OPINION | JOHN PAUL BRIZZOLARA: Stopping the cycle

Recurrent UTIs? No need to suffer


Dealing with a persistent health issue can be draining, physically and emotionally, particularly when it begins to disrupt our daily lives. Urinary tract infections (UTIs) are no exception.

Nearly half of all women will develop a symptomatic UTI in their lifetime. A quarter will experience the infections recurrently, with potential long-term impacts on their self-esteem, social activities or ability to succeed at work.

But those facing UTIs don't have to grin and bear the distress. Safe, proven medical treatments are available for lasting relief and a better quality of life.

For many women, UTIs are a fact of life. Inflammation caused by bacteria like E. coli can affect any component of the urinary system--the bladder, ureter, urethra or kidneys. The infections can cause slight to severe discomfort, with the most reported symptoms being the urge to urinate or pain while doing so, primarily in the abdomen, flank, lower back or pelvic area. Other signs may include bloody, cloudy or foul-smelling urine, pressure in the lower pelvis and urge or urinary incontinence.

According to a study in Frontiers in Public Health, the incidence rate of UTIs is significantly higher in women than men in all age groups due to several risk factors, including anatomical differences like a shorter urethra and menopause, which reduces circulating estrogen in the body.

There are proactive measures women can take to reduce their risks of developing UTIs, including staying hydrated, fully emptying their bladders, urinating after sexual intercourse and avoiding the use of spermicides. But a visit to the urologist for further evaluation may be warranted for those battling recurrent UTIs--characterized as two culture-proven infections in six months, or three in a year. Once referred, the urologist will likely recommend and perform imaging of the kidneys and bladder to ensure no drainage issues or stones are present.

For most patients, the urologists' workups will be normal. In these cases, the standard of care is to prescribe low-dose antibiotics. These pills are taken nightly for up to three to six months or longer, as needed. For post-menopausal women, urologists will often pair the medication with low-dose topical estrogen cream for additional symptom relief. This course of treatment does not cause any antibiotic resistance or immunity or increase the incident rate of vaginal yeast infections, which can occur with full doses. For 90 to 95 percent of women, using low-dose antibiotics is an efficient and effective way to stop the cycle of frequent UTIs.

There are countless online articles about how supplements like cranberry extracts can help prevent or address UTIs. Yet scientific and anecdotal evidence remains mixed, with some women saying it's helpful while others say it provides minimal to no benefit.

Along with at-home remedies, there's also promising research into potential treatment methods like electrofulguration, a minimally invasive outpatient procedure targeting chronic areas of infection inside the bladder wall. However, more in-depth studies are needed.

What we do know is that low-dose antibiotics can help change the trajectories of those facing recurrent UTIs. These treatments significantly reduce individuals' symptoms so they can fully participate and enjoy their daily lives.

If you or a loved one are dealing with UTIs regularly, talk to your health-care provider about seeing a urologist for evaluation.


John Paul Brizzolara, M.D., F.A.C.S., is a urologist with CARTI, serving patients at the not-for-profit cancer care provider's flagship campus in Little Rock and in Pine Bluff. He is certified by the American Board of Urology and a member of the American Urological Association and American College of Surgeons.


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