Not everything needs to be treated

You may have a urinalysis done that shows you have bacteria in your bladder.  This only needs to be treated if you have symptoms.  Your body will most likely take care of the bacteria on its own.  This approach minimizes the amount of antibiotics that you get.  Fewer antibiotics means fewer side effects from the medication and your treatment won’t addi to the growing problem of antibiotic resistance.

Some bladder infections require a physical

A garden-variety blader infection doesn’t require an exam.  But there are certain times when you should be examined.  Examples include

• Seeing blood in your urine
• Symptoms of a kidney infection like fevers or back pain
• Frequent UTI’s.  If you get more than 2 UTI’s in 6 months, you should see your doctor

Talk to your doctor about having antibiotics on hand

There are times when I will give a patient antibiotics to have on hand.  This works well for women who are going on vacation, especially if they are going somewhere remote or with poor healthcare.  It also is a reasonable strategy for women who get one infection per year, but always on a Saturday night.  It keeps them out of urgent care and makes life a little more convenient.  I do ask them to call me when they use the prescription so I can track their infections.

Common beliefs about bladder infections that are wrong

Cranberry doesn’t keep bladder infections away.  This is a common belief and there have been many research studies about it.  But the data doesn’t support using cranberry.  Wiping from front to back, peeing after sex, wearing cotton underwear and avoiding hot tubs and bubblebath also have not been shown to protect against bladder infections.  If you swear by one of these things, you don’t have to stop doing it. But I don’t recommend these strategies.

Things that can help

If you are getting regular bladder infections, you need to see a provider.  Providers at urgent care or zoomcare do a good job of addressing the issue at hand, but they aren’t going to investigate why you may be getting lots of infections.  This is usually done by a primary care provider, urologist or urogynecologist.  It is important to make sure that there isn’t a treatable cause for the infections.  If that evaluation is negative, there are a few thing you can try.  d-Mannose is a natural sugar that can inhibit some types of bladder infections.  It is very helpful for some women with few side effects.  In women with low estrogen levels, vaginal estrogen (either in cream, ring, or pill form) can prevent bladder infections.  d-Mannose is available over the counter but the estrogen requires a prescription.

Nicolle LE et al.  Clinical Practice Guidelines for the Management of Asymptomatic Bacteriuria: 2019 Update by the IDSA. Clinic Infect Disease 2019;68(10):e83-110.

Brubaker L et al. AUGS Best Practice Statement:Recurrent UTI in Adult Women.  FPMRS 2018;24:321-35.