Urinary Incontinence

Recurrent Urinary Tract Infections
Getting Back On Tract

We are all familiar with the term infection. Basically, some critter, a bacteria, virus, or fungus invades our body and our body fights back. When our body doesn’t fight back and the organism lives harmlessly on or in our body, that is called colonization. When our body fights back, it is called an infection. Infections are common. Most of us will get a cold this year, hence the term “common cold." Another common infection is the Urinary Tract Infection or UTI. At least one in every three women will have at least one UTI in their lifetime. If you have had one, you have a 25% chance of getting another.

Symptoms of a urinary tract infection include new onset urgency and or frequency of urination and or burning with urination that is sometimes accompanied by discomfort over your pubic area and lower back pain. Some UTIs are associated with blood in the urine, cloudy urine, or odor. Bacteria are the cause of almost all urinary tract infections. As the urethra lives so close to the anus, bacteria from your bowel movements are the most common culprits. These bacteria are also the most common cause of false positive tests for UTI.

When a woman gives a urine specimen, it is very common for the urine to touch the skin before it goes into the cup. Hence, fecal bacteria living on the skin can contaminate your urine specimen. This results in a “false positive” urine test. The test suggests that you have bacteria living in your bladder. However, that bacteria was really from your skin. Overactive bladder disease has many of the same symptoms of UTI and many women with OAB are incorrectly diagnosed with recurrent UTIs secondary to false positive urine tests.


Dr. Zipper Explains Recurrent Urinary Tract Infections


Do I Have Recurrent Urinary Tract Infections?

Do you have urgency of urination, frequency of urination, and or burning with urination that comes suddenly and goes away quickly with antibiotics? Does this happen at least twice every 6 months? If you answered yes to both of these questions, you probably have recurrent UTIs. If your symptoms never seem to go away completely or your urine tests are sometimes negative, there is a good chance that you really have OAB, overactive bladder disease. Many women with OAB get occasional UTIs. This makes their OAB symptoms worse. Many women with OAB are incorrectly diagnosed with recurrent UTIs secondary to false positive urinalysis or urine cultures.

How Do I Get Recurrent Urinary Tract Infections?

You didn’t get it from sitting on a toilet seat. Although urban legend suggests that you might get it by wiping from back to front, the medical literature says, “NOPE!” The number one risk factor for UTIs is sexual activity. The more active you are, the more likely you are to get a UTI. The movement of a penis in and out facilitates the movement of bacteria into your bladder. Aging is also associated with an increased risk of recurrent UTIs. Decreased vaginal estrogen results in a change of the cellular lining of the vagina. The good bacteria fade away and the bad bacteria from your bowels, move in. These bad bacteria are now too close to the urethra and have access to your bladder.

The most common form of bacteria is known as E. Coli. Other common infectors are Klebsiella and Proteus.


Our Thoughts

Each year we evaluate and treat hundreds of women for possible recurrent UTIs. We have developed unique protocols that allow us to quickly find out if you are really having recurrent UTIs or if you have a disorder that mimics recurrent UTIs. We have an open door policy. If you think you have a UTI, call us. We will almost always get you into our office the same day. Whether you are diagnosed with recurrent UTIs or a disorder that mimics UTIs, we have a wide range of simple, safe, and effective treatments.


Our Treatments


Should we determine that your symptoms are indeed caused by Recurrent Urinary Tract Infections, we will then select a custom course of treatment suited to your needs. Once the initial infection is treated effectively through antibiotics, there are multiple treatment options to keep our UTIs from recurring.

Our Treatments


Our initial priority is to cure your current Urinary Tract Infection. After we successfully treat your infection with a short course of antibiotics, we will then focus on preventing infection recurrence. Long-term use of low-dose antibiotics is a proven and effective treatment for recurring UTIs. Common regimens include one pill after sexual activity, one pill at bed time, and one pill three times each week. Examples of antibiotics used in low doses include nitrofurantoin, sulfamethoxazole, trimethroprim, cephalexin, and quinolones. When used in low dosages, yeast infections are uncommon. Low-dose, long-term antibiotics are often used in conjunction with other therapies as listed below.

Estrogen Cream

The decrease of estrogen that results from menopause can lead to a variety of bladder symptoms including frequency, urgency, and incontinence. Local Estrogen therapy (ET) is one of the few treatments to be shown effective for decreasing recurrent UTIs. The use of Estrogen Cream also thickens the vaginal lining and healthy bacteria or Lactobacilli are able to return. These healthy bacteria push out the bad bacteria responsible for UTIs. The vast majority of studies have shown that vaginal estrogen does not significantly increase systemic estrogen levels and therefore does not have the majority of risks that are associated with oral hormone replacement therapy.


Methenamine is a unique salt that is broken down in acidic urine to form formaldehyde and ammonia. The formaldehyde is very effective at killing bacteria and can decrease the chances of new bacterial growth. Unlike typical antibiotics, bacteria do not develop resistance to formaldehyde. Most brands of methenamine include a component that acidifies the urine, allowing the breakdown of methenamine into its active form. Common brands include Urex® and Hiprex®.


D-Mannose is a type of sugar that has limited absorption and is well excreted by the kidneys. This results in high urine concentration of D-Mannose. E. Coli, the most common bacteria associated with UTIS, is attracted to D-Mannose. The E Coli tend to stick to the D-Mannose in the urine and are excreted with urination. While there is minimal data available to support the efficacy of D-Mannose, many patients benefit.

Cranberry Therapy

Cranberry extract in pill or juice form is capable of decreasing the amount of symptomatic UTIs in a twelve-month period. The benefits of cranberry are often attributed to its anti-adhesive activity on uropathogenic E. Coli.

At Zipper Urogynecology we do not recommend cranberry therapy for acute treatment, but sometimes suggest it as a supplemental treatment for recurrent infections. Patients experiencing infections due to the presence of E. Coli will benefit the most from cranberry therapy. While there is limited data available to support the efficacy of cranberry, many patients benefit.

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