You recognize the symptoms immediately—a relentless need to urinate, followed by a painful burning sensation when you do…unpleasant odor or cloudy color to your urine…and cramping or pressure in the lower abdomen. For millions of people—women and men—urinary tract infections (UTIs) are more than just a nuisance. They happen several times a year and may, although not commonly, travel into the kidneys, causing a more serious infection that comes with fever, nausea/vomiting and even confusion. Bottom Line Personal asked urology specialist Suzette E. Sutherland, MD, what you can do to prevent these infections…

Most women will experience at least one UTI in their lifetime…between 20% and 40% of those who do will have a recurrence…and up to 50% of those women will have multiple recurrences. Men almost exclusively in their 50s and older also get UTIs.

UTIs happen when bacteria enter the urinary tract through the urethra, the tube that carries urine out of the body. In most cases, antibiotics clear up the infection. But for some people, the UTI returns. Three or more UTIs within a year—or two within six months—are considered recurrent UTIs (rUTIs). Patients suffering from rUTIs often live in fear of the next infection.

Fortunately, there are strategies that may help prevent the next one…

Recurrent UTIs in Women

Why UTIs happen: In women, the vagina and anus are colonized with billions of bacteria. This is normal and healthy and has nothing to do with hygiene. (Men are colonized with just as many bacteria.) The good bacteria usually outnumber the bad, preventing infections. But sometimes infection-causing bacteria make their way from the vagina or anus up toward the urethra. This can happen during sex or when wiping back to front.

Another little-known yet common cause of UTIs in menopausal women has to do with hormone levels. Estrogen helps the good bacteria, such as Lactobacillus, maintain the right balance in the vagina. As estrogen depletes during perimenopause and menopause, troublemaking bacteria get a leg up. Since a woman’s urethra is only three inches long (versus seven to eight inches in men), once those bacteria move up from the vagina or anus, it’s easy for them to reach the bladder.

A three-pronged approach that factors in the vagina, the anus and the ­urethra-bladder complex can help women keep these bacteria in balance and under control, preventing rUTIs.

Vagina: Local estrogen can make a big difference in minimizing rUTIs in menopausal women. It is available in three forms—vaginal cream (Estrace, Premarin)…vaginal suppository (Vagifem, Yuvafem)…and vaginal ring (Estring). These are not systemic estrogens, meaning they stay in the vaginal area and don’t travel into the blood stream and throughout the body. This helps avoid any of the risk for increased blood clots, heart attack, stroke or breast cancer associated with larger-dose, systemic estrogens. Low-dose vaginal estrogen even can be used by women with a history of breast cancer. A urogynecologist or female urologist can explain how to use vaginal estrogen correctly. Encouraging: In a 2021 study by researchers at University of South Florida, Tampa, nearly 70% of 167 postmenopausal women with rUTIs reported that vaginal estrogen cream improved or resolved their symptoms.

Anus: The following strategies can help minimize the number of bad-for-you bacteria in and around the anus…

Avoid constipation. As stool builds up in the rectum, more bacteria proliferate. Keep things moving by slowly increasing daily fiber intake, aiming for 25 grams a day from plant-based, fiber-rich foods such as beans, produce, nuts and popcorn. You also can try a fiber supplement such as Metamucil or Citrucel or take 400 milligrams (mg) of magnesium citrate a day to stimulate the bowels. Caution: Avoid laxatives—they can cause diarrhea, introducing even more problematic bacteria into the perineal area, and can cause long-term bowel dysfunction due to laxative dependence.

Consume bowel-friendly ­probiotics. Probiotics are good-for-you bacteria found in fermented beverages and foods such as kefir, yogurt, sauerkraut and kimchi. Try: Lifeway Kefir and Activia yogurt. If you opt for probiotic supplements: Look for ones that are specifically marketed for bowel and digestive health.

Bladder and urethra: The following techniques keep your bladder and urethra healthy…

Stay hydrated. Dehydration is the number-one cause of UTIs. That’s because the less you drink, the less often you need to use the bathroom, and urinating helps flush bacteria from the urinary tract. Aim for at least two liters of fluid a day, with about half of this being water. Goal: Drink enough that your urine is a light-yellow color and any bacteria that do make their way to the urethra are diluted and carried away.

Try proanthocyanidin supplements. You’ve heard that cranberry juice helps prevent UTIs. That’s only partly correct. Cranberry juice—more so than the skin, seeds and stems—contains a soluble bioavailable compound called proanthocyanidin (PAC) that attaches to UTI-causing bacteria, preventing them from latching on to the cells that line your urinary tract. These immobilized bacteria are flushed out during urination.

Some products contain high amounts of PAC…some have very little. Look for products that contain 36 mg of PAC in a single serving…are derived from pure cranberry juice and not the whole cranberry…and are labeled “soluble” or “bioavailable,” which are most easily used by the body and most effective at fighting bacteria. Products to try: Ellura capsules ($49.50 for 30 capsules, or Utiva Cranberry PACs ($39.99 for 30 capsules, Take one a day for prevention (not treatment) of rUTIs.

Drinking regular cranberry juice may help, but it’s difficult to determine the PAC content. Make sure it’s unsweetened pure cranberry juice. You can temper the bitterness by mixing it with some club soda, but not too much, or it will dilute the PAC concentration.

Urinate after sex. This can help flush out any bacteria that have migrated up the urethra. Women who tend to develop UTIs after sex can take one to two capsules of PAC-containing supplements before sex and again the following day for additional protection.

Recurrent UTIs in Men

Men also have billions of bacteria residing all over their body, including below the belt. But the most common reason older men develop rUTIs involves an enlarged prostate gland, also called benign prostatic hyperplasia (BPH), which makes it difficult to empty the bladder. That means urine sits in the bladder for prolonged periods, allowing bacteria to multiply. BPH is the most common prostate problem affecting men over age 50.

Men with BPH can help reduce the frequency of rUTIs by fully emptying their bladder as regularly as possible. This can be facilitated by treating BPH, which can be accomplished by…

Taking prescription medication to shrink the prostate gland. Finasteride (Proscar), a 5-alpha reductase inhibitor, is commonly used for this reason.

Taking medication to relax the muscles at the bladder opening (bladder neck) and part of the urethra that runs through the prostate. These alpha ­blockers make it easier for urine to flow and for the bladder to empty completely. Tamsulosin (Flomax) is a popular one.

Having the prostate removed in a procedure called a transurethral resection of the prostate. Risks include ­retrograde ejaculation (semen flows into the bladder during sex), urinary incontinence and erectile dysfunction.

Men with rUTIs also should stay hydrated, use PAC supplements, avoid constipation and consume probiotics.

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