Watch out for recurrent urinary tract infections

Recognizable by the pain and discomfort they cause, so-called lower urinary tract infections – located in the bladder – are frequent. They indicate the presence of germs in the urine, most often from the digestive system, such as the bacterium Escherichia coli, at the origin of suggestive symptoms: burning sensation when urinating, pain in the lower abdomen, frequent need to urinate, sometimes blood in the urine… Concerning women in 90% of cases, these cystitis are favored by the particularity anatomy of the female urethra, shorter and closer to the anus than that of the man. “The presence of bacteria in the urine does not necessarily mean that there is an infection. It is the extent of the inflammatory response, specific to each individual, which will generate the symptoms, ”explains Dr. Angela Huttner, Associate Associate Physician at the Infectious Diseases Department of the University Hospitals of Geneva (HUG).

When to worry?

Beyond three urinary tract infections per year or more than two in six months, it is fair to speak of “recurrent infections”. A consultation is then necessary to carry out possible explorations in order to identify a specific cause and set up an appropriate treatment. “The presence of other symptoms, such as blood in the urine, pain in the back, flank or even fever, should also lead to an emergency consultation. Indeed, they can indicate a urinary tract infection spreading to the kidneys – or to the prostate in men – which is much more dangerous than simple cystitis”, warns Dr. Vanessa Fenner, assistant doctor in the HUG Urology Department. People at risk, such as pregnant women, men, children or immunocompromised people, even if they do not experience repeated infections, should also consult quickly.

drink enough

In prevention or in the event of a specific urinary tract infection in a healthy adult woman, increasing hydration is often enough to treat the problem. The action is mechanical: increasing your water consumption increases urination, allowing bacteria to be better expelled from the bladder and urethra. « The intake of a liter and a half of water in addition to the basic intake during the day almost halves the risk of urinary tract infection », notes Dr. Huttner.

Among the other preventive actions, it is recommended to urinate and wash after each sexual intercourse, the latter favoring the rise of bacteria towards the urethra. On the other hand, repeated vaginal douching is to be avoided, because it leads to the destruction of the « good » protective bacteria of the vaginal flora.

On the side of phytotherapy or food supplements, there is no robust evidence to attest to their effectiveness. If the cranberry (cranberries) is often cited, its direct action on urinary tract infections has never been scientifically proven. « But if it can encourage the women concerned to drink more, so much the better, it can’t hurt, » says Dr. Fenner.

Only D-mannose, a clinically tested natural sugar, has shown some effectiveness. By binding to the cilia of bacteria responsible for inflammation, it prevents them from attaching to the bladder wall. It can therefore present a first line of treatment without the risk of adverse effects. In case of persistence of symptoms or in the face of recurrent cystitis, antibiotic treatment, sometimes combined with an anti-inflammatory, is prescribed.

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