Recurrent Urinary Tract Infection

What it is

Recurrent urinary tract infection is defined as two or more infections in six months, or three or more in one year. It is very common in women and may be related to sexual intercourse, changes in the vaginal flora, menopause, the habit of holding in urine, low water intake and changes in the urinary tract. Symptoms include burning during urination, a frequent and urgent need to urinate, pain in the lower abdomen and cloudy or bloody urine. The consultation investigates the factors that favor these episodes, with a urinalysis, urine culture and, when necessary, imaging tests, to guide treatment of each episode and the most appropriate prevention measures, which may include lifestyle changes, care during menopause and other individualized strategies.

Most common symptoms

• Burning or pain when urinating
• Frequent, urgent need to urinate, in small amounts
• Pain or heaviness in the lower abdomen
• Cloudy urine, with a strong odor or blood
• Feeling of incomplete bladder emptying
• Fever and lower back pain, when the infection reaches the kidneys

Causes and risk factors

• Intercourse, which favors bacteria entering the urethra
• Changes in the vaginal flora and drop in estrogen at menopause
• Habit of holding in urine and low water intake
• Use of spermicides or a diaphragm
• Constipation
• Anatomical or functional changes in the urinary tract

How it is diagnosed

At the consultation, your gynecologist reconstructs the history of the infections: how many episodes have occurred, their relationship with sexual activity, hydration and bathroom habits, and the symptoms of each episode. The gynecological exam assesses signs of vaginal atrophy and pelvic floor changes. A urinalysis and urine culture with antibiogram identify the bacteria and guide antibiotic choice. When a urinary tract abnormality is suspected, ultrasound or other imaging tests are ordered and, depending on the case, a urology evaluation.

How we treat it at Femi Saúde

Each episode is treated with an antibiotic guided by the urine culture, avoiding unnecessary repeated medication use. The main focus, however, is prevention. Femi Saúde's gynecology team provides guidance on lifestyle changes, such as increasing water intake, urinating after intercourse and not holding in urine, and treats constipation and changes in the vaginal flora. During menopause, vaginal estrogen may be indicated to restore the mucosa, and CO₂ laser is an option in selected cases. When episodes persist, options such as low-dose antibiotic prophylaxis or prophylaxis after intercourse, immunoprophylaxis and pelvic physical therapy may be considered. The plan is individualized.

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