Struggling with recurring UTIs? You're not alone. UTIs are the second most common infection in the United States. Half of all women get UTIs, and thirty to forty percent of women who have experienced a UTI will have to deal with oneagain in a few months.
Have you ever heard that once you get one UTI your likelihood of getting another UTI increases? Recurring UTIs can happen two ways: 1) bacteria (most often E.coli) can enter the urethra again and cause another UTI or 2) bacteria from a previous infection can stay hidden in the urinary tract using a tool called biofilm, releasing itself later to cause another UTI that seems to come out of the blue.
Generally, some of us are at greater risk of UTIs. Some risk factors are conditional, and some are event-based. Here are some UTI causes that might increase your risk:
Understanding the cause of your recurrent UTIs can help you prevent UTIs. If you struggle with chronic UTIs or recurrent UTIs and want to prevent UTIs, consider Uqora. At Uqora, we make effective prevention products using ingredients found in nature to help women break the cycle of recurring UTIs. Uqora Target, our preventive drink mix, flushes out new bacteria, especially after specific activities that tend to trigger UTIs. Uqora Control, a daily prevention capsule, breaks down biofilm, the tool bacteria use to hide from a previous infection, later causing a recurring UTI.
Have you ever heard that once you get one UTI, your chances of getting another goes up? That's because bacteria can hide themselves with a tool called biofilm, and wait for a good time to release themselves. That's why some UTIs seem to come out of nowhere, leading to recurring UTIs. Take Uqora Controlto combat recurring UTIs, and drink Uqora Target to flush out any new bacteria introduced from specific activities, like sex or exercise.
"I suffered from CHRONIC UTIs and have had some pretty serious repercussions from taking mass amounts of antibiotics. I have not had a UTI since I started taking uqora. I drink it after things that are my triggers (sex in particular) and it stops it in it’s tracks!"
Lacey, Uqora customer
A recurrent UTI, also called a chronic UTI, is an infection that keeps coming back, even after treatment with antibiotics. These infections can happen 2 or 3 times per year, once every other month, once per month or even multiple times per month. This can be endlessly frustrating for the person on the receiving end of these repeat infections, as they mean more painful UTIs, more visits to the doctor's office, and more cycles of antibiotics.
If the individual continues to experience recurrent UTIs, their doctor might put them on prophylactic antibiotics, which means the constant use of antibiotics just to prevent an infection from happening. Antibiotic resistance puts those with recurrent UTIs at serious risk. The more frequently an individual takes antibiotics for an infection, the more likely it is bacteria will develop resistance to those antibiotics, which makes it less likely that treatment will be effective the next time around. This makes it very important that specific antibiotics are used to treat recurrent UTIs. It has become more and more apparent that bacteria are in a constant arms race with not only antibiotics but our immune system as well.
What puts people at risk for recurrent UTIs, and why can they happen? Some reasons are physical, behavioral, or age-related, but as we’ll learn, running into the wrong type of bacteria can make all the difference in developing a recurrent UTI.
Recent research has shown that strategies bacteria use to avoid our immune system and our antibiotics may be the main cause of recurrent UTIs. 90% of urinary tract infections are caused by the bacteria E. coli. Yet, there are many different types of E. coli, and some are better equipped at dodging the immune system than others.
What makes some of them so much worse than others is the ability to lay dormant, and survive long periods of time inside our own cells. These bacteria get inside cells in the urinary tract and create what is called a ‘biofilm’, a protected cluster that is safe from our immune cells and even from antibiotics. These bacteria can survive through a cycle of antibiotics, and once complete when the immune system is weakened the bacteria can grow and re-establish an infection.
New research has also shown that inflammation and damage to cells during an infection can weaken the outer protective cells and make you more susceptible to a subsequent infection, leading to recurrent UTIs if the protective mucosal layer is not able to be repaired before being exposed to more bacteria.
In a recent review entitled Urinary Tract Infections: Epidemiology, Mechanisms of Infection and Treatment Options, the authors detail the risks of continuing to use antibiotics as a treatment method for recurrent UTIs noting “Moreover, high rates of recurrent UTIs suggest that antibiotics are not an effective therapy for all UTIs."
The way our bodies are built can put some women at higher risk of recurrent UTIs. UTIs are much more common in women than in men as a result of physical difference. For example, women’s urethras are shorter than men’s, and the urinary tract opening is positioned more closely to the rectum. Both of these differences make it easier for bacteria to establish themselves in the urinary tract.
These same factors play a role in the likelihood of some women getting UTIs more easily than others. If a woman’s urethra is particularly short, she can be at higher risk of urinary and bladder infections. In addition, bacteria are often flushed out by the flow of urine. If the urethra is particularly wide or the muscles surrounding the bladder are weak, the flow of urine can be light, making it easier for bacteria to hold on to the urinary tract wall.
Certain behaviors put an individual at risk of developing a urinary tract infection. That means that repeating those behaviors can lead to frequent or recurrent UTIs developing. These behaviors can include not urinating after sexual activity, not drinking enough water, wearing undergarments that don’t breathe well, prolonged physical activity, and long periods without a shower.
As women age, they become more at risk of recurrent UTIs. There are 3 main reasons.
