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Anyone who has gotten a urinary tract infection (UTI)—which is about 50 percent of all women, per the National Institutes of Health—knows the relief when the infection finally clears. You can finally pee without burning, the bladder pain subsides, and you just feel comfortable again. But for some, the relief is fleeting: one in four women with a UTI will have another infection within six months. It’s a cycle of treatment and pain that can feel endless for the women who experience it.
Recurrent UTIs are defined as more than two UTIs in six months or more than three in one year, says Unwanaobong Nseyo, MD, a urologist at Weill Cornell Medicine and NewYork-Presbyterian. People with vaginas are much more likely to get UTIs than people with penises, she says, which if you think about it, makes sense. It all comes down to anatomy. First, because a female urethra is only about four centimeters long, bacteria doesn’t have very far to travel to get to the bladder and start an infection, says Charna Coren, MD, an OBGYN at Redeemer Health in Philadelphia. Second, because the vagina is located so closely to the anus, there are a lot of opportunities for it to do so.
All that said, if you’re part of the unlucky club of people who suffer from recurrent UTIs, you probably have a few questions, like why me? and how can I make it stop? Those questions have answers. Here’s what doctors suggest you do if you are searching for relief.
Meet the experts: Unwanaobong Nseyo, MD is a urologist at Weill Cornell Medicine and NewYork-Presbyterian. Charna Coren, MD, is an OBGYN at Redeemer Health in Philadelphia who goes by the Vag Doc on TikTok.
3 Potential Reasons Behind Recurrent UTIsYou’re genetically predisposed.
When bacteria enters into the bladder, it attaches onto proteins on the bladder wall, says Dr. Nseyo. “Certain women have proteins on their bladder walls that make them more likely to get recurrent UTIs,” she says. Imagine your bladder wall as a climbing wall: certain handholds are going to make it easier for that bacteria to hang on for longer. If you have those easy-to-grab handholds—or proteins—you might wind up with more bacteria in your bladder.
“Someone without those proteins might get that same bacteria in their bladder and drink water and it will flush out and they won’t get a UTI. Someone who gets recurrent UTIs might have that same bacteria stick on to their bladder wall and get an infection from the same exposure,” says Dr. Nseyo.
This means that you’re not only more likely to get an infection in the first place, but that your UTIs can be more difficult to treat. There aren’t any tests to determine your genetic predisposition—these proteins have only been identified in research settings—but your likelihood of getting recurrent UTIs increases if you have a mother or sister who gets them, says Dr. Nseyo.
While there’s nothing you can do about your anatomy or genetics, recurring infections of the same bacteria in your bladder might just require more hands-on, long-term treatment from your doctor.
The original UTI never got treated properly.
Dr. Coren often sees patients who think they’re getting recurring infections—when the problem is actually ineffective treatment for the original one. “You may think you’re having a UTI that’s coming back, but it could just be that you didn’t treat it right,” says Dr. Coren. “You treated it with something that the infection has resistance to.”
While antibiotics are a strictly prescription medicine, services like Amazon Health, GoodRX, or TreatMyUTI.com promise as soon as same-day UTI prescriptions without the need of a urine culture or other testing. Self-diagnosing UTIs, or even trying to completely treat them on your own with antibiotics or other measures, becomes a bit of a dangerous game, Dr. Coren says. Even if you get some temporary relief, the infection may not be totally cleared. Without a urine culture, it’s impossible to tell what bacteria is causing the infection, and therefore what medication can get rid of it for good.
“The worst thing you can do is go and get a different antibiotic from every doctor in town, because that’s what really messes up your resistance patterns,” says Dr. Coren. Antibiotics can also cause yeast infections, vaginitis, and other infections because they clear out all the good bacteria in addition to the bad bacteria. So if you are on antibiotics, you want to use them pretty sparingly. Although a urine culture can be an inconvenience, it can save you long-term pain and the struggle of antibiotic resistance.
You have low estrogen levels.
While low estrogen levels are most often associated with perimenopause or menopause, young women can also experience dips in estrogen due to birth control or breastfeeding. “If the levels of estrogen in the vagina are lower, it makes the vagina a better home for the bad bacteria that lead to a UTI,” says Dr. Nseyo.
Low estrogen can lead to thinning of the tissue around the urethra and vulva, resulting in itchiness, discomfort, and—you guessed it—a higher risk of UTIs. If you keep getting UTIs, especially if you’re peri or postmenopausal or have other risk factors for low estrogen, it’s worth bringing up an estrogen imbalance to your doc.
Beyond a course of antibiotics, doctors recommend these 7 strategies to prevent recurring UTIs.The MustsDrinking lots of water
For some people, simply increasing fluid intake is an appropriate form of UTI treatment in and of itself, says Dr. Nseyo. In one 2020 randomized controlled trial in The Journal of Family Practice, scientists followed women who experience recurrent UTIs for one year. The group that increased their fluid intake by 1.7 liters a day experienced about half the number of UTIs as the control group by the end of the year. Dr. Nseyo recommends shooting for around 2L to 3L (70-100 oz) of water per day, especially when you feel a UTI coming on.
