Persistent Bladder Infections
For the past year, I have had multiple bladder infections (three in the past 30 days), most often with very minimal symptoms. I have been told by my urologist that my infections have nothing to do with poor hygiene, but with organisms that my immune system does not seem to fight very well. I take antibiotics to treat the infections, and cranberry juice supplements and probiotics to help prevent the infections, and I have not had a sexual partner for some time. I know that people with diabetes, and women in general, are more susceptible to urinary tract infections, but wonder how common it is for women with diabetes to have so many infections. I am also concerned about possible kidney damage due to asymptomatic infections that may be untreated for weeks or months at a time. I would appreciate any information you could give me on the subject. Name Withheld
Frank Rodriguez, MD, responds: First and foremost, you need to make sure you have good blood glucose control, or you will continue to have these problems.
Second, symptomatic cystitis and bladder problems in people with diabetes will occur, and it may be useful to schedule periodic urinalysis and/or bacterial cultures to keep the problem from recurring.
Third, cranberry derivatives are only useful intermittently. If used to prevent cystitis, they should only be used one day out of the week. The cranberry products inhibit the common intestinal bacteria E. coli's ability to attach to membranes in your bladder—that is a short-term effect. Beyond 48 hours, the E. coli adapt to the active agent, and then you just have expensive urine.
Fourth, are you pre- or postmenopausal? If you have already gone through menopause, then you need local estrogens to keep the epithelium, the layer of tissues around the bladder (and other organs, including skin), healthy and resistant to pathogens.
Try logging a urinary diary. Chances are good that you may not be urinating frequently enough. Also, you mention that you're not sexually active, but this can be an issue for some people. Partners of sexually active women should use condoms. Everyone thinks of the diagnosis of diabetes in a woman with recurrent bladder and vaginal yeast infections, but they forget that the partner may have chronic prostatitis, meaning that a man with diabetes may be depositing glucose-laden semen in the vaginal channel.
Finally, always obtain an HIV test on recurrent cases of urinary tract infection. Rule that out and then move on.
If these tips don't address your problem, a urogynecologist should be able to help you get to the root of the issue.