How to Prevent Recurrent UTIs: Practical Tips for Long-Term Relief

What is a Urinary Tract Infection (UTI)?

A Urinary Tract Infection (UTI) is a bacterial infection that affects any part of the urinary system. This includes the kidneys, bladder, urethra, and ureters. Most UTIs involve the lower part of the urinary tract (bladder and urethra), but they can also spread to the kidneys, which makes them more serious. UTIs are more common in women due to the shorter length of the urethra, which makes it easier for bacteria to reach the bladder.

Interestingly, about 50% of women who present with UTI symptoms have negative urine cultures, which suggests that other conditions like urethral syndrome or interstitial cystitis (inflammation of the urethra) may be the underlying cause.

What causes a UTI?

UTIs are typically caused by bacteria, most commonly Escherichia coli (E. coli). tHIS normally lives in the intestines. When such bacteria enter the urinary tract, they can cause an infection. UTIs can also result from:

• sexual activity
• improper hygiene practices
• hormonal changes
• pregnancy
• menopause
• dehydration
• certain birth control methods (like diaphragms or condoms coated in spermicide)
• diabetes
• abnormalities in the urinary tract such as kidney stones and bladder prolapse
• difficulty emptying your bladder fully 
• a weak immune system – for example from chemotherapy or HIV
• a urinary catheter (a tube in your bladder used to drain urine)

Symptoms

The symptoms of a UTI can vary depending on which part of the urinary tract is infected. Here are some common signs to watch for:

• Needing to go to the bathroom frequently, even if little urine comes out
• a strong sense of urgency to urinate
• Pain, a burning sensation or discomfort during urination is a hallmark symptom.
• Changes in urine colour (cloudy) or strong odour
• Lower abdominal pain, pressure cramping or discomfort in the pelvic area
• A high temperature, or feeling hot and shavery, or a very low temperature below 36C
• Urine that appears to have pink, red, or brownish blood

If the infection has spread to the kidneys, you may also experience symptoms such as fever, chills, nausea, vomiting, and lower back pain.

How is a UTI diagnosed?

If you suspect you have a UTI, it’s important to see a healthcare provider for a proper diagnosis. Here’s what you can expect during the diagnostic process:

• Urine dipstick test: Your healthcare provider may ask for a urine sample to test for presence of white blood cells, nitrites and sometimes blood.
• Urine culture: If bacteria are present, a urine culture can identify the specific type, helping the doctor choose the most effective antibiotic.
• Additional testing: For recurrent UTIs or complex cases, further tests like an ultrasound, CT scan, or cystoscopy (a procedure that uses a camera to view the inside of the bladder) may be recommended.

How to treat and prevent UTIs

While a single episode of UTI is typically treated with a course of antibiotics, managing recurrent UTIs often involves a combination of treatments and preventative strategies. Below, we outline evidence-based treatments alongside anecdotal measures that may help reduce the risk of recurrence.

Preventative antibiotics

The standard treatment for a UTI is a prescribed course of antibiotics, tailored to target the bacteria causing the infection. For individuals with frequent UTIs, some healthcare providers may recommend a preventive antibiotic regimen. This could mean taking standby antibiotics, a single dose taken within two hours after sexual activity, or long-term prophylactic antibiotics to prevent future infections. You should complete the full course prescribed, even if you start to feel better. 

Preventive antibiotics work by eliminating bacteria before they can multiply and cause an infection. However, it’s essential to use these antibiotics only under the guidance of a healthcare provider. This is to avoid the risk of antibiotic resistance, which can make future infections harder to treat.

Take paracetamol for pain and temperature

Paracetamol is a reliable over-the-counter option to help manage the pain and fever often experienced with UTIs. It works to relieve discomfort in the lower abdomen and back, where pain is commonly felt during a urinary tract infection. Paracetamol also helps reduce fever, a symptom that sometimes accompanies UTIs when the infection spreads or worsens. For the best results, take paracetamol according to the dosage instructions on the packaging. If symptoms don’t improve, check in with a healthcare provider, as you may need further treatment.

Avoid having sex

During a UTI, it’s best to avoid sexual activity to prevent further irritation and give your body the opportunity to heal. Sex can introduce additional bacteria into the urinary tract, which can exacerbate symptoms and prolong recovery. Also, sexual activity may worsen the discomfort, pain, and inflammation commonly associated with UTIs. For those prone to recurrent infections, taking a temporary break from intercourse until symptoms fully subside can allow your urinary tract to fully recover.

Urinate frequently and after intercourse

Make it a habit to empty your bladder every three to four hours. Holding in urine for an extended period gives bacteria more time to multiply and increases the risk of infection. Urinating after sexual activity is particularly important – intimacy can introduce bacteria into the urinary tract. By emptying your bladder afterwards, you flush out bacteria that may have entered the urethra during intimacy, significantly lowering the chance of infection.

