Urinary tract infections are among the most common bacterial infections of all. Roughly every second woman has at least one episode of cystitis, and in some women the episodes come back several times a year. Every new episode means days of discomfort, another course of antibiotics and a growing risk that the bacteria will become resistant to treatment.
The good news is that recurrent infections can usually be made less frequent or stopped – by changing your habits and, when that is not enough, with a preventive treatment plan from a urologist. Below, Dr Penev ranks the measures by how well they are supported by evidence, including which popular remedies do not work.
Why infections come back
The cause is most often a gut bacterium (Escherichia coli), which reaches the urethra from the area around the anus and travels up into the bladder. In women the urethra is only a few centimetres long, which is why cystitis mainly affects women. Recurrences are made more likely by sexual activity, spermicides, constipation, incomplete emptying of the bladder, diabetes and, after the menopause, the thinning of the lining as oestrogen levels fall. Infection is called recurrent when there are two or more episodes in six months, or three or more in a year.
Habits and measures that reduce the risk
Fluids and regular urination
In a study of women with frequent cystitis who drank little, adding about one and a half litres of water a day almost halved the number of episodes. A useful guide is the colour of your urine – pale yellow throughout the day. Do not put off passing urine for hours, and empty your bladder completely: stagnant urine is a breeding ground for bacteria.
Sex and contraception
Passing urine within half an hour after sex flushes out bacteria that have got into the urethra. If the episodes are clearly linked to sex, discuss with your gynaecologist replacing spermicides and the diaphragm with another method, and use a lubricant if you have dryness – tiny injuries to the lining open the door to infection. If the link is persistent, the urologist may prescribe a single dose of antibiotic after sex; this is a treatment plan from a doctor, not self-medication.
Hygiene without going to extremes
Wipe from front to back, wear cotton underwear and change out of a wet swimsuit promptly. Just as important is what to avoid: vaginal douching, perfumed intimate washes and antiseptics destroy the protective lactobacilli and make infection more likely rather than preventing it.
Constipation, the menopause and protecting the lining
Constipation hinders emptying of the bladder and increases the bacterial load – more fibre, exercise and fluids help with both problems. After the menopause, local oestrogen (a vaginal cream or pessaries) restores the lining and, according to the guidelines of the European Association of Urology (EAU), reduces repeat infections. Another option with relatively good evidence is oral immunoprophylaxis with a bacterial lysate.
Cranberry, D-mannose and probiotics – honestly
Cranberry is the most popular folk remedy, but studies are conflicting: some show a slight reduction in episodes, others no effect at all. You can try it, as long as you do not regard it as treatment. For D-mannose, newer and larger studies do not confirm the encouraging early data, and probiotics are harmless but have no convincingly proven benefit.
When you need a preventive treatment plan from a doctor
If the infections continue despite these changes, do not treat them with antibiotics from memory. At the urology consultation in Plovdiv or Karlovo, Dr Penev arranges a urine culture to identify the bacterium and its sensitivity, and performs an ultrasound to check for residual urine, stones and changes in the kidneys. Only then is the plan chosen – first the non-antibiotic options and, if needed, a low dose of antibiotic for several months or a single dose after sex.
In men and children the cause is always looked for
In men an infection is rarely a matter of chance: behind it there is usually an enlarged prostate with residual urine, a stone, a narrowing of the urethra or chronic prostatitis, so every episode in a man needs a consultation. In children, recurrent urinary infections also need to be investigated – constipation, holding on to urine or urine flowing back up towards the kidneys are often found.
When to see a doctor
Book a consultation if you have two or more episodes in six months, if the symptoms do not settle within two to three days of starting treatment, if you are pregnant, if you are a man or if the patient is a child, and whenever there is blood in the urine – especially if it is painless, because it may have another cause. Do not wait for an appointment if you have a temperature above 38 °C with shivering and back pain – these are signs of a kidney infection, which needs treatment straight away. If the fever comes together with a known kidney stone, or you cannot pass urine, go to an emergency department or call 112 (the European emergency number).
Recurrent cystitis is a problem with a solution – most often a combination of a few simple habits and correctly chosen prevention. Book an appointment with Dr Penev in Plovdiv or Karlovo to find the cause and break the cycle of antibiotics.
Frequently asked questions
Do I need treatment for bacteria in my urine if I have no symptoms?
Usually not. Bacteria in the urine without symptoms in healthy women are not treated with antibiotics, because this does not protect against future infections and encourages bacterial resistance. The exceptions are pregnant women and patients about to have urological surgery.
Can I take the antibiotic left over from my last cystitis when the symptoms come back?
Not without agreeing it with a doctor. With recurrent infections, a urine sample is first sent for culture so that the bacterium and the antibiotics it is sensitive to are known. Some patients are given a plan by the urologist for starting treatment themselves, but only once the diagnosis has been confirmed.
Do cold and swimming pools cause cystitis?
Not by themselves. Getting cold can weaken the local defences of the lining and help bacteria that are already in the urethra, but chlorinated pool water does not cause infection. It is more important to change out of a wet swimsuit promptly.
Does my partner need treatment if I get cystitis often?
With ordinary cystitis, no. It is not sexually transmitted and your partner does not need an antibiotic. Urethritis caused by a sexually transmitted infection is different – in that case both partners are treated at the same time.
Does cranberry juice help once cystitis has started?
No. It does not cure an infection that has already started and does not replace an antibiotic. Its only possible role is in prevention, and even there study results are conflicting.
The information on this website is for general education and does not replace an examination and consultation with a doctor. If you have urgent symptoms, seek medical help immediately or call 112.