UTIs in Women: Why They Keep Coming Back and How to Stop Them

Urinary tract infections are one of the most common reasons women visit the clinic, and they recur in about a quarter of cases within six months. The short female urethra means bacteria reach the bladder far more easily than in men.

Typical symptoms include burning on urination, frequency, urgency, cloudy or strong-smelling urine, and lower abdominal discomfort. Fever, back pain or blood in the urine suggest the infection may have reached the kidneys — this needs prompt medical attention.

A urine culture before starting antibiotics is ideal, because it tells us exactly which bacteria are responsible and which antibiotics will work. In Pakistan, resistance to commonly used antibiotics like ciprofloxacin and co-amoxiclav is rising, so blind treatment increasingly fails.

Prevention is as important as treatment for women with recurrent UTIs. Drink at least two litres of water daily, urinate after intercourse, wipe front to back, and avoid holding urine for long periods. Cranberry extract (not juice with added sugar) has modest evidence for reducing recurrence.

Postmenopausal women are especially prone to UTIs because oestrogen decline changes the vaginal and urethral lining. Local vaginal oestrogen cream, prescribed after assessment, can reduce UTI frequency significantly in this group. If you are getting more than three UTIs a year, a targeted prevention strategy is worth discussing.