Recurrent UTI in women – 8 things you need to know

If you're left wondering 'Why do I keep getting urinary tract infections?', read on for 8 things you need to know about recurrent UTIs (RUTI), including what causes them and how you can stop them from happening.

1. What makes a UTI recurrent?

A recurrent UTI is when you get 2 UTIs in 6 months or 3 or more UTIs in a year. In most cases, this means that you have a UTI and get it treated so it goes away – but then you get new infections on a regular basis. Most of the time, when you hear about the condition ‘recurrent UTI’, that’s what it means.

But occasionally, RUTI can be the same infection that hasn’t gone away or hasn’t been treated properly, in this case, a recurring UTI. Some experts are now looking into whether this could be a different condition called chronic – or long-term – UTI. While not yet officially recognized as a condition in its own right, the concept of chronic UTI is getting more attention.

2. What causes frequent UTI in females?

We don't know exactly what can cause a UTI to keep coming back, but you may be more at risk of RUTI if you:

• have regular sex
• have had a new sex partner in the last year
• use spermicides
• are going through menopause
• have problems with the structure of your urinary tract, such as an obstruction from kidney stones or a prolapsed bladder (where your bladder sags into your vagina)
• have inherited a risk of developing a bladder infection
• have a mother with a history of UTI. This is because you may inherit genes that regulate your body’s immune response to infection
• had your first UTI at or before you were 15 years old. This may also be linked to inherited factors

Read our article on urinary tract infections (UTI) in women to find out more about why these factors can make you more likely to get frequent UTIs.

3. Is there anything I can do to stop recurrent UTIs?

The best way to treat recurrent UTI in females is still being examined, but there are steps you can take to reduce your risk of getting RUTI, such as always wiping from front to back after pooping and staying hydrated and peeing after sex. These are the same preventative measures you’d take for a one-off UTI, and it’s a good idea to follow them if you keep getting UTIs to see if they help. Read more about prevention in our article, Urinary tract infections (UTI) in women – how to treat them.

4. Are there any supplements I can take to stop UTIs coming back?

If you get frequent UTI, there’s some evidence that you may be able to reduce your risk by taking a daily dose of the nutritional supplement, D-mannose. This is a type of natural sugar found in some fruits. While having lots of sugary food and drinks isn’t recommended as it can encourage bacteria to grow in your urinary tract and lead to UTIs, with D-mannose it’s a different story.

Here’s why: most sugars are broken down by your body into glucose. That glucose doesn’t usually appear in your pee unless you’re diabetic or you eat or drink a lot of sugar at once. When there’s glucose in your pee this can help bacteria to grow and increase your risk of getting a UTI.

But with D-mannose, your body doesn’t break it down into glucose. Most of it passes out of your body in your pee where it’s thought to stop bacteria sticking to your urinary tract. There’s some evidence that it can help prevent recurrent UTIs in non-pregnant women.

But be aware that although it’s not an added sugar, it’s still high in sugar so if you have diabetes, check with your doctor before taking it. D-mannose is available to buy as a powder or as tablets from pharmacies and health food stores.

5. Any other home remedies that could prevent recurrent UTI?

Taking probiotics may help lower your risk of RUTI. Some research shows that certain strains of lactobacilli can be helpful but the evidence isn’t conclusive and more research is needed.

You’ve probably also heard of drinking cranberry juice to keep RUTI at bay – there isn’t much evidence that it works, but staying well-hydrated does.

6. When should I see a doctor about recurrent UTI?

You should always see a doctor if you keep getting new UTIs or if you never seem to shake the UTI you’ve had treatment for, as there may be something else going on.

'Some women continue to get UTI symptoms regularly but when they have a dipstick urine test to check for infection, the test doesn’t pick up any infection. If this is happening to you, there could be a different cause such as a sexually transmitted infection (STI) or a condition called interstitial cystitis,’ says doctor and Healthily expert, Dr Adiele Hoffman. ‘There's also the new concept of chronic UTI.’

You should see your doctor urgently if you:

• see blood in your pee
• feel the need to pee urgently or often – and this is happening all the time or very often
• feel bloated frequently or all the time, or your abdomen looks bigger than normal
• feel full easily after eating or you’ve lost your appetite

These are symptoms of other health conditions so it’s a good idea to get them checked.

If you have new urinary symptoms and think you have an infection, read more in our article on urinary tract infections (UTI) in women.

7. How to treat recurrent UTI in females

If you keep getting UTIs, your doctor may:

• give you a short course of antibiotics to keep at home, which you can start taking as soon as RUTI symptoms come on
• prescribe you a vaginal cream containing estrogen if you’ve gone through the menopause and are experiencing vaginal dryness. This will help stop the thinning of your urethra and vaginal walls, which may help prevent infections
• prescribe another antibiotic to treat your current infection if it’s not gone, or a low-dose preventative antibiotic for up to 6 months
• refer you to a specialist for further tests such as an ultrasound scan, a computed tomography (CT) scan or a cystoscopy (a procedure to look inside your bladder) to see if there are any underlying causes. The specialist may also recommend further treatment

8. Are there any non-antibiotic alternatives for treating recurrent UTI?

Methenamine hippurate is a urinary antiseptic (it stops the growth of bacteria in your urine) and a non-antibiotic alternative, which has shown some promise in studies for RUTI. There’s also some research to show that vaccines might help to keep RUTI at bay in the short-term. In one research review involving more than 3,000 people with RUTI, up to 81% of people given a vaccine called Uromune were UTI-free at 3 months – compared to 5.6% for those given antibiotics. But more research is underway to find out if there’s any long-term benefit from vaccines in treating RUTI. Watch this space.

9. Can recurrent UTIs be a sign of cancer?

'For most women, there's no underlying cause for their RUTI,’ says Dr Adiele. ‘But occasionally the symptoms of a UTI can overlap with some symptoms of more serious conditions like cancers. So if you notice any 'red flag' symptoms, such as blood in your pee or needing to pee very often or urgently – particularly if you are aged 50 or older – you should see your doctor immediately.’