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• Stress Incontinence
• Overactive Bladder
• Pelvic Organ Prolapse
• Chronic Urinary Tract Infections
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• Diamond Labial Rejuvenation™
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Recurrent Urinary Tract Infections in Women (UTIs and Cystitis)

The Overview

If you have ever had a urinary tract infection, you are at risk of developing recurrent urinary tract infections (recurrent UTIs).  Up to 25% of women who have one UTI will go on to develop recurrent UTIs. If you get more then 2 UTIs in 6 months, you have a diagnosis of Recurrent Urinary Tract Infections. Sympoms of UTIs can be quite debilitating and can include:

• Pressure in the lower pelvis
• Painful urination (dysuria)
• Frequent need to urinate (frequency)
• Urgent need to urinate (urgency)
• Need to urinate at night
• Abnormally colored or "cloudy" urine color
• Blood in the urine (hematuria)
• Foul or strong urine odor

Most urinary tract infections (UTI or cystitis) occur in the lower urinary tract, which includes the bladder and urethra. This  common condition,  also called cystitis , is caused when the normally sterile lower urinary tract is infected by bacteria and becomes inflamed. Although fungus can also cause a UTI, this is quite uncommon. Most of the time, symptoms of cystitis disappear within 24 – 48 hours after treatment begins. However, as many as 25% of women will go on to develop repeat episodes of cystitis (more than 2 in 6 months), or infections that do not respond to the usual treatment.

Risk Factors

Bacteria that cause UTIs are known as uropathogens. These are often found in the feces and vaginal secretions of normal, healthy women. The most uropathogen is called E. Coli. In some women, intercourse may help move such uropathogens up the urethra and into the bladder.  Poor bladder emptying often occurring with pelvic organ prolapse (e.g. cystocele or bladder prolapse) can make the bladder more susceptible to infection.  Patients with diabetes are also more susceptible to UTI.

Postmenopausal women are at increased risk of urinary tract infection.  Estrogen loss results in thinning of the vaginal lining and loss of protective bacteria call Lactobacilli. This creates an environment that is favorable to uropathogens. The use of a pessary (vaginal support device) is also associated with increased risk of UTI secondary to increased vaginal discharge.

Evaluation

Did you know that many patients being treated for recurrent urinary tract infections do not have them? 
That is correct.  A common disorder known as Overactive Bladder may masquerade as recurrent UTIs.  When a woman urinates in a cup, bacteria from the skin and vagina often get into the specimen. This can lead to false positive urine cultures.

So, are first  rule is “if you think you have a UTI, come in to see us today”. We will get a clean specimen with a tiny catheter. Many patients will have negative cultures and find out that their problem is actually Overactive Bladder. We will evaluate and treat you for that.

If however we find that you have two specimens that are positive in 6 months, we will begin a thorough evaluation. In this evaluation we will look for causes such as bladder stones, diverticula (pockets) in the urethra or bladder, and any evidence of other areas that can collect bacteria.

Evaluation includes:

• Cath urine culture
• High Definition Cystoscopy
• Possible CT scan of kidneys and bladder
• Possible computer testing of bladder (urodynamic testing)