THE DOCTOR IS IN When UTIS Keep Coming Back

Recurrent UTIs hit women more often than men— here’s what does and doesn’t work to prevent them.

- LAUREN STREICHER, M.D.

It can start with a constant "Gotta go!" feeling that's accompanied by knifelike pain when urinating, followed by the terrifying sight of pee the color of cranberry juice. But what makes a miserable urinary tract infection (UTI) experience even more miserable is when it happens again and again and again.

This is recurrent UTI, defined as two or more infections in six months or three or more infections in one year.

UTIS occur when bacteria, most commonly E. coli, reach the urethra and then travel up to the bladder. A lot of bacteria hang out around the anus and surrounding tissue, and the distance between the anus and the urethra is much shorter in women than in men, as is the length of the urethra itself.

While any woman is at risk (thanks to that short urethra), clearly some women are more prone to recurrent UTIs than others. If your mom suffered from them or you had your first one before you were 15, you may have a genetic predisposition that makes E. coli bacteria more likely to "stick" to the walls of your urinary tract than to get flushed out.

Intercourse is often the culprit, since it facilitates the journey of E. coli from the rectum to the urethra no matter how many showers you take, how often you pee, or how well you wipe.

DIAGNOSING THE PROBLEM

Perimenopausal and postmenopausal women are particularly prone to getting recurrent urinary tract infections, since a lack of estrogen not only makes the urinary tract tissue more susceptible to infection but also changes the genital microbiome.