Q. Now that I am postmenopausal, I have been getting bladder infections more frequently. Why is that, and is there anything I can do to prevent them?
A. You're said to have recurrent urinary tract infections (UTIs) if you get two or more infections in a six-month period. Postmenopausal women may be more susceptible to these infections for a few reasons. The cells in the urinary tract that help prevent infection depend on estrogen, so they don't work as effectively when less estrogen is being produced. Also, as you get older, the function of your urinary tract can change in ways that increase your risk for infection. For example, bladder contractions can be weaker, which means some urine tends to pool in the bladder. That leftover urine provides a good environment for bacteria to grow. Women with urinary incontinence, as well as those with bladder prolapse, are also at greater risk for infection.
If you do get frequent infections, don't try to treat yourself! It's important to report any urinary symptoms to your doctor and get checked to see if you do have an infection. Sometimes women think they have a bladder infection when they actually don't. Your doctor should take a focused medical history and do a thorough physical exam to determine whether you have changes in your urinary tract function. That information can help determine what treatment you need.
There are only a few proven remedies for recurrent UTIs. Topical or vaginal estrogen can help prevent repeat infections if you're not already taking oral estrogen. Some women may benefit from preventive antibiotics, which are effective for warding off future infections but create the risk of developing antibiotic resistance. Oral or vaginal probiotics have been studied, but there isn't enough good evidence yet to support their use. There also isn't enough research to confirm that cranberry juice or tablets prevent infection, but because they can't hurt, your doctor may not be opposed to you trying them.
— Anne Fabiny, MD
Editor in Chief, Harvard Women's Health Watch
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