on antibiotic prophylaxis. This means, the woman takes a single small dose of an antibiotic pill each night to prevent a urinary tract infection from recurring.
Therefore, in patients with recurrent urinary tract infections, the goal is to suppress the infection without selecting for resistant strains of bacteria in the vaginal area and rectal area, where bacteria normally reside. The antibiotics with minimal unwanted effects include:
These prophylactic regimens are over 90% effective in preventing recurrent urinary tract infections. However, once the patient stops taking the antibiotic prophylaxis, she returns to her pretreatment rate of recurrent urinary tract infections.