Get examined by your own physician

It is pretty common to go to urgent care for a bladder infection.  While urgent care does a good job, their job is to treat your “urgent” need.  they just look at the problem at hand.  They aren’t looking for the reasons behind your recurrent bladder infections and ways you might prevent future infections.  Your own physician will do a better job at this.  And if they think you need a subspecialist, they will refer you.  There may be something about your past surgical history, your hormone levels or your anatomy that is causing you to get your infections.

Be sure to get a urine culture

A urine culture is the best test to detect a bladder infection.  When we do a urine culture, we know what bacteria is in your urine and what antibiotics will treat the infection.  Without this information, we are just guessing about the best treatment.  A culture also confirms that it is bacteria causing your symptoms- there are many other diagnoses that can cause similar symptoms.  It can be almost impossible to tell the difference between a urinary tract infection, symptoms from low estrogen levels, and tight pelvic floor muscles.  With a culture, we have to wait for the bacteria to grow and this takes 48 hours.  If you have symptoms, we may treat you before the culture is back.  When the culture comes back, it will indicate if you are on the right antibiotic.  There’s always a chance that you will have to switch antibiotics.

Preventing bladder infections

• Even though it is popular, cranberry does not help prevent bladder infections.  I don’t recommend cranberry but I also don’t ask women to stop taking it.  It is fairly low risk and if you feel like it has helped you, stay on it.
• Probiotics are not very helpful althought I’m still hopeful about them.  Changing your microbiome with a probiotic theoretically should help but the research out there hasn’t supported this yet. But stay tuned, there is a lot of research being done in this area.
• Vitamin C holds promise and has been shown to work against some bacteria (like e.coli) in the lab.  There isn’t enough data yet though to really recommend it.
• In women with low estrogen levels, vaginal estrogen (but NOT estrogen taken by mouth) is an excellent preventative.
• D-mannose, an over-the-counter medication, can help prevent bladder infections.
• Methenamine salts, which require a prescription but are not an antibiotic, can also prevent infections.
• A low dose antibiotic can also be used (usually for 6 months) to prevent infections.

There are lots of different things you can try to prevent your infections.  Some women respond well to one treatment and some women need a combination of things.  But to move forward on many of these options, you need to have a trusted provider working with you.  This is one more reason to plug into your primary care provider and not urgent care.

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

Schwenger EM. et al Cochrane Database Syst Rev: Probiotics for preventing UTI’s in adults and children. 2015:CD008772. doi: 10.1002/14651858.CD008772.pub2.