Twenty percent of women in the United States will develop a urinary tract infection at some time and 20% of that group of women will have a problem with recurrent urinary tract infections, defined as more than three infections per year. The most common kind of urinary tract infection in women is cystitis (bladder infection). The cause of most episodes of simple cystitis is Escherichia coli (E. coli). E. coli causes about 80% of urinary tract infections in women. E. coli and other colonic bacteria (bacteria from the colon) enter the bladder through the urethral (the opening into the bladder). Women are more susceptible to urinary tract infections, because their urethral meatus is close to the source of the bacteria, i.e. the anus and rectum. Also, the urethra is shorter than in the male. Another common bacteria that causes cystitis is staphylococcus saprophyticus.

The risk factors that increase a woman’s chances of developing cystitis include sexual intercourse, which can push the bacteria up the short urethra and into the bladder; use of diaphragms or condoms and spermicidal foam; use of tampons; or constipation, which will increase the bacterial count in the rectum and perianal area. Other risk factors for recurrent cystitis include failure to empty the bladder completely; congenital or acquired abnormalities of the urinary tract, such as kidney stones; vesicoureteral reflux of urine; urethral abnormalities; or suppressed immune system.

The signs and symptoms of cystitis are typically back pain, blood in the urine, cloudy urine, inability to urinate, despite the urge, the frequent need to urinate, and pain during urination. The diagnosis of a bladder infection depends on a urine sample that shows bacteria and white blood cells in the urine. Most times, this can be obtained by a clean catch mid-stream urine sample. If this is not possible, a catheter urine sample can be obtained. The usual evaluation of recurrent urinary tract infections would be an upper tract evaluation (x-rays of the kidneys) and a cystoscopy (looking at the bladder)to rule out any anatomic problems that may be predisposing factors for infections.

Treatment is a six-month course of prophylactic antibiotics to keep the patient free of infections for six months and allow her natural defense mechanisms (i.e., normal perineal and vaginal flora) to reestablish it self. Trimethoprim-sulfamethoxazole or Macrodantin are first choice antibiotics for this long-term prophylactic use. After six months of prophylactic antibiotic treatment, 60-70% of women with no anatomic problem will be cured of the recurrent urinary tract infection problem.

Other measures that a woman can take to reduce her risk of recurrent cystitis are:

• Avoid products that irritate the urethra, for example, bubble bath and scented feminine products. These can damage the perineal skin or vaginal mucosa
• Clean the genital area before sexual intercourse.
• Urinate after sexual intercourse.
• Drink plenty of water to flush any bacteria from the bladder.
• Avoid constipation, as there is an increased risk of bladder infections in women with chronic constipation.
• After menopause, estrogen replacement therapy may be beneficial.