What to Ask Your Doctor About Recurrent UTIs

A urologist or urogynecologist can examine you and assess the situation to strategize ways to prevent and reduce the frequency of UTIs for you.

“Treatment should be individualized, not one size fits all,” says Jason Kim, MD, a board-certified urologist and codirector of the Women’s Pelvic Health and Continence Center at Stony Brook Medicine in East Setauket, NY. “A collaborative approach [to recurrent UTI treatment] is essential.” A key part of that approach is open communication.

Consider asking these questions to help improve your recurrent UTI care plan:

1. Are My Urine Cultures Positive for UTI Bacteria?

First and foremost, Dr. Kim says, it’s extremely important to understand whether the UTI symptoms are actually caused by a UTI.

“Many patients are seen at urgent care facilities for acute UTI symptoms, and antibiotics are started [right away] for symptoms,” says Kim. “But when these urine cultures come back, they’re negative.” If this is happening to you, you actually might not be experiencing a UTI.

Other conditions can have similar symptoms, including bladder pain syndrome, genitourinary syndrome of menopause, overactive bladder, pelvic floor dysfunction, sexually transmitted infections, and trouble fully emptying the bladder. If you’re receiving antibiotics for a UTI that doesn’t exist, they’re not going to help. Plus, you risk antibiotic resistance, which causes antibiotics to become less effective when you do need them.

If you’re having symptoms but testing negative for a UTI, you and your team can explore what else might be happening and help you find an effective treatment.

2. Do I Need Imaging or Further Evaluation for Recurrent UTIs?

When you first see a specialist for recurrent UTIs, they’ll usually ask for your medical history and do a pelvic exam to look for signs of other things that could be contributing to the urinary symptoms. They may also do a bladder scan, called a post-void residual, to see if your bladder is emptying properly when you urinate. And they’ll likely test your urine.

For the majority of people, these standard tests provide enough information to understand potential causes and begin treatment, says Dr. Gleicher. In some cases, though, additional testing, such as imaging — ultrasound, CT scan, or even MRI — is needed to see how the bladder and kidneys are functioning. There’s also a cystoscopy, which is when the doctor looks inside the bladder with a tiny camera. Usually, these extra tests are reserved for people who haven’t responded to treatment.

3. How Can I Prevent UTIs Without Antibiotics?

Experts say to try to rely on antibiotics as little as possible when treating recurrent UTIs. Your nonantibiotic UTI prevention plan may include:

• Plenty of Water Hydration can flush bacteria out of the urinary tract, says Gleicher. In a study, premenopausal women who increased the amount of water they drank by 1.5 liters (50 ounces) daily had 50 percent fewer UTIs than women who didn’t increase their water intake.
• Cranberry Juice or Tablets Cranberry has the ability to prevent bacteria from adhering to the bladder wall, says Kim. Studies support its effectiveness, too. Gleicher suggests cranberry supplements with at least 36 milligrams of proanthocyanidins, because that’s what research has shown to be most effective for UTI prevention.
• D-Mannose Supplements D-mannose is a simple sugar that can be taken in pill form. It can also help clear the bladder of bacteria when you urinate. “The data isn’t as strong for D-mannose as cranberry. So if, financially, we’re considering which one to choose, I usually steer people toward cranberry,” says Gleicher. “But if we want to do everything we possibly can, I’d suggest at least 2,000 milligrams daily of D-mannose.”
• Nonantibiotic Medication If nondrug therapies don’t work well for you, you could be prescribed a medication called methenamine, which is taken in tablet or liquid form and can make it difficult for UTI-causing bacteria to thrive in the bladder. Gleicher recommends taking vitamin C along with the methenamine to enhance its effectiveness.

4. Is Something About My Health Putting Me at Higher Risk?

Certain health conditions or stages of perimenopause or menopause can put you at higher risk for recurrent UTIs. It’s important that you and your doctor address those factors to prevent future UTIs. A few examples are:

• Perimenopause or Postmenopause Women in perimenopause or menopause can have lower vaginal estrogen, which means some protective properties of the vagina are reduced. Topical vaginal estrogen cream can restore lubrication and lower vaginal pH so that it has enough protective flora. “It’s been shown to reduce the risk of UTI by 50 percent,” says Gleicher, “so it’s very effective, and it’s very safe.”
• Diabetes For people living with diabetes, UTIs are more common, often due to blood sugar fluctuations. Your urological specialist will help treat UTIs, but will also likely suggest you see your primary care doctor and/or an endocrinologist to adjust your diabetes care plan so that your blood sugar is better controlled.
• Difficulty Emptying the Bladder If you have a condition that affects your ability to empty the bladder — bladder obstruction, chronic constipation, overactive pelvic floor, pelvic organ prolapse, pelvic organ stones — talk to your provider about what you can do. They may be able to provide treatment or suggest a complementary treatment.

5. Would Antibiotic UTI Prevention Be Right for Me?

Your doctor might do everything they can to treat recurrent UTIs without antibiotics, but they may need to prescribe them, especially if you’ve tried everything else. There are several ways your doctors might use these medications to prevent UTIs, say Kim:

• Self-Start Antibiotics The doctor may prescribe an antibiotic to keep on hand, so you can begin taking it at the first sign of a UTI.
• Post-Sex Antibiotics If you find that you get UTIs after having sex, the doctor may give you a prescription for a postcoital UTI. This is meant to be taken in a single dose after sex.
• Continuous Low-Dose Antibiotics This is when you take an antibiotic regularly. Kim says it’s only for people who frequently get UTIs and is meant to be used short term.

While it may take some time to find the right treatment, working with a specialist can put you on a path toward fewer UTIs and less reliance on antibiotics — and help you feel less anxious in general.

“You don’t have to feel trapped,” says Gleicher. “Success, of course, is minimizing the infections in general and also being equipped with the tools to prevent them down the road. Knowing that the two of us are working together, that we’re collaborating, that I’m available to them, is also very helpful for my patients.”

The Takeaway

• If you’re getting UTIs often, it’s a good idea to see a urologist or urogynecologist for evaluation and treatment.
• Nonantibiotic prevention, such as increasing water intake, taking cranberry supplements, or using vaginal estrogen cream if you’re in menopause or perimenopause, can help prevent future infections.
• In some cases, your doctor may also recommend a preventive antibiotic regimen.
• Ask your doctor about testing to help identify factors that could be increasing your risk for UTIs or causing symptoms that could be mistaken for a UTI. Seek treatment for those issues, as well.