Lifestyle and anecdotal preventative measures

While there is limited scientific evidence to confirm the effectiveness of certain lifestyle changes for preventing recurrent UTIs, many individuals report benefits from the following practices:

Stay well-hydrated

One of the simplest yet most effective ways to prevent UTIs is by staying hydrated. When you drink plenty of water, you produce more urine. Water dilutes the urine, reducing its concentration and making it less hospitable for bacteria. It also helps flush any bacteria out of the bladder and urinary tract before they get a chance to multiply. Aim for six to eight glasses of water daily to keep your system running smoothly.

Wipe from front to back

Maintaining good hygiene, especially when using the bathroom, is essential! Always wipe from front to back to avoid transferring bacteria from the rectal area to the urethra. E. coli bacteria from the anus are a common cause of UTIs. Using this technique is a simple habit that can go a long way in keeping them out of the urinary tract.

Wear breathable, cotton underwear

The type of underwear you wear can influence your risk of developing UTIs. Bacteria thrive in warm, moist environments. So, it’s beneficial to wear breathable fabrics like cotton, which allow air circulation and keep the area dry. Avoid tight clothing, especially synthetic materials, as they can trap moisture and create an ideal environment for bacteria to grow.

Limit use of irritating products

Certain hygiene products, such as scented soaps, douches, and feminine sprays might seem helpful. But they can actually disrupt the natural pH balance of your genital area and irritate the urethra. This makes it easier for harmful bacteria to grow, and increases the risk of infection. So, it’s best to stick to unscented, gentle products. 

For cleansing, you can try a mild, unscented soap and warm water. These can maintain the natural bacterial balance in your genital area and reduce the likelihood of infection.

Take short showers instead of baths

While baths can be relaxing, spending prolonged periods soaking in bathwater can introduce bacteria into the urethra. This is especially if bath products are being used. How? Baths create a warm, moist environment that encourages bacterial growth, which can lead to UTIs.

Opt for showers as your main form of cleansing. or if you prefer baths, try to limit the time and avoid soaking for too long. Also, avoid using products like bath oils that can contribute to irritation.

Consider probiotics for natural defence

Probiotics, especially those containing Lactobacillus, can help maintain a healthy balance of bacteria in the body, including the urinary tract. These “good” bacteria naturally inhabit the vagina and help prevent harmful bacteria from overgrowing. Consuming probiotics regularly, either through fermented foods like yoghurt, sauerkraut, and kefir or as a supplement, can support this balance and lower the risk of infection. Aside from vaginal health, probiotics also improve overall immune function!

Incorporate cranberry supplements

Cranberry is well-known for its potential benefits in UTI prevention. Cranberry supplements, which are more concentrated than cranberry juice, contain proanthocyanidins (PACs). These compounds prevent bacteria, particularly E. coli, from sticking to the walls of the urinary tract. By making it harder for bacteria to adhere to the bladder lining, cranberries can help reduce the likelihood of an infection taking hold. 

Supplements are a convenient option and provide these beneficial compounds without the added sugars found in juice. This can make them a healthier alternative for daily use.

D-Mannose supplements

This sugar is thought to prevent bacteria, especially E. coli, from adhering to the urinary tract. It is available over-the-counter as a powder or capsule.

Menopause and UTIs

Your urinary tract has cells that respond to hormones like oestrogen, progesterone, and testosterone. These hormones help keep the tissues strong, flexible, and healthy. Oestrogen, in particular, encourages the production of natural antimicrobial substances in the bladder and vaginal tissues, boosting your body’s ability to fight infections. During the perimenopause and menopause, as hormone levels drop, the lining of the urinary tract can become thinner, and your immune defences may weaken, increasing the likelihood of urinary symptoms and recurrent UTIs.

You might also notice changes in the vulva and vaginal area, such as dryness, soreness, or thinning. This can make wiping after using the toilet uncomfortable, and you might adjust your habits without realising it, which could increase the risk of infection. Some women also experience UTI-like symptoms during this time, even without an actual infection, because of the reduced hormones affecting the bladder and nearby tissues.

Hormone Replacement Therapy (HRT) can be a helpful option to replenish hormone levels throughout the body, easing urinary symptoms caused by hormonal changes. There are also local treatments, which specifically target the vulva, vagina, bladder, and surrounding areas. If you’re struggling with these symptoms, it’s a good idea to talk to your doctor. They can help you explore the right treatment for your situation, taking into account your symptoms, medical history, and preferences.

When to seek medical attention

Despite your best efforts, there may be times when a UTI still occurs. It’s essential to know when to seek medical help to avoid complications. If you experience any of the following symptoms, contact your healthcare provider promptly:

• Persistent or severe abdominal or pelvic pain
• Blood in your urine (hematuria)
• Fever or chills (a sign that the infection may have spread)
• Nausea or vomiting
• Frequent, painful urination with no relief after a few days

These symptoms could indicate a more severe infection or complications, such as a kidney infection, which requires immediate attention.

The bottom line

Preventing recurrent UTIs is all about maintaining good habits and being mindful of how you care for your urinary health. By incorporating these simple practices into your routine, you can reduce the risk of future infections and enjoy a healthier, UTI-free life. If, however, recurrent UTIs persist despite preventive measures, consult your healthcare provider to explore further treatment options and tailored advice.

Reviewed by Dr Hajra