Preventing recurrent urinary tract infections

A urinary tract infection (UTI) is a common health problem affecting women. One in three women will have at least one episode of a UTI requiring antibiotics by the age of 25. Half of all women will have at least one episode of a UTI at some point in their life. Approximately 25–30% of women may then have a recurrent infection within six months. 

Recurrent episodes of UTIs cause discomfort, lead to increased sick leave and increase the risk of antibiotic abuse. Preventing these infections is important — not only for women’s health but also to reduce the growing problem of antibiotic resistance. 

Women’s vulnerability 

Women have a shorter urethra compared to men, and its opening is close to the vagina and anus, making it easier for bacteria from the bowel to reach the bladder. Vaginal tissues are naturally more receptive to certain bacteria, and this risk is higher during early adulthood (with the start of sexual activity) and again after menopause, when hormonal changes reduce natural protection. 

Diagnosis and prevention 

A recurrent UTI is defined as two or more culture-proven infections in six months, or three or more in a year. Lifestyle changes can go a long way towards preventing UTIs. Some tips include:  

• Drink a lot of water/fluids 

• Don’t hold in urine for too long  

• Pass urine after sexual intercourse  

• Avoid spermicides   

• Consume a healthy, balanced diet 

• Ensure strict blood sugar control 

Medical treatment

Appropriate antibiotics must be taken as per the culture report for five to seven days. 

Other antibiotic measures include: 

Low-dose antibiotic prophylaxis – a small daily dose of antibiotics at bedtime. Preferred drugs are Nitrofurantoin, Trimethoprim or Fosfomycin for 3–6 months after completion of the appropriate antibiotic course.  

Post-coital antibiotics – A single dose after intercourse if infection is clearly linked to sex. 

Non-antibiotic measures include: vaginal oestrogen cream – in postmenopausal women, restoring vaginal oestrogen levels can help prevent UTIs.   

Cranberry products – Patients may be advised to use cranberry products, preferably juice for recurrence prevention, but should be informed that current evidence is of low quality and findings are contradictory. In diabetic patients, cranberry juice with added sugar may worsen glycaemic control, though this can be avoided by drinking it without sugar. 

Immunomodulatory prophylaxis – Vaccines such as StroVac, OM-89, ExPEC4V, MV140, and Solco-Urovac aim to stimulate the body’s immune response against urinary pathogens. However, current evidence doesn’t support their routine use. 

Probiotics – Lactobacillus species may help restore healthy vaginal flora. But benefits remain uncertain. 

Phytotherapeutics – Plant-derived preparations aim to reduce antibiotic use and support urinary health. Examples include: Xyloglucan, Gelose, Hibiscus, and Propolis, Centaury herb, Levisticum officinale and Rosemary leaf, traditionally used for urinary tract health. Evidence of these, however, is limited. 

Also Read: Rapid, diagnostic test for UTIs may help stem super bug crisis

The bigger picture 

Overuse of antibiotics can lead to multidrug-resistant infections. Hence, an accurate diagnosis, antibiotics for a short duration and preventive measures must be prioritised. If you have frequent UTIs, consult your doctor. A specialist referral may be needed if there is a suspicion of a complicated UTI. 

Preventing stone diseases  

An oft repeated adage for kidney stones is – ‘Once a stone former, always a stone former.’  

However, there are certain measures that can minimise the risk of stone recurrence. The first and most important step would be to ensure two litres of urine output every day. The amount of fluids to take cannot be prescribed by a physician but would depend on the climate and the individual’s activity levels.  

Unhealthy diets can increase stone formation. High levels of salt in junk food increase calcium levels in the urine, and phosphoric acid in some carbonated beverages increase urinary acidity. Irregular food habits and a lack of physical exercise compound the risk of stone formation.  

Obesity is a related risk factor that causes inflammation and increases excretion of stone components such as uric acid, calcium and oxalates. 

The intuitive advice of restricting calcium-containing foods to reduce calcium stone formation is, surprisingly, counterproductive. Reduced calcium in the gut increases oxalate absorption from foods. More oxalate reaches the kidneys where it crystallizes to form stones. A diet with moderate amounts of milk and yoghurt helps reduce the chances of recurrence of stone disease by binding oxalate in the gut. 

Do we need to give up on oxalate-rich foods? The usual amounts of spinach or nuts in an Indian diet are not going to enhance stone growth and there is no need to omit these. 

Common practices in India include avoiding tomatoes and brinjal and increasing banana stem juice intake. While banana stem juice may help by adding to the total fluid intake, avoidance of any plant-based foods is not recommended.  A fibre-rich diet, in fact, is advisable; as dietary fibre can alter the gut microbiome and help metabolise oxalate in the gut. Animal proteins, on the other hand, increase sulphur and acid in the urine and must be restricted to one gram per kilogram of your body weight.  

Patients often request pills or syrups as a quick fix. These, unfortunately, do not work in most patients. Citrate tablets may work in theory, but in a real-life situation, these need to be taken at least three times a day on a lifelong basis. The compliance with such treatment wanes off very quickly. 

There are some specific circumstances, such as a strong family history, and multiple, frequently recurrent stones where your clinician may suggest a myriad of blood and urine tests. The idea here is to search for specific abnormalities that can be targeted by simple interventions. 

In summary, a healthy lifestyle of adequate hydration, a fibre-rich diet and avoidance of excess animal protein will benefit most recurrent stone formers.  

Remember, what is good for your heart is also good for preventing recurrence of stone disease. 

This article was first published in The Hindu’s e-book Care and Cure. 

(Dr. Nitin Kekre is consultant urologist and head of urology, Naruvi Hospitals, Vellore. nitin.k@naruvihospitals.com)

Published – January 29, 2026 05:06 pm IST