Urinary Tract Infections and Recurrent UTIs
Urinary tract infections (UTIs) are among the most common bacterial infections, affecting millions annually. While uncomplicated UTIs are typically mild and respond well to treatment, complicated UTIs—or those associated with structural abnormalities, kidney involvement, or antibiotic resistance—can be more serious.
At Tower Urology, our specialists provide expert diagnosis, treatment, and long-term strategies to manage and prevent recurrent UTIs, helping patients regain control of their urinary health.
What is a urinary tract infection?
A urinary tract infection (UTI) occurs when uropathogenic bacteria, most commonly Escherichia coli (E. coli), enter and multiply within the urinary system. This system can include the bladder, urethra, ureters, or kidneys.
While some infections remain confined to the lower urinary tract (the bladder, urethra, and prostate in men), more serious infections can spread to the kidneys, leading to potential complications.
What are the symptoms of a UTI?
The most common UTI symptoms are a strong urge to urinate and pain while urinating. But others can occur, including:
- Pain or burning with urination (dysuria)
- Increased urinary urgency and frequency
- Cloudy or foul-smelling urine
- Lower abdominal or pelvic pain
- Blood in the urine (hematuria)
If a UTI spreads to the renal system, symptoms may become more severe, such as:
- Flank pain
- Fever and chills
- Nausea and vomiting
Early diagnosis and treatment are essential to prevent UTIs from progressing to kidney infections (pyelonephritis) or becoming complicated UTIs that require more intensive medical intervention.
Types of urinary tract infections
UTIs are generally classified as lower or upper urinary tract infections, depending on the location of the infection.
Lower UTIs
Lower UTIs affect the bladder and urethra and include:
- Cystitis. A bacterial infection of the bladder, the most common form of UTI.
- Urethritis. A urethral infection is often associated with sexually transmitted infections (STIs) or bacterial overgrowth.
Upper UTIs
Upper UTIs involve the kidneys and require urgent medical attention:
- Pyelonephritis. A severe kidney infection may develop when bacteria travel upward from the bladder. This can lead to renal complications and, in rare cases, sepsis.
Why are UTIs more common in women?
Women experience UTIs more frequently than men due to anatomical differences. The female urethra is shorter and positioned closer to the vagina and anus, increasing the likelihood of bacterial migration into the urinary tract during things like sexual intercourse or wiping back to front after voiding. Risk factors include:
- Sexual activity can introduce bacteria into the urethra.
- Menopause, where low estrogen levels can thin genital tissues, reduces their natural defenses against infection.
- Certain forms of contraception, including diaphragms and spermicides, can disrupt the normal bacterial balance.
- Pregnancy can alter bladder emptying and urine flow, increasing infection susceptibility.
- Catheter use can allow bacteria to enter the urinary tract more easily.
Men, while less prone to UTIs, tend to experience more severe infections when they do occur, often linked to prostate enlargement, bladder dysfunction, or reflux of urine back into the kidneys.
How are UTIs diagnosed?
UTI diagnosis begins with a urine sample. The sample can be sent for a urine culture to identify the bacterial strain causing the infection and determine antibiotic susceptibility for precise antibiotic treatment. Urinalysis can also detect the presence of white blood cells, blood, or nitrites, which indicate infection.
For patients with recurrent or complicated UTIs, additional testing may include:
- Cystoscopy. A small camera is inserted into the bladder to evaluate for structural abnormalities.
- Imaging studies. Testing such as renal ultrasound, computed tomography (CT), or MRI can assess for kidney stones, urinary reflux, or anatomical blockages.
Patients with frequent UTIs may require a more detailed evaluation to rule out underlying conditions, including bladder dysfunction, immune deficiencies, or chronic bacterial colonization.
What are recurrent UTIs?
A recurrent UTI is defined as three or more UTIs in a year or two within six months.
Recurrent UTIs can be disruptive and significantly impact your quality of life. Women are particularly susceptible, with nearly 30% of women who experience one UTI developing another within six months.
Identifying the underlying cause of recurrent infections is crucial to preventing long-term complications. Recurrent UTIs can be caused by several things, including anatomical abnormalities in the urinary tract, inadequate fluid intake, frequent sexual intercourse, use of spermicides, or hormonal changes (especially during menopause).
Treatment options for UTIs
Treatment for your UTI depends on which type of infection you are experiencing.
