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Writer's pictureDr. med. Marian Howaldt

Recurrent urinary tract infections.. or: Why antibiotics may not always be the best solution.


E.coli, the most common causative agent of a urinary tract infection.

Hardly any woman is spared from it, and it also affects men from time to time. When there is a burning sensation during urination and the toilet becomes your best friend, a diagnosis of a urinary tract infection is very likely. If fever and kidney pain occur, the risk of a kidney infection increases, and in the worst case, sepsis may occur.





How do urinary tract infections develop?


Contrary to what is often assumed, neither poor hygiene nor one's partner is to blame for most cases. In the vast majority of cases, bacteria from the intestine or surrounding skin and mucous membranes are the cause of a bladder infection. The female urethra is much closer to the starting point of bacterial migration, with a shorter path to the bladder. This is why women are much more often affected.


Risk factors for urinary tract infections include a low fluid intake, chronically holding urine for a long time, or weakening of the immune system due to other illnesses. Certain methods of contraception or even overly thorough genital hygiene can also contribute to this. Anatomical factors can also promote an infection in both women and men. If urine remains in the bladder after going to the toilet, it provides a good breeding ground for bacteria. The reasons for this can include a lowering of the bladder, such as after giving birth, narrowing of the urethra, or in men, an enlarged prostate.


In the case of simple bladder infections, antibiotics should not always be the first course of action, especially if it occurs frequently. The indiscriminate use of antibiotics over time has led to numerous bacterial resistances. These bacteria can pump the substances out of their cells or not allow them to enter in the first place.


What can I do?


For prevention: Drink enough water regularly, don't unnecessarily delay urination, and visit the toilet after sexual intercourse. This sounds easier than it is in everyday life. Urologists often see – especially in young women – that regular visits to the toilet are skipped. In the context of stressful office jobs or fieldwork, a large volume can accumulate in the bladder over time, which can ultimately not be completely emptied. We can diagnose this residual urine formation, in which bacteria quickly multiply, easily using ultrasound.


A change in behavior in this area can often prevent the next infection. Drinking regularly, in particular, is difficult for many people, especially for older people. If the kidneys and urinary tract are not sufficiently flushed out, naturally occurring bacteria can more easily find their way into the bladder and kidneys. Keeping a record can be helpful: how much and how often do you drink? How often do you urinate? The results can be analyzed and discussed with your urologist.


In a larger study, an increase in fluid intake to over 1.5 liters per day was able to roughly halve the rate of infections (Hooten et al., JAMA Intern Med. 2018). Medical reasons that speak against a strong increase in fluid intake (heart failure, kidney failure, etc.) must be ruled out beforehand. In case of doubt, a brief discussion and/or examination before attempting this is recommended.


There are many other well and less well-researched prevention measures, which, however, should only be individually tailored after medical clarification.


From vaccination against the most common pathogens to acidifying urine with various methods to long-term administration of certain antibiotics or taking them directly after sexual intercourse. Not all prevention measures work for all patients, so medical therapy should always be accompanied.


If you are affected or recognize yourself in the description, please feel free to make an appointment with our practice for a consultation and individual therapy.





Foto: CC 2.0, Credit: NIAID




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