Why do I get recurrent bladder infections?

Written by: Ms Charlotte Chaliha
Edited by: Cameron Gibson-Watt

A bladder infection is a common condition in women, and unless you’re the lucky few who’s never had one, you’ll be very familiar with the symptoms.

For many of these women, almost 30%, a bladder infection returns within the following six months. Ms Charlotte Chaliha, a leading obstetrician and gynaecologist in London, explains why an infection reoccurs and what preventative measures you can take.



What is a bladder infection?

A bladder infection, sometimes known as a urinary tract infection, occurs when bacteria gets inside the urethra, the tube that carries urine out of the body. The bacteria then moves its way up towards the bladder.


Once inside, the bacteria can cling to the lining of the bladder and cause it to become inflamed. This is known as cystitis.


Why does recurrent infection occur and who is affected?

Recurrent UTIs can return after previous infection in healthy young women with normal urinary tracts – even after appropriate treatment and recovery. It can present as a relapse or reinfection.


Recurrent urinary tract infections (UTIs) are much more common in women. The clinical features, diagnostic testing and causative organisms are often similar to those of single cases of UTI, although there are additional treatment strategies and prevention measures to consider with recurrent infections.


One study showed that of college women with their first UTI, 27 % had at least one reoccurrence of UTI within the following six months, and 2.7 % experienced a second recurrence over the same period.


In symptomatic women, predictors of recurrent UTIs include symptoms following intercourse, signs or symptoms of pyelonephritis, and prompt resolution of symptoms with antibiotics.


Another group of patients who present with recurrent UTIs are those with a predisposing structural or functional abnormality of the genitourinary tract (the reproductive organs and the urinary system). Sexual intercourse is the most common predisposing factor.


What infection causes recurrent UTI?

Escherichia coli, a type of bacteria, is usually the main cause (around 80%) followed by staphylococcus saprophyticus (between 10 to 15%).


Enterococcus, Klebsiella, Enterobacter, and Proteus species are less common causes.


What sort of symptoms should I worry about?

Common symptoms are pain when you pass urine, frequent urination, and lower abdominal pain. If pain occurs around the kidneys (back and upper abdomen) and a fever occurs, medical help should be sought in case a kidney infection has developed.


How is recurrent bladder infection treated?

Treatment of an initial recurrence of UTI is the same as for other cases of uncomplicated cystitis. This will be guided by the results of the urine test.


Patients with recurrent UTIs should be counselled about the risk factors. These include spermicide use, frequent sexual intercourse and new sex partners, as well as about preventive measures.


Treatment and preventative measures include:

  • Antibiotic prophylaxis – antibiotics are sometimes given as a precaution to prevent infection. This can be prescribed either as a nightly low-dose or to be taken just after sex. Six months of treatment, followed by observation for reinfection after discontinuing prophylaxis, has been recommended but this can be modified according to relapse frequency and patient preference.
  • Vaginal oestrogen – the female hormone may help to protect women who are menopausal.
  • Cranberry tablets - There is an active ingredient in cranberries that are able to prevent bacteria such as E. coli from sticking to the bladder wall.


If you are experiencing recurrent bladder infections and need to see a specialist, visit Ms Charlotte Chaliha’s profile and make an appointment with her.

By Ms Charlotte Chaliha
Obstetrics & gynaecology

Ms Charlotte Chaliha is a leading obstetrician and gynaecologist in London. She graduated in physiological sciences from St Anne's College, Oxford, and in medicine from Selwyn College, Cambridge. She had dual accreditation in obstetrics and gynaecology as well as higher sub-specialist training in urogynaecology and a fellowship in uro-neurology.

Ms Chaliha's area of expertise lies in postpartum pelvic floor problems, postpartum perineal trauma such as anal sphincter damage, vaginal prolapse, bladder pain, recurrent urinary tract infections and urinary incontinence.

Her MD thesis was based on the: "Risk factors and causes of trauma to the pelvic floor during childbirth." She has a particular expertise in this area and has developed a specialist clinic for at the Royal London Hospital for women with childbirth-related problems such as urinary or faecal incontinence and perineal pain.

In 2007 she was appointed as a consultant obstetrician and gynaecologist with a special interest in pelvic floor disorders at The Royal London Hospital. She has been lead urogynaecologist since 2013 for Barts Health NHS Trust and is the lead gynaecologist at the Royal London Hospital.

Ms Chaliha has authored numerous chapters and publications covering all aspects of pelvic floor investigation, surgery and pelvic floor damage related to childbirth. She has extensive obstetrics experience in high risk obstetrics and covers both NHS and private births. She has co-authoured the popular pregnancy book " the Contented Pregnancy" with the popular author Gina Ford.

Ms Chaliha co-leads one of only two nationally accredited pelvic floor services in the UK, integrating the management of bowel, bladder and pelvic floor dysfunction. Her expertise in this clinic is in the management of pelvic floor prolapse, constipation, urinary and faecal incontinence.

Ms Chaliha provides expert evidence for the courts in England and Wales on behalf of claimants and defendants in personal injury and clinical negligence actions. She has obtained the Bond Solon Cardiff University Expert Witness Certificate and completes around 50 medico-legal reports per year.

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