Tired of Recurrent UTIs? See How a Nephrologist Can Make a Difference

What are UTIs?

Urinary tract infections (UTIs) develop due to infectious diseases of the urethra, kidneys, or bladder that make up the urinary tract. The function of the urinary tract is to make urine in the kidneys, store it in a sac called the bladder, and expel it out of the body through the urethra. Infections to any part of this urinary tract can lead to UTIs. UTIs are very common in females; about half of the women might have developed these at some point.  

Frequent UTIs:

Frequent or recurrent UTIs occur when two or more occur within a few months or at least three happen in a year. They are also frequently seen in women and cause substantial economic burdens. About half of women with recurrent UTIs had a recurrence within six months of follow-up.            

The top risk factors for frequent UTIs:

The following factors are some of the causes of recurrent UTIs:

• Structural defects leading to stagnation of urine in the bladder, obstruction to the free flow of urine, and incomplete emptying of urine from the bladder increase the risk of recurrent UTIs. Some examples are the development of pockets or diverticula in the urinary bladder and prolapse or sagging of the internal organs into the pelvic area, which can lead to frequent UTIs.  
• Urinary bladder conditions like overactive bladder and urinary incontinence that lead to an increased urge to urinate can also cause recurrent UTIs.  
• Older men who have prostate disorders or nerve diseases have difficulty emptying the urine from the bladder, leading to the accumulation of urine in the bladder, which leads to UTIs.  
• Sexually active women can also develop recurrent UTIs without any structural defect or any underlying disorder.  
• Urinary tract conditions such as stones, stents, catheters, foreign bodies or tumors in the bladder, narrowing of the ureter tubes, fibrosis, and fistulas can also increase the risk of developing recurrent UTIs in females.  
• Incomplete treatment of the first UTI or having the first UTI before the age of 16 can also lead to the recurrence of infection.  
• Rising antibiotic resistance in bacteria can also increase the risk of having recurrent UTIs.  
• Metabolic diseases like diabetes and inadequate water intake
• Having multiple sexual partners and having frequent sexual intercourse in a week can also increase the risk of recurrent UTIs.  
• Use of a diaphragm with spermicide or spermicide-coated condoms also increases the risk.  

Why are women more susceptible to recurrent UTIs:

Recurrent UTI in females occurs mainly due to the anatomy. Females have a shorter urethra than males, and also the urethra is located closer to the anus and vagina. The anatomical position of the urethral opening, vaginal opening, and anus hole quickly spread the bacteria to and fro. Hence, the urethra can collect bacteria from the vagina after sex and also from the anus after defecation.  

There is a complex and poorly understood relationship between intestinal, vaginal, and urinary tract bacteria that mainly consists of Escherichia coli, Enterococcus faecalis, Klebsiella, Proteus mirabilis, or Staphylococcus. Most recurrent UTIs are reinfections that develop newly from the bacteria about 2 weeks after treatment. Recurrence is different from the type of UTI that causes relapse within 2 weeks of treatment.  

Menopause and aging cause atrophy of the vagina, which results in the reduction of protective bacteria present there. Reduced force of contractions of the bladder leads to increased stagnation of urine in the bladder, causing recurrent UTIs in females. Reduction in the protective lactobacilli and total bladder emptying are frequently seen in old-aged women, leading to recurrent UTIs.

Role of nephrologist in recurrent UTIs:

• A nephrologist is a doctor who manages kidney diseases, infections, and any condition that affects the functioning of the renal system. A nephrologist identifies the causes of recurrent UTIs by taking a history, performing physical examinations, and performing specific tests.  
• History and physical examination help them to differentiate between relapse of infection or recurrence of infection. They also check for specific symptoms, such as blood in urine and urinary urgency, that indicate recurrent UTIs. They also check for vaginal atrophy, prolapse of organs, and any abnormalities that are causing recurrent UTI in females.  
• Males are evaluated for prostate infections for recurrent UTIs. Fever, confusion, and delirium without proper urinary symptoms are general signs of infection observed in recurrent UTIs in old age.  
• After clinical evaluation, specific tests are prescribed to diagnose recurrent UTIs and differentiate between the types of UTIs. These tests include urine culture and sensitivity tests. They distinguish between the two types of UTI: recurrent and relapse. Urological imaging and cystoscopy are reserved for specific conditions only.
• Based on the diagnosis, nephrologists suggest maintaining personal hygiene, avoiding spermicides, hydration, and necessary antibiotic prophylaxis. Cranberry extracts, estrogen vaginal creams, lifestyle, and behavioral modifications also help to treat recurrent UTIs in females.  
• Recurrent UTIs are common yet annoying and can significantly impact quality of life. Despite certain risk factors, timely diagnosis and appropriate treatment help manage the condition. Fortis Hospital has a multidisciplinary approach to managing recurrent UTIs. With expertise in diagnosis and state-of-the-art facilities, they provide comprehensive and patient-centric care to improve outcomes.  

Conclusion

Frequent urinary tract infections can significantly impact daily life, but a nephrologist can help by diagnosing underlying causes and recommending targeted treatments. Preventive strategies, lifestyle modifications, and medical interventions can reduce recurrence. Seeking expert care ensures effective management, promoting long-term urinary health and overall well-being.