In May 2019, the American Urological Association released its updated guidelines for recurrent uncomplicated urinary tract infections in women.
Women who have a sudden onset of dysuria or painful urination or burning with urination with a history of recurring urinary tract infections have been over 90% likelihood of having a urinary tract infection. Other associated symptoms include urinary urgency and frequency as well as bladder or pelvic discomfort, cloudy urine or even blood in the urine.
While it is not known what the exact prevalence of recurrent urinary tract infections are, it cuts across all socio-and economic and racial boundaries. Up to 60% of women will have at least one urinary tract infection in her lifetime and at least a quarter of those patients will have recurrent urinary tract infections.
Risk factors for recurrent urinary tract infections include:
Menopause plays a huge role in the degree of vaginal dryness that patients may experience. This in turn, provides a less hospitable place for the desirable bacteria, lactobacillus.
Causes of UTI’s
Most common organism cultured is E. coli although other species may also cause urinary tract infections. Usually, cultures are important in helping determine the type of antibiotics chosen. It is recommended that the most specific antibiotic and the least broad-spectrum antibiotic be chosen. In some cases, antibiotic prophylaxis prior to intercourse or just after intercourse can be helpful depending on if the patient has 3 or more infections per year. Daily prevention with antibiotics is not recommended as ultimately it can lead to emerging resistances.
The American Urologic Association does endorse cranberry supplements as does the American Association of family physicians guidelines.
Women should void shortly after intercourse to flush out any bacteria trying to enter the bladder. Other preventative measures include improving vaginal estrogenization either with low-dose vaginal estrogen or with the MonaLisa touch vaginal laser. In addition, probiotic supplementation with lactobacillus species has anecdotally improved the vaginal flora although neither of the guidelines recommends that specifically. In fact, there is some controversy regarding probiotics as we learn more about gut flora. D-mannose has also been used in prevention similar to cranberry supplements although again, both guidelines do not mention d-mannose.
Urinary tract infections can be frustrating and inconvenient to deal with. There are several preventative tactics you can employ to reduce your risk. Staying hydrated and voiding after intercourse are simple tactics. Cranberry, D-Mannose and probiotic natural remedies can help. For postmenopausal women, considering vaginal pH factors associated with atrophic vaginitis and correcting them with either low dose vaginal estrogen or the MonaLisa Touch vaginal laser can help prevent UTI’s.
By: Karny Jacoby, MD