Recurrent Urinary Tract Infection
The main symptoms of cystitis are frequent urination, discomfort when urinating (dysuria) and a painful bladder. These symptoms are usually because of a urinary tract infection (UTI) which occurs when invading bacteria cause inflammation of the bladder wall. These symptoms are very common and when the problem keeps recurring can cause a great deal of misery, interfering with normal activities and everyday life. Frequently we see ladies who have had repeated courses of antibiotics overy many months with no improvement.
Why am I getting recurrent cystitis?
Firstly it is important to recognise that UTI is not the only possible cause of cystitis symptoms. Other potential causes are painful bladder syndrome, overactive bladder, urethral stenosis (tight waterpipe), atrophic vaginitis, vaginal prolapse and much more rarely bladder stones or tumours. These causes of cystitis will not be cured by antibiotics and the cystitis symptoms will persist.
In cases of recurrent cystitis it is vital that a properly collected mid stream urine (MSU) sample is analysed by the microbiology laboratory each time an episode occurs. Dipstick testing alone is not reliable in this setting. When it can be proven that the recurrent cystitis is because of recurrent bacterial infection it is important to rule out an underlying bladder problem as a possible cause.
It is most often the case that there is no specific cause for recurrent UTI's and it usually becomes a simple case where advice and the appropriate use of antibiotics will break the cycle of recurrent infection.
What investigations are necessary?
Listening to your story together with careful interpretation of the previous urine test results is the most important part of the evaluation of recurrent cystitis. When underlying problems are suspected and need to be ruled out the following tests may need to be performed -
- Urinary flow rate measurement
- Bladder Ultrasound Scanning
- Flexible Cystoscopy
What can be done to reduce the chances of infection recurring?
Once any underlying problems have been safely ruled out we will support you and give you detailed advice on measures you can take to reduce the risk of recurrent UTI. Sometimes we will recommed a course of very low dose antibiotics (antibiotic prophylaxis) to break the cycle of re-infection and allow the bladder to fully recover. Unlike repeated treatment courses of high dose antibiotics which we do not recommend, low dose antibiotic prophylaxis is safe and does not result in the devlopment of bacterial resistance or vaginal thrush (candida).