Paying attention to your vaginal and bladder hygiene
From peeing after sex to cleaning sex toys, maintaining a clean area down there can be your first line of defense against UTIs, says Dr. Coren. It’s also important to avoid nonoxynol-9-based spermicides, which have long been associated with UTI risk. “Spermicide changes the microbiome of everything. It’s always been a pretty annoying thing for urinary health,” she says.
The MedsNon-antibiotic medication: methenamine (Hiprex)
Methenamine, more commonly known as Hiprex, is a prescription anti-infective pill that makes your pee more acidic, which in turn makes it harder for bacteria to grow in your bladder, per the Mayo Clinic. Docs use methenamine as an alternative to long-term prophylactic antibiotics, and find that it’s just as effective in preventing recurring UTIs, says Dr. Coren.
In a 2022 study, 240 women who experienced recurrent UTIs were split into two groups and given either daily low-dose prophylactic antibiotics or methenamine. The study found that methenamine performed just as well as the low-dose antibiotics, but didn’t run the risk of antibiotic resistance. “It’s fantastic for people that are stuck on antibiotics,” Dr. Coren says. “What I’ve generally done is put people on it for a six-month run and see if we can break the UTI cycle.”
Low-dose antibiotics after sex
For some patients, Dr. Coren prescribes a low-dose antibiotic to be taken when the risk of developing a UTI is at its highest: right after sex. “For some people, every time they have sex they have to pop a single antibiotic, and if you take a single antibiotic prophylactically, you can take somebody from symptoms after every encounter of intimacy to living a normal life,” she says.
This way, they can preventatively clear bacteria from their bladder on an as-needed basis, helping to prevent longer courses of higher dose antibiotics for an acute infection. Though there’s a risk of developing some antibiotic resistance with prophylactic meds, Dr. Coren says that it’s lower than chronically treating UTIs with those high doses of antibiotics.
Related StoryVaginal estrogen
If you’re in perimenopause or menopause, or just experience low estrogen because of other conditions, low-dose vaginal estrogen can help reduce UTI risk, says Dr. Nseyo. One study in The American Journal of Obstetrics and Gynecology on postmenopausal women with low estrogen levels found that vaginal estrogen reduced their risk of UTI frequency by 50 percent. “The biggest risk reducer for those later years is truly vaginal estrogen, which has a really great safety profile across the board,” says Dr. Coren.
The SupplementsCranberry supplements with PACs
The advice to drink cranberry juice isn’t just an old wives’ tale. Cranberries naturally contain proanthocyanidins (PACs), which help prevent E.coli—the most common culprit of UTIs—from binding onto the bladder wall, per a review in Cochrane Database of Systematic Reviews. “It basically really acidifies the urine and then creates a less desirable environment for bacteria to grow in,” says Dr. Coren.
An Ocean Spray cranberry cocktail won’t do the trick, though. You’ll need something that is made with PACs to actually help prevent UTIs, says Dr. Nseyo. Likely, the best way to do this is to go straight for the supplement compared to even 100 percent fruit juice. One meta-analysis in Frontiers in Nutritionfound that patients who had a daily intake of at least 36 mg of PACs experienced an 18 percent reduction in UTI risk. Dr. Nseyo recommends cranberry supplements along with a dose of Hiprex for many of her recurrent UTI patients.
Related StoriesFlush drinks
In addition to water, you can include UTI flush drinks in your hydration regimen—Dr. Nseyo recommends Uqora Flush. She has patients take the drink when they feel UTI symptoms coming on to cleanse out their system. “It just makes you increase your hydration levels [and] it has some vitamin C in it, which also helps change the pH of the urine, so it’s less of a good home for bacteria,” says Dr. Nseyo. Uqora Flush also contains d-mannose, which is a naturally-occurring sugar found in fruits and vegetables. While it has mixed data on efficacy, it’s become a big name in UTI treatment over the past few years.
Another potential treatment: a UTI vaccine in the near future.
In 2023, scientists conducted the first North American clinical study of a UTI vaccine, finding that it greatly improved recurrent infections in women, per the Canadian Urological Association Journal. In the study, 67 subjects between the ages of 18 and 80 who reported an average of 6.8 UTIs a year were given the new MV140 vaccine. Within nine months, 40 percent reported being UTI-free and within one year, 80 percent reported that their symptoms had greatly improved.
While these vaccines aren’t FDA-approved in the United States yet, the trials show a promising ray of hope for future UTI treatment. They’re currently approved in 26 countries, including Portugal, Spain, the United Kingdom and Mexico, according to Pharmacy Times.
In the meantime, if you’ve tried all of the above and you’re still struggling, it’s time to meet with a provider to investigate other underlying causes. “We’ll try to see if there are things that might be triggers for the UTIs, like sexual activity, issues with either constipation or leakage of stool, urination habits, dehydration, diabetes…things like that,” says Dr. Nseyo. Together, you can find a solution.
Halle Newman is a freelance journalist and copywriter based in New York City. When she’s not writing, she’s probably strolling through Central Park with a matcha or trying out a new dance class.