Why do my Urinary Tract Infection (UTI) Symptoms Come and Go?

Dealing with discomfort while urinating or suddenly feeling the need to go can be unsettling. However, you’re not alone; urinary tract infections (UTIs) are one of the most common reasons people head to their doctors.

These infections can pop up anywhere along your urinary tract, which includes the urethra (the tube that lets urine leave your body), the ureters (the tubes that connect your kidneys to your bladder), the bladder itself (where urine is stored), and the kidneys (which filter your blood to create urine).

To find out if you have a UTI, doctors usually look for a positive urine culture that identifies the bacteria causing the trouble, along with symptoms like painful urination, difficulty fully emptying your bladder, frequent trips to the bathroom, bloody urine or pain in your lower back or pubic area.

The way people respond to UTI treatment can vary quite a bit. It often depends on the specific type of bacteria involved, the antibiotics prescribed, and any other health conditions you might have. Usually, you can expect some relief within 48 hours after starting antibiotics. But if your symptoms stick around or seem to come and go, that might mean you’re dealing with a recurrent UTI or something else entirely.

In this blog, we’re going to take a closer look at why those UTI symptoms can be so unpredictable, what factors might lead to recurrent infections, and the best ways to tackle this common health issue. 

What is a recurrent UTI?

A recurrent UTI is when someone experiences two