Recurrent urinary tract infections
rUTIs are defined as having 2 or more urinary tract infections over a 6 month period or more than 3 infections over 12 months. These infections have to be diagnosed with a urine culture test showing bacteria and be associated with symptoms in the absence of an obvious cause (like pregnancy). UTI symptoms include pain with urination, blood in the urine, increased frequency, fever, foul smelling or dark coloured urine and general fatigue.
Women with rUTIs tend to be trapped in a cycle of pain, infections, repeated urine tests followed by courses of antibiotics which provide temporary relief before the whole cycle kicks off again. This can be a frustrating and debilitating ordeal which doesn't seem to end.
Recurrent UTI's are not simply bad luck. They are a recognised medical condition with identifiable risk factors and a range of effective management strategies that go well beyond short-term antibiotic treatment. Dr Shahid provides a holistic subspecialist level assessment and a tailored prevention plan to reduce the frequency and severity of your symptoms with the aim of prevent UTIs all together.
Understanding why some women get urinary tract infections (UTIs) is a fundamental step towards developing an individualised management plan and breaking the cycle of recurrent UTIs.
Most cases of UTIs are caused by bacteria known as Escherichia coli (E coli). These bacteria or 'germs' naturally colonise the anus and frequently ascend to the bladder via the urethra when UTIs occur.
A number of factors can increase the risk of rUTIs and need individual treatment for effective UTI prevention:
The management of an rUTIs requires an in depth exploration of the root causes and assessment of symptoms before management is tailored to address individual patient concerns and improve quality of life.
Before you are reviewed you will be sent an electronic link to complete the following:
While at your review:
Urine test to exclude an active urinary tract infection and to establish known bacterial resistance.
Urodynamics: this is an investigation done (in clinic) with the insertion of catheters to test the bladders ability to store and pass urine. This may be required as part further testing as part of your recurrent UTIs assessment.
Pelvic floor ultrasound is also conducted as part of the urodynamics. This allows for assessment of urethral hypermobility (while you leak urine), 3D visualisation of prolapse and how well your bladder empties.
Effective management of rUTIs requires a personalised, multimodal approach treating acute infections but more importantly focussing on long term prevention. This is achieved through:
Hydration: ensuring adequate fluid intake by drinking plenty of water (1.5 - 2L a day) dilutes the urine and 'flushes' the bladder. Caffeine and alcohol can irritate in the inner lining of the bladder and should be cut down as much as possible.
Voiding habits: this ensures the bladder is frequently and effectively emptying
Wiping technique: wipe from front to back (away from urethra)
Wear loose fitting, cotton, breathable underwear: which is less likely to lead to bacterial colonisation
Vaginal oestrogen is commonly used by doctors to help manage rUTIs. A simple intervention which maintains the vaginal microbiome and pH thus making it less likely to be colonised by bacteria. Well tolerated and established long term efficacy in preventing UTIs. There is now good data that shows vaginal oestrogen is safe to use in patients with previous breast cancer
Similar to cranberry supplementation, D-mannose makes it harder to bacteria to attach to the bladder wall. Its efficacy is less well established but there are some trials showing benefit.
As part of management a medical professional may consider an oral vaccine which is an under the tongue spray. The vaccine targets common bacteria causing UTIs and has a growing body of evidence to support its use. It is usually well tolerated.
This can be used as an adjunct having some synergistic effect with antibiotics.
There is only one established procedure for the management of rUTI's
Bladder injections are a surgical management option for the treatment of recurrent UTIs. Following chronic infections of the bladder, bacterial 'nests' can form and these can be particularly difficult to treat. This procedure directly targets those inflammatory changes by visualising them with a camera (cystoscope) and injecting a combination of specific antibiotics (gentamicin which cant be taken orally), steroids and pain relief into the bladder wall.
The injections work by decreasing inflammation and pain and directly administering antibiotics to the bladder. Most people will need to procedure repeated if their infections start becoming frequent again (down the track), which the average duration between injections of 12 months.
The is done under a general anaesthetic as a day procedure (no overnight hospital admission required) and is quick (takes 15 minutes to perform).
A cystoscope (camera) procedure (through which the injections are administered) also excludes other pathology which could be causing rUTI's (like a bladder cancer, bladder stones, cystitis or mesh exposure into the bladder from previous surgery).
Bladder injections are overall a safe and well tolerated procedure. There are some potential side effects that are important to understand:
Bladder injections are done as a day surgery (no overnight hospital admission is required). The procedure itself takes 15 minutes and you are monitored in recovery for 2 hours following the procedure and go home the same day.
Over the next few days it is normal to experience a mild discomfort, slight burning sensation when passing urine or small amounts of blood in your urine. This is normal and settles quickly. The pain is adequately managed with simple analgesia in paracetamol and ibuprofen, if you are able to take it. If your pain is worsening, please call the post-operative phone number or consult your doctor.
Most women return to their normal daily activities the same day or the following day
Tips for success:
You will be contacted by our team and have your post-operative appointment booked in 4 weeks time. We will review your symptoms and confirm that you are emptying your bladder well with an ultrasound. We will ensure that you are closely followed up.
Recurrent UTI's can be exhausting, distressing and disruptive to your day to day life. They are not something you simply have to live with. There are solutions to this endless cycle of pain, tests and antibiotics.
If you are searching for help with recurrent UTIs, Wollongong-based urogynaecologist Dr Usama Shahid offers comprehensive specialist assessment and personalised prevention strategies right here in the Illawarra.
Not necessarily. Management options involve doing watching and waiting (and observing progress), conservative (or non surgical options) and then surgical options. Dr Shahid will discuss all available options for your prolapse as an individualised experience. The decision to proceed with any management is always your choice.
Yes, referrals are required in order for you to obtain Medicare rebates. Please see your GP and mention you want a referral to see Dr Usama Shahid or otherwise contact our rooms and we will guide you to known GP’s for referrals.
Anytime you are bothered by your symptoms and they are affecting your quality of life. All options for management will be openly discussed with you. There are treatments available.
Pelvic floor health is personal, and Dr Shahid understands that. He is committed to making every patient feel at ease. Your first consultation is an opportunity to discuss your symptoms in a confidential, supportive environment. Dr Shahid will take a history, perform an examination to assess your pelvic floor and if needed do further tests like urodynamics and ultrasound before having a robust discussion about options available to you. Thus allowing you to make an informed decision about your care.
