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Recurrent Urinary Tract Infections (rUTI)

Expert assessment and treatment of recurrent urinary tract infections in Wrexham, Chester and Shrewsbury

Urinary tract infections (UTIs) are common, but recurrent urinary tract infections can be frustrating and significantly affect your quality of life.

Repeated infections may cause burning or discomfort when passing urine, urinary frequency, urgency, lower abdominal discomfort or blood in the urine. In some people, recurrent UTIs may be associated with an underlying problem such as bladder stones, kidney stones, incomplete bladder emptying, an enlarged prostate or another abnormality of the urinary tract.

As a Consultant Urological Surgeon specialising in endourology, I provide specialist assessment and treatment for recurrent UTIs in Wrexham, Chester and Shrewsbury, with investigation tailored to the individual patient rather than simply treating each infection as an isolated episode.

What is a recurrent UTI?

A urinary tract infection occurs when bacteria infect part of the urinary system, which includes the bladder, urethra, ureters and kidneys.

A UTI is generally considered recurrent when there are:

  • Two or more UTIs within six months, or

  • Three or more UTIs within 12 months.

Recurrent infections can represent repeated separate infections or a persistent infection that has not been completely eradicated.

Understanding why infections keep returning is an important part of specialist management.

What are the symptoms of a UTI?

Common symptoms include:

  • Burning or pain when passing urine

  • Needing to pass urine more frequently

  • A sudden or urgent need to urinate

  • Passing small amounts of urine frequently

  • Lower abdominal or pelvic discomfort

  • Cloudy or unpleasant-smelling urine

  • Blood in the urine

Some people, particularly older adults, may have less typical symptoms.

Symptoms such as fever, shivering, pain in the side or back, vomiting or feeling significantly unwell can indicate an infection involving the kidneys and require prompt medical assessment.

Why do some people develop recurrent UTIs?

Incomplete bladder emptying

If urine remains in the bladder after urination, bacteria may have an opportunity to multiply.

Incomplete emptying can occur because of:

  • Enlarged prostate (BPH)

  • Urethral narrowing or stricture

  • Bladder dysfunction

  • Pelvic organ prolapse

  • Neurological conditions

  • Certain medications

Kidney or bladder stones

Urinary stones can sometimes harbour bacteria and contribute to recurrent infections.

If recurrent infections occur alongside blood in the urine, persistent urinary symptoms or known stones, imaging of the urinary tract may be appropriate.

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Learn more about kidney stones

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Enlarged prostate

In men, benign prostatic hyperplasia (BPH) can obstruct urinary flow and prevent the bladder from emptying properly.

Recurrent UTIs can therefore sometimes be a consequence of underlying prostate obstruction.

If appropriate, treating the obstruction may reduce the risk of further infections.

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Learn more about enlarged prostate and BPH

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Urinary tract abnormalities

Less commonly, recurrent UTIs can be associated with structural abnormalities of the urinary tract.

A urological assessment can help determine whether further investigation is appropriate.

Other risk factors

Recurrent UTIs can also be associated with factors including:

  • Previous urinary tract surgery

  • Urinary catheters

  • Diabetes

  • Menopause and reduced oestrogen levels

  • Sexual activity

  • Previous antibiotic exposure

  • Certain medications or medical conditions

Sometimes, despite appropriate investigation, no single underlying cause is identified.

How are recurrent UTIs diagnosed?

The first step is to establish whether the episodes are genuinely urinary infections.

Urine testing

A urine culture is particularly important in recurrent UTI.

It can identify the bacteria responsible for the infection and determine which antibiotics are likely to be effective.

Repeated treatment based only on symptoms, without appropriate urine cultures, can make it difficult to distinguish recurrent infection from other conditions that can cause similar symptoms.

Blood tests

Depending on your symptoms and medical history, blood tests may be recommended to assess kidney function or look for evidence of significant infection.

Bladder scan

A bladder ultrasound can measure the amount of urine remaining after you have passed urine.

A significant post-void residual urine volume may indicate incomplete bladder emptying and can be an important clue to the underlying cause of recurrent infections.

Ultrasound or CT imaging

Imaging may be recommended if there is suspicion of:

  • Kidney or bladder stones

  • Urinary obstruction

  • Structural abnormalities

  • Kidney problems

  • Complications associated with recurrent infection

The appropriate imaging depends on your symptoms and clinical circumstances.

Cystoscopy

In selected patients, flexible cystoscopy may be recommended to examine the inside of the bladder and urethra.

This can help identify abnormalities such as bladder stones, tumours, foreign bodies or urethral narrowing.

Recurrent UTI treatment

Treatment depends on the cause, the bacteria identified and the patient's individual circumstances.

Antibiotics

When a bacterial UTI is confirmed, an appropriate antibiotic may be prescribed based on the urine culture and antibiotic sensitivity.

For recurrent infections, it is particularly important to avoid unnecessary or repeated antibiotics when there is no evidence of an active infection.

Treating the underlying cause

Where possible, treatment should address why the infections are occurring.

For example:

  • Enlarged prostate causing incomplete bladder emptying may require treatment for prostate obstruction.

  • A bladder or kidney stone may require stone treatment.

  • Urethral narrowing may require treatment of the stricture.

  • Significant residual urine may require investigation of bladder function or obstruction.

Treating the underlying problem can sometimes be more important than repeatedly treating individual infections.

Preventing recurrent UTIs

Prevention depends on the individual's circumstances.

Measures that may help include:

  • Maintaining adequate fluid intake

  • Avoiding prolonged holding of urine

  • Treating constipation

  • Ensuring the bladder is emptied regularly

  • Addressing incomplete bladder emptying

  • Reviewing unnecessary urinary catheters where appropriate

  • Avoiding unnecessary antibiotics

For some women with recurrent UTIs, vaginal oestrogen may be recommended after the menopause where appropriate.

In selected patients, a urologist may consider additional preventive strategies, including methenamine hippurate or antibiotic prophylaxis, depending on the individual's circumstances and previous urine cultures.

Recurrent UTI in men

Recurrent UTI in men deserves particular attention because an underlying urological cause may need to be excluded.

Possible contributing factors include:

  • Enlarged prostate

  • Chronic urinary retention

  • Bladder stones

  • Kidney stones

  • Urethral stricture

  • Previous urinary tract procedures

  • Prostatitis

A specialist assessment can determine whether further investigations are necessary and whether treating an underlying problem could reduce the risk of further infections.

When should I see a urologist?

You should consider specialist assessment if you experience:

  • Repeated confirmed UTIs

  • Two or more infections within six months

  • Three or more infections within a year

  • Recurrent UTIs in a man

  • Recurrent infections despite appropriate antibiotics

  • Blood in the urine

  • Difficulty emptying your bladder

  • Recurrent urinary retention

  • Known kidney or bladder stones

  • Persistent urinary symptoms between infections

  • Recurrent infections associated with an enlarged prostate

Recurrent UTI management in Wrexham, Chester and Shrewsbury

Mr Mohamed Yehia Abdallah provides specialist private urology consultations for patients from Wrexham, Abergele, Chester, Shropshire and surrounding areas who are experiencing troublesome urinary tract infections (UTI), a consultation can provide an opportunity to review your diagnosis and discuss the available treatment options.

Book an Appointment
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