“Not Again!” — When UTIs won’t quit at midlife

Hope Ricciotti, MD

Editor in Chief, Harvard Women's Health Watch

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This week, a patient came in reporting two awful urinary tract infections that she had this summer while traveling on vacation. She is in her 50s, postmenopausal, and fit and healthy. After having sex with her partner, she woke up with burning and pain with urination. She was treated for a urinary tract infection with antibiotics and felt better in a few days. She did fine for two weeks until they had sex again, when the same symptoms returned. Although antibiotics worked again, and quickly, at this point she felt consumed by the whole thing. She was unable to enjoy her vacation, and she was afraid to have sex. It took several weeks before she felt normal “down there.”

If this sounds familiar, then you may be suffering from recurrent urinary tract infection (UTI). Recurrent UTIs are defined as either three episodes of infection in the previous 12 months or two episodes in the previous 6 months.

Recurrent UTIs are common among both young healthy women and healthy women at midlife. Here’s why. There are many types of bacteria that normally live in the vagina and happily coexist. And they keep each other in check, like a mini-ecosystem. The hormone estrogen allows the “good” bacteria called Lactobacillus to thrive. These bacteria produce acid, which lowers the pH in the vagina, which helps keep the “bad” bacteria in check.

For younger women, frequent sex is one of the biggest risk factors for a UTI. Sexual intercourse can cause the bacteria in the vagina and rectum to get into the urinary tract, since they are close neighbors. But at midlife, the main culprits behind recurrent UTIs are physical changes, including thinning of vaginal tissue, pelvic organ prolapse, incontinence, and trouble completely emptying the bladder. The lower levels of estrogen after menopause are also a factor.

There are effective prevention strategies for healthy women at midlife who are struggling with recurrent UTIs. A good place to start is with urination habits. When sitting on the toilet, make yourself as comfortable as possible in a relaxed seated position (not squatting). Start the stream of urine by relaxing the pelvic floor muscles, rather than straining to urinate. Allow enough time for your bladder to completely empty. Also empty your bladder after intercourse. This can help wash away any bacteria that might have been introduced into the urinary tract during sex. Some studies suggest that cranberry extracts can help prevent UTIs by decreasing the “stickiness” of the bacteria. I prefer cranberry supplements to cranberry juice, which tends to be very high in sugar and calories.

Vaginal estrogen creams or rings can help restore the normal bacterial balance of the vagina. Ask your doctor about taking antibiotics preventively, either after sex, or regularly at a low dose. Your doctor can also check to see if you have pelvic organ prolapse, which can be associated with an inability to fully empty your bladder.

Take charge of your bladder health, and don’t let recurrent UTIs get in the way of your active lifestyle. If you are struggling with recurrent UTIs, see your doctor for a thorough check-up — and know that this condition is both entirely preventable and easily treatable.

Related Information: Better Bladder and Bowel Control

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