Acute UTI treatment
Most UTIs respond well to a short course of antibiotic therapy, such as Trimethoprim-sulfamethoxazole (Bactrim), Nitrofurantoin (Macrobid), or Fosfomycin.
Patients with antibiotic-resistant bacteria may require a more extended antibiotic regimen or an alternative approach based on bacterial susceptibility testing.
Recurrent UTI management and prevention
For patients with frequent UTIs, a more comprehensive approach is necessary. Strategies include:
- Prophylactic antibiotic therapy. A low-dose antibiotic regimen to prevent future infections.
- Post-coital antibiotics. Taken immediately after sexual activity to reduce bacterial migration.
- Vaginal estrogen therapy. To restore the natural lactobacillus balance in postmenopausal women and protect against infection.
- Probiotics. Mainly those containing lactobacillus can promote a healthier vaginal and urinary microbiome.
- D-mannose and cranberry products. These supplements may help reduce the likelihood of bacteria sticking in some individuals’ urinary tract (bacterial adhesion).
- Behavioral modifications. Lifestyle changes such as increasing fluid intake, urinating before and after intercourse, and wiping front-to-back can reduce the chances of bacteria being introduced to the urinary tract.
For complicated UTIs that do not respond to traditional treatments, procedural interventions such as bladder fulguration, which destroys abnormal bladder tissue, or, in rare cases, bladder surgery or kidney surgery (nephrectomy) may be considered.
Why trust Tower Urology with your UTI concerns in Los Angeles?
Tower Urology’s board-certified urological team has been a leader in effectively treating general urology for over two decades, with specialists trained in all aspects of urological health.
Tower Urology’s advantage lies in our unwavering commitment to providing world-class urologic care through advanced technology, personalized treatment plans, and a patient-centered approach. With a reputation for excellence and innovation, we deliver superior outcomes that distinguish us as leaders in urologic health.
Tower Urology treats the full range of urological and gyno-urological conditions, including nocturia, neurogenic bladder, kidney stones, incontinence/overactive bladder (OAB), hematuria, and UTIs.
We invite you to establish care with Tower Urology.
Tower Urology is a proud affiliate of Cedars-Sinai Medical Center, ranked #1 in California and #2 nationwide by U.S. News & World Report. This partnership reflects our dedication to delivering the highest standard of urologic care alongside the best urologists in Los Angeles. Our years of experience and access to Cedars-Sinai’s world-class facilities ensure that our exceptional and innovative urological care positions Tower Urology as a leader in Southern California.
Tower Urology is conveniently located for patients throughout Southern California and the Los Angeles area, including Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, and Downtown Los Angeles.
UTI Frequently Asked Questions
Recurrent UTIs can be caused by bacterial persistence, antibiotic resistance, urinary reflux, or anatomical abnormalities. A complete evaluation is essential to determine the cause.
Cranberries contain proanthocyanidins, which may prevent bacterial adhesion in the bladder. However, for effectiveness, high-concentration formulations are typically needed.
Common choices include nitrofurantoin, trimethoprim-sulfamethoxazole (Bactrim), and fosfomycin, though selection depends on antibiotic resistance patterns.
To prevent recurrent UTIs, you can try to focus on staying hydrated by drinking plenty of fluids, urinating frequently, wiping from front to back after using the toilet, peeing after sexual intercourse, wearing breathable cotton underwear, or considering cranberry supplements. But it’s essential to consult your urologist if you experience three or more UTIs in a year or two or more UTIs within six months.
Sources
Urinary Tract Infection Basics
https://www.cdc.gov/uti/about/index.html
Bladder Infection (Urinary Tract Infection—UTI) in Adults
https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-infection-uti-in-adults
Daily cranberry juice for the prevention of asymptomatic bacteriuria in pregnancy: a randomized, controlled pilot study
https://pubmed.ncbi.nlm.nih.gov/18707726/
Recurrent Urinary Tract Infections in Postmenopausal Women | Clinical Infectious Diseases | Oxford Academic
https://academic.oup.com/cid/article/30/1/152/320582
The Role of Excretory Urography and Cystoscopy in the Evaluation and Management of Women with Recurrent Urinary Tract Infection | Journal of Urology
https://www.auajournals.org/doi/10.1016/S0022-5347%2817%2955849-8
Urinary Tract Infections (UTIs)
https://www.plannedparenthood.org/learn/health-and-wellness/urinary-tract-infections-utis