Why do some women get UTIs so frequently, while others do not? Those of us who get frequent UTIs sometimes have a specific condition or circumstance that puts at higher risk—specifically, pregnant women, elderly women and people with diabetes are at higher risk. For women who do not fall into those categories, the risk of developing frequent UTIs can be related to anatomy or habits.
A woman’s risk of developing a UTI throughout pregnancy increases for a few reasons. For one, the uterus is located directly above a woman's bladder. As her uterus grows, it can obstruct her bladder. Sometimes that can block drainage, and stagnant urine can be an inviting place for bacteria to grow. Additionally, hormonal changes during pregnancy can make it easier for bacteria to travel up the urinary tract. These changes make frequent UTIs a common phenomenon in pregnant women.
As we age, our risk of developing frequent UTIs increases for a few reasons. In general, our immune system weakens over time, making it more difficult for our body to defend itself against harmful bacteria. As women age and go through menopause, estrogen production declines, too. Reduced estrogen may allow UTI causing bacteria to grow and establish themselves more easily, causing an infection.
Another important change is that the muscles around the bladder weaken as we age. Weakened muscles make it more difficult to fully expel urine, and the remaining urine can be an inviting place for bacteria to grow.
Finally, catheters often introduce bacteria that can cause UTIs, and catheters are more often necessary for elderly patients.
Another group of people more prone to frequent UTIs is people with diabetes. People who have diabetes have an increased risk because they may also struggle to fully release the bladder due to a range of things such as neural damage and compromised blood flow.
Additionally, people with diabetes commonly take a medication called Jardiance that works by filtering sugarfrom the blood and releasing it in the urine. The sugar in the urine makes infection more likely for two primary reasons:
There are also a large number of women who suffer from recurrent UTIs that are not pregnant, post-menopausal, or diabetic.
The reasons why these women are prone to frequent UTIs range. In some cases, women’s anatomical difference makes it easier for bacteria to travel throughout some of our urinary tracts than others. Some women may develop more UTIs because of hygienic habits, like wiping back to front, or because they are frequently dehydrated and as such are not urinating enough.
Additionally, your odds of getting another UTI increases once you’ve had one, so even if you came down with a UTI as a one-time result of circumstances, you make become someone who gets UTIs frequently after your first.
Between 26 and 44 percent of women who experience a first-time UTI will suffer another one within six months. This is despite antibiotic treatment and otherwise being in good health with no physical abnormalities present in the upper or lower urinary tract. Each recurring UTI also increases the chances of the next one developing.
Two occurrences of a UTI within a previous six-month time-frame or three occurrences during the previous three months is officially defined as a recurrent urinary tract infection. Reports point to a recurrent UTI trend lasting between one and two years. Although the infections typically end after that, a time-frame of that length represents a great deal of suffering. Research based on interviews with women who have experienced chronic urinary tract infections has also shown that a recurrent trend can last much longer than two years.
Antibiotic resistance is generally known to be a contributing factor in repeat occurrences of an infection. The World Health Organization has been tracking the rapid growth of bacterial resistance to various antibiotics; after a virtually zero measurable effect in the 1980s, the problem has grown to become widespread and one of great concern. One of the most common pathogens associated with urinary tract infections is Escherichia coli (E. coli), a bacterial strain which has been attributed to greater than 85 percent of UTIs worldwide as reported in the CDC journal Emerging Infectious Diseases. The antibiotic resistance rate for E. coli is also rising rapidly. Klebsiella pneumoniae and Staphylococcus saprophyticus can also cause urinary tract infections. Like E. coli, these bacterial strains are demonstrating a growing resistance to antibiotics.
A somewhat less generally known contributor to recurring and frequent UTI cases is the formation and presence of bacterial biofilms. They can play a significant role in what causes UTIs in women to develop. After treatment, a majority of UTI sufferers tested for the presence of bacteria in their urine were thought to be free of infection after testing showed negative results. Their urinary tract infections, however, returned. Biofilms can be blamed; their presence can result in patients being incorrectly assumed to be free of UTI-causing bacteria.
Free-floating microorganisms, such as E. coli, can attach themselves to a surface. In the case of urinary tract infections, the surface can be the bladder wall. After the first few microorganisms adhere to the attachment surface, they can be joined by others in a process termed dispersal. At this stage, the bacterial colony can spread on the bladder wall and increase in size. The process eventually becomes irreversible and the colony begins to develop a protective external covering around itself. This is the biofilm, and it allows the bacterial colony to exist undetected and remain protected from the effects of medications. Because the bacterial colony remains encased within a protective shell, the body’s immune system is less likely to become aware of its presence and respond.
Only free-floating bacteria can be detected by standard microbiological urine testing. Negative test results will be obtained when no free-floating bacteria are present in urine, even if biofilm colonies remain attached to the bladder wall. When these undetected biofilm colonies eventually release bacteria, the body’s immune system will react and the acute and distressing symptoms of a urinary tract infection will once again begin to appear.
Biofilms are also formed by fungal microorganisms, but bacterial biofilm infections are the more common factor in UTI causes. The National Institute of Health has estimated that bacterial biofilms account for about 80 percent of human infections. Combined with the rise of antibiotic resistance, biofilms account for a great deal of the suffering that women with recurrent UTIs are forced to endure. The best approach to end the suffering can be found in taking preventive steps that will help to avoid both first-time and recurring UTIs.