Recurrent Bladder Infections: Causes and Solutions

About cystitis?

Hello Doctor: My mother has recently been diagnosed with cystitis (combined with vaginitis).
After taking antibiotics for a week, she returned for a follow-up appointment at the Urology Department of Chung Shan Medical University Hospital, where the doctor said her urine test results were normal (I noticed some yellow indicators in the urine test on the computer, but the doctor said that was not a concern).
She was advised not to continue antibiotics.
However, two days later, my mother reported experiencing frequent urination (with cloudy urine), so she underwent another urine test and cystoscopy with a different doctor.
The urine test results indicated inflammation again (the cystoscopy results showed moderate inflammation and post-inflammatory biofilm).
That day, a urine culture was performed, and after taking antibiotics for another week, she returned for a follow-up.
The urine test indicated it was clean (the urine culture results showed no growth), and she was told not to take antibiotics anymore.
Yet, two days later, my mother experienced frequent urination and a burning sensation again, leading her to consult a doctor (this time at the Obstetrics and Gynecology Department of China Medical University Hospital).
The doctor said her urine was contaminated and prescribed another week of antibiotics.
I am unsure about the underlying cause.
Has my mother experienced a recurrent infection, or was the previous bacteria not completely eradicated? (Note: At the end of March this year, she also had an episode of cystitis, and after taking antibiotics for a week, the doctor said her urine was clean and she did not need to continue antibiotics.
However, the next day she went to the emergency room with a temperature of 37.6°C, an inflammation index of 6, and a white blood cell count of 11,000.) I am curious about the reasons for the repeated inflammation in such a short period.

A Bin, 50~59 year old female. Ask Date: 2022/05/27

Dr. Cai Zhuorong reply Urology

Recurrent infections may be due to antibiotic-resistant bacteria that cannot be eradicated.
Additionally, other common urinary tract conditions, such as urinary retention and stones, may also be contributing factors.
It is recommended that you continue treatment with the same urologist and undergo further evaluation.

Reply Date: 2022/05/27

More Info

Recurrent bladder infections, also known as urinary tract infections (UTIs), can be a frustrating and painful experience, especially for older adults. Your mother's case highlights several important aspects of recurrent infections, including potential causes, diagnostic challenges, and treatment options.

Causes of Recurrent Bladder Infections
1. Incomplete Eradication of Bacteria: One of the primary reasons for recurrent infections is that the initial course of antibiotics may not have fully eradicated the bacteria. This can happen for several reasons, including antibiotic resistance, the presence of biofilms (a protective layer formed by bacteria), or the bacteria being in a dormant state that is not affected by the antibiotics.

2. Underlying Conditions: Conditions such as diabetes, urinary retention, or anatomical abnormalities can predispose individuals to recurrent UTIs. In your mother's case, the presence of vaginal inflammation could also contribute to the recurrence of bladder infections.

3. Biofilms: The bladder can develop biofilms, which are clusters of bacteria that adhere to the bladder wall and are resistant to antibiotics. This could explain why your mother experiences symptoms of infection even after negative urine cultures.

4. Hormonal Changes: In postmenopausal women, decreased estrogen levels can lead to changes in the vaginal flora and urinary tract, making them more susceptible to infections.

5. Hygiene Practices: Sometimes, improper hygiene practices can lead to the introduction of bacteria into the urinary tract. Ensuring proper hygiene, especially after using the bathroom, can help reduce the risk of infections.

Diagnostic Challenges
The diagnostic process for UTIs can sometimes be misleading. Urine tests can show signs of infection, but if the bacteria are not actively multiplying, cultures may come back negative. This can lead to confusion about whether the infection is truly resolved or if it is recurring. In your mother's case, the presence of symptoms like frequency and burning sensation suggests that there may still be an underlying issue, even if cultures are negative.

Treatment Options
1. Antibiotic Therapy: The primary treatment for UTIs is antibiotics. However, if recurrent infections occur, a healthcare provider may consider a longer course of antibiotics or a different antibiotic that the bacteria have not developed resistance to.

2. Preventive Measures: Some doctors recommend preventive antibiotics for patients with frequent UTIs. This could involve taking a low dose of antibiotics for an extended period or using antibiotics after sexual intercourse if that is a trigger for your mother's infections.

3. Lifestyle Modifications: Increasing fluid intake can help flush out bacteria from the urinary tract. Additionally, cranberry products (though evidence is mixed) may help prevent infections for some individuals.
4. Vaginal Estrogen Therapy: For postmenopausal women, vaginal estrogen therapy can help restore the normal flora of the vagina and urinary tract, potentially reducing the risk of infections.

5. Further Investigations: If recurrent infections persist, further investigations may be warranted. This could include imaging studies to check for anatomical abnormalities or a urodynamic study to assess bladder function.

Conclusion
Recurrent bladder infections can be complex and multifactorial. It is crucial to work closely with healthcare providers to identify the underlying causes and develop an effective treatment plan. If your mother continues to experience recurrent infections despite treatment, it may be beneficial to seek a second opinion or consult a specialist in urology or infectious diseases. They can provide a more comprehensive evaluation and tailored management plan to address her specific needs.

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