I'm a woman and I've had a chronic bladder infection for four years. My doctor keeps giving me antibiotics, but the infection keeps coming back. What can I do?

Answers from Erik P. Castle, M.D.

Several factors make women more likely to get recurrent bladder infections, a type of urinary tract infection (UTI). These factors include:

  • Kidney or bladder stones
  • Bacteria entering the urethra during intercourse
  • Changes in estrogen levels during menopause
  • An abnormal urinary tract shape or function
  • An inherited risk of developing bladder infections (genetic predisposition)

If you've had two or more culture-documented bladder infections during a six-month period, consider seeing a urologist — a doctor who specializes in diagnosing and treating urinary tract diseases.

To figure out what's causing the repeat infections, your urologist may recommend a:

  • Urine culture test of a sample obtained with a catheter
  • Visual exam of the bladder and urethra with a lighted scope (cystoscopy)
  • Computerized tomography (CT) scan of the urinary tract

Treatment is directed at the underlying cause, when possible. If your doctor can't find a cause, one of these options may help:

  • A long-term, low-dose antibiotic for as long as six months to two years
  • Intermittent or self-directed antibiotic therapy — for instance, taking an antibiotic after intercourse or starting a course of antibiotics supplied in advance by your doctor at the first sign of a UTI
  • Vaginal estrogen therapy — if you don't already take oral estrogen — for signs or symptoms related to vaginal dryness (atrophic vaginitis) after menopause

Expert opinions vary on whether certain lifestyle changes reduce the risk of bladder infection, but it may be helpful to:

  • Drink plenty of liquids, especially water, to help flush out bacteria
  • Urinate often, especially when you feel the need
  • Wipe from front to back after urination or a bowel movement
  • Take showers rather than baths
  • Gently wash the skin around your vagina and anus daily using a mild soap and plenty of water
  • Use forms of birth control other than a diaphragm and spermicides
  • Empty your bladder as soon as possible after intercourse
  • Avoid deodorant sprays or scented feminine products in the genital area

Studies show conflicting results on whether cranberry juice may have infection-fighting properties that help prevent urinary tract infections. But, there's likely little harm in trying cranberry juice to see if it helps you — just watch the calories. For most people, drinking cranberry juice is safe, but some people report an upset stomach or diarrhea.

Sept. 20, 2016