Problems Identifed in Handling of Recurrent UTIs
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More than half of U.S. women will experience at least one urinary tract infection (UTI) in their lifetimes, while a quarter will have a subsequent infection. Recurrent urinary tract infections are defined as two or more infections in six months or three or more in a year.
Despite the prevalence of the painful condition, women are fearful and frustrated with limited management options, according to Cedars-Sinai research published in the Journal of Urology.
Women who participated in the study were critical of healthcare providers for failing to understand their experiences while over-prescribing antibiotics as a treatment option.
"We were inspired to conduct the study due to the large number of women coming to us feeling hopeless and helpless when it came to the management of their UTIs," said lead author Victoria Scott, MD, a urologist at the Female Pelvic Medicine and Reconstructive Surgery clinic at Cedars-Sinai.
To help give voice to those suffering with recurrent urinary tract infections, researchers led a focus group study of 29 women who experienced recurrent UTIs to learn about gaps in their care. UTIs are infections of any part of the urinary tract, including the kidneys, ureters, bladder or the urethra. The term is most commonly used to describe a bladder infection.
One of the biggest concerns expressed by study participants revolved around the frequent prescribing of antibiotics and fears of the potential adverse and long-term effects of the medication.
"Many of the participants were aware of the risks of bacteria developing resistance to antibiotics," Scott said.
"They also were aware of the 'collateral damage' of antibiotics and disruption they can have on the normal balance of good and bad bacteria throughout the body."
The focus group discussions also reported concern with the medical system and limited research efforts to investigate new non-antibiotic management strategies.
Participants voiced frustration and resentment toward their medical providers for “throwing antibiotics” at them without presenting alternative options for treatment and prevention, and for not understanding their experience. In addition, many women described seeking advice from herbalists and acupuncture practitioners, as well as from peers in online forums and chatrooms.
Treatment and Prevention
Although studies show that antibiotics are often the most effective treatment option for urinary tract infections, research also shows that up to 40% of bladder infections can be cleared with non-prescription steps that can include increased water intake and pain relief medications such as ibuprofen.
Taking these steps when UTI symptoms initially develop and urine test results are pending can be important for avoiding unnecessary antibiotics and ensuring that appropriate antibiotics are prescribed when needed.
Among steps women can take to avoid a urinary tract infection are drinking water, taking cranberry supplements or a low-dose antibiotic after sexual intercourse, and using vaginal estrogen for those who are postmenopausal.
While over-the-counter treatments are preferred by many, Scott recommends seeing a doctor if a fever develops or symptoms persist beyond a day, as antibiotic therapy can be crucial for some infections to ensure they don’t spread from the bladder to the kidneys.
"Antibiotics are amazing drugs and in certain settings are lifesaving," Scott said. "There are absolutely some instances in which antibiotics are necessary, but it's also important for women to be educated regarding all their options."
Those who experience recurrent urinary tract infections should seek evaluation by a specialist. Some women will benefit from undergoing a kidney ultrasound or a cystoscopy, which uses a small camera that can be inserted into the urethra to give a view of the urethra and bladder to rule out anatomic abnormalities.
Scott notes that while less common, men also can experience urinary tract infections.
Some healthcare providers might not think that a single episode of a urinary tract infection could have a significant impact on a patient's life. But when UTIs recur, often without warning, they can have a negative impact on social life, work, families and relationships.
The study recommended that physicians modify management strategies to address women's concerns and to devote more research to improving non-antibiotic options for prevention and treatment of recurrent urinary tract infections, as well as management strategies that better empower patients.
"Unfortunately, we see many women who blame themselves for developing UTIs. It’s important to understand that UTIs are a very common problem and should not invoke shame" Scott said. "If you are experiencing recurrent UTIs I encourage you to connect with a doctor who specializes in female pelvic medicine and reconstructive surgery to work together to come up with individualized prevention and management strategies."
Reference: Scott VCS, Thum LW, Sadun T, et al. Fear and frustration among women with recurrent urinary tract infections: Findings from patient focus groups. J. Urol. 2021;206(3):688-695. doi: 10.1097/JU.0000000000001843
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