Recurrent Urine Infections
When bladder infections keep coming back — investigation and treatment beyond repeat antibiotics, in Johannesburg.
Breaking the cycle
One bladder infection is bad luck. Two or more in six months, or three or more in a year, is a pattern — and a pattern deserves investigation rather than another repeat prescription. Recurrent infections are exhausting and disruptive, and in most cases something can be done about them. Recurrent infections are especially common in women, and I see both women and men with this problem.
When to see a urologist
- Infections keep returning despite treatment
- Blood in the urine with or between infections
- Infections with fever or pain in the side or back, which suggest kidney involvement — if you have a fever with shivering or pain in your side right now, go to your nearest emergency unit today
- Any urine infection in a man — an underlying cause, such as incomplete bladder emptying from an enlarged prostate, is more likely
Investigation and treatment
Investigation includes proper urine cultures (to identify the bacteria and which antibiotics actually work), a scan of the kidneys and bladder, a check that the bladder empties properly and, where indicated, a cystoscopy.
- Targeted treatment guided by culture results, rather than repeated blind courses
- Treating any underlying cause — such as stones, incomplete emptying or prostate obstruction
- A prevention plan, including non-antibiotic options — see “Prevention beyond antibiotics” below
Prevention beyond antibiotics
Repeated courses of antibiotics have downsides — side effects, disrupted gut and vaginal bacteria, and growing resistance. Depending on your situation, I usually combine several non-antibiotic measures:
- D-mannose and cranberry products, which make it harder for bacteria to stick to the bladder wall
- UTI Pro Plus AF, a combination supplement I currently use for selected patients
- Vaginal oestrogen for post-menopausal women — restoring the natural protective tissue and bacteria around the urethra substantially reduces infections in many women
- An oral bladder vaccine (Uro-Vaxom), which trains the immune system against common urine bacteria. It is not registered in South Africa, so it is obtained for you through a Section 21 application to the regulator — the rooms will help with this
- Bladder instillations that help restore the protective lining of the bladder, for selected patients
- Simple habits: good fluid intake, not delaying passing urine, and passing urine after intercourse
Where needed, a low-dose preventive antibiotic is still an option — but as part of a plan, not instead of one.
Bladder pain syndrome and interstitial cystitis
Some patients have bladder pain, pressure, urgency and frequency, yet their urine tests keep coming back clear. That is not “in your head”. Bladder pain syndrome and interstitial cystitis are recognised conditions, and I treat them in the practice.
Treatment is individual and usually combines several steps — identifying triggers, medication, and bladder instillations — with a cystoscopy where needed to examine the bladder lining and rule out other causes. It often overlaps with overactive bladder treatment.
Related: Blood in Urine · Prostate Enlargement · Overactive Bladder
If you have stopped counting your bladder infections, it is time. Call 011 794 3549 or email appointment@urology.joburg.
This information is general in nature and is not a substitute for a consultation.