How to determine if a UTI is new or just recurring

Dr. Keith Roach M.D.

DEAR DR. ROACH: I have a problem with chronic urine infections. I am 78 years old, and suffer often from it. I frequently go to the bathroom five or six times during the night and feel pressure under my stomach. My doctor suggested a biopsy and found blood in my urine, which was later tested for cancer. I was told a week later that I do not have cancer.

       My doctor is aware that I cannot take antibiotics because I get side effects. He gave me Monurol. I had no aftereffects, but still get recurrences of pressure, burning with urination and a burning sensation in my vaginal area. How can I treat this uncomfortable feeling? Must I be on antibiotics for the rest of my life? -- W.W.

      ANSWER: Your doctor may have done a comprehensive evaluation, but I don't have enough information to say exactly why you continue to get these symptoms. Even so, there is some advice I can give.

       Recurring symptoms of urine infections can come from either a series of new infections or a single infection that is only partially treated and then comes back. The doctor can settle this by getting several cultures of the urine to see what bacteria are growing. If it's the same strain each time, that is likely a persistent infection; different organisms indicate recurring new infections.

       If it is recurring new infections, the bacteria are having an easy time getting into the bladder. Some women have this issue with sexual activity, but in a 78-year-old woman, one very common reason is that lower estrogen levels lead to thinning of the lining of the vagina and vulva -- and that includes the lining of the urethra, where urine exits the body. If this lining is thin, bacteria can get into the bladder through the urethra. It is normally treated by vaginal estrogen cream, which is very effective.

       Persistent infections lead the doctor to suspect an abnormality in the kidney, bladder or ureters, which are the tubes that connect the kidneys with the bladder. A stone is a common source of persistent infection, and it would also explain the blood. 

       I am puzzled by your doctor recommending a biopsy. Did he see something on exam or study that worried him? 

       Fosfomycin (Monurol) is a unique antibiotic, not chemically related to others. It is a good choice for urine infections in people with multiple allergies or sensitivities. But chronic antibiotic use is a last resort. If your doctor hasn't done a thorough job of investigating the possibilities, I would recommend consultation with an expert. A urogynecologist would be the ideal specialist.

       DR. ROACH WRITES: Recent data have shown that the number of breast cancer diagnoses in the past year is dramatically down. This is not good news, since it means there are more cases of undiagnosed breast cancer. Anecdotal reports from my breast cancer colleagues confirm that women are showing up with more advanced breast cancer than in the past. I am sure that part of this is due to people who need mammograms not being able to, or feeling uncomfortable about, going to get them during the pandemic. 

       I am sure also that this phenomenon isn't limited to breast cancer. All kinds of screening and preventive care needs to be done in a timely fashion, for both women and men. Please come back for your routine visits.