Post-Urinary Tract Infection Symptoms and Management

Post-Urinary Tract Infection Complications

Hello Dr.
Hsu, I am a 31-year-old female currently working in Macau.
This year, I have experienced multiple episodes of urinary tract infections (UTIs), specifically in March, May, and June, each time presenting with acute hematuria at night, which led me to visit the emergency department.
The emergency physicians prescribed antibiotics for 3-7 days, and I completed the course each time.
After recovering from the third episode, I consulted a urologist who performed a urine culture and a renal and bladder ultrasound, both of which returned normal results.
However, since then, I have frequently felt on the verge of a recurrence, occasionally experiencing contractions in the urethral area without pain.
I am unsure if this is related to the frequent antibiotic use, but in October, I developed a vaginal infection, which has since been treated and resolved.
Nevertheless, I still have a feeling of heaviness in my lower abdomen, and I occasionally experience pain on both sides of my abdomen in a V-shape.
I underwent a gynecological examination, including a transvaginal ultrasound of the uterus, which was normal, ruling out any gynecological issues.

Due to my fear of recurrence, I have adhered to the recommended habits, including maintaining cleanliness, drinking plenty of water, not holding in urine, urinating before and after intercourse, and wearing cotton underwear.
I have also been taking cranberry probiotics and avoiding alcohol (as I notice a strong urge to relapse after drinking).
Currently, aside from the heaviness and pain in my lower abdomen, I am experiencing frequent urination (though I am unsure if it is related to my fluid intake; I currently drink about 1500-2000 cc per day, with each voiding being around 200-250 cc, urinating every 1-2 hours, and the volume is sufficient at around 400 cc, unlike during the UTIs when the frequency was high but the volume was low).
Additionally, I have a decreased sensitivity to the urge to urinate (sometimes I do not feel the urge to urinate, or I experience urgency without a clear sensation).
I am concerned whether this could be developing into chronic urethritis or cystitis.

The healthcare system in Macau is not as comprehensive as in Taiwan, and due to the current pandemic, I am unable to return to Taiwan for medical care.
Therefore, I would like to seek your advice.
Thank you very much! Additionally, I work in a hotel where I have to stand for long periods and wear compression stockings.
I have made the genital area of the stockings breathable, but the abdominal part remains tight, and I am unsure if this could also be affecting my condition.

Zhang, 30~39 year old female. Ask Date: 2020/12/03

Dr. Xu Wencang reply Urology

The bladder capacity is still 400 cc, which is normal.
Chronic inflammation can lead to a reduced capacity.
It can be monitored, and if symptoms arise, a urinalysis and bacterial culture should be performed.

Reply Date: 2020/12/03

More Info

Understanding post-urinary tract infection (UTI) symptoms and management is crucial, especially for individuals who have experienced recurrent infections. Your situation reflects a common challenge faced by many, particularly women, who may suffer from UTIs and related complications.

Firstly, it’s important to recognize that recurrent UTIs can be caused by several factors, including anatomical predispositions, hormonal changes, lifestyle factors, and even the use of antibiotics. In your case, the recurrent nature of your UTIs, along with the symptoms of urgency and discomfort, suggests that there may be an underlying issue that needs to be addressed.

Diagnosis and Symptoms
You mentioned experiencing acute episodes of hematuria (blood in urine) and subsequent treatments with antibiotics. While antibiotics are effective in treating bacterial infections, they can also disrupt the natural flora of the vagina, potentially leading to secondary infections such as vaginitis, which you experienced in October. The symptoms you describe, including a feeling of pressure in the lower abdomen and changes in urinary frequency and urgency, could indicate a few possibilities:
1. Chronic Cystitis: This is a condition where the bladder becomes inflamed, often due to recurrent infections. Symptoms can include pelvic pain, frequent urination, and a feeling of urgency.

2. Interstitial Cystitis: This is a chronic condition characterized by bladder pressure, bladder pain, and sometimes pelvic pain. It can mimic UTI symptoms but is not caused by an infection.

3. Post-Infectious Symptoms: After a UTI, some individuals may experience lingering symptoms due to irritation of the bladder lining, which can take time to resolve.

4. Vaginal or Vulvar Issues: Given your history of vaginitis, it’s also possible that irritation or inflammation in the vaginal area could contribute to your symptoms.

Management Strategies
1. Hydration: Continue to drink plenty of fluids, as this helps flush out bacteria from the urinary tract. Aim for at least 2 liters a day if possible.

2. Dietary Adjustments: Incorporating cranberry products (like cranberry juice or supplements) may help prevent UTIs, although evidence is mixed. Avoiding irritants such as caffeine, alcohol, and spicy foods can also be beneficial.

3. Hygiene Practices: Maintaining proper hygiene is essential. Always wipe from front to back after using the restroom and urinate after sexual intercourse to help reduce the risk of infection.

4. Clothing Choices: Wearing breathable cotton underwear and avoiding tight-fitting clothing can help reduce moisture and irritation in the genital area.

5. Consider Probiotics: Probiotics can help restore the natural flora of the vagina and may reduce the risk of recurrent infections.

6. Medical Follow-Up: Since you are experiencing persistent symptoms, it may be beneficial to consult a urologist or a gynecologist specializing in urinary health. They may recommend further testing, such as a cystoscopy, to examine the bladder directly or urine cultures to identify any persistent infections.

7. Pain Management: For the discomfort you are experiencing, over-the-counter pain relievers may help. However, consult with your healthcare provider before starting any new medication.

8. Physical Activity Considerations: If your job requires prolonged standing, consider taking breaks to sit down and relieve pressure on your abdomen. Tight compression garments can sometimes exacerbate discomfort, so ensure that your clothing is comfortable and not overly restrictive.

Conclusion
In conclusion, while your symptoms may be related to recurrent UTIs, they could also indicate other underlying conditions that warrant further investigation. It’s essential to maintain open communication with your healthcare providers and advocate for your health, especially in a challenging healthcare environment. If your symptoms persist or worsen, seeking a second opinion or further evaluation may be necessary. Remember, managing recurrent UTIs often requires a multifaceted approach, including lifestyle modifications, medical treatment, and sometimes, addressing underlying health issues.

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