Recurrent urinary tract infections

The most common causes of recurrent urinary tract infections are:

- **Bacterial infections**: In most cases, the infection is caused by bacteria such as *Escherichia coli*, which enter the urinary tract from the intestines. Frequent reinfections can be favored by incomplete treatments or resistant bacterial strains.

- **Anatomical anomalies**: Structural problems in the urinary tract, such as a narrowing of the urethra or vesicoureteral reflux (backflow of urine into the kidneys), can increase the risk of recurrent infections.

- **Enlarged prostate**: In men, an enlarged prostate can obstruct urine flow, leading to incomplete bladder emptying and thus an increased risk of infections.

- **Sexual activity**: Sexually active women have an increased risk of urinary tract infections, as bacteria can more easily enter the urethra during intercourse.

- **Pregnancy**: During pregnancy, the risk of urinary tract infections increases because the pressure on the bladder can impair urine flow.

- **Weakened immune system and other underlying conditions**: A weakened immune system, diabetes, or neurological disorders that impair bladder emptying can contribute to recurrent infections.

• Frequent urination, often with only small amounts of urine
• Burning or pain during urination
• Cloudy or foul-smelling urine
• Pain in the lower abdomen or lower back
• Blood in the urine (hematuria)
• In severe cases, when the kidneys are affected, fever, chills, and nausea may occur

Recurrent urinary tract infections are diagnosed through a combination of medical history, physical examination, and laboratory diagnostic tests. The doctor will review the history of the infections and perform the following:

- **Urinalysis**: To determine the presence of bacteria, leukocytes, and other abnormalities in the urine.

- **Urine culture**: To identify the type of bacteria and choose an appropriate treatment.

- **Imaging techniques**: Ultrasound or computed tomography (CT) can be used to detect structural abnormalities or kidney stones that may be causing recurrent infections.

- **Cystoscopy**: An endoscopic examination of the bladder and urethra may be performed in special cases to determine the cause of the infections.

The treatment depends on the cause of the recurring infections and may include the following:

- **Antibiotic therapy**: The standard treatment involves administering antibiotics to eliminate the infection. In some cases, prophylactic antibiotics in low doses may be given over a longer period to prevent infections.

- **Behavioral changes**: Increased fluid intake, avoiding irritating substances (e.g., soaps), and regular bladder emptying can reduce the risk of infections.

- **Surgical interventions**: In cases of anatomical abnormalities or severe prostate enlargement, surgery may be necessary to address the underlying problem.

- **Immunotherapy**: In some cases, immune preparations may be administered to strengthen the immune system and prevent recurring infections.

To prevent recurrent urinary tract infections, it is recommended to drink sufficient fluids to flush the urinary tract. It is advisable to empty the bladder after sexual intercourse to flush out bacteria. Good intimate hygiene, avoiding aggressive soaps, can also help prevent infections. Additionally, longer delays in urination should be avoided to ensure complete bladder emptying. In some cases, a low-dose prophylactic antibiotic therapy over a longer period may be considered, especially in cases of frequent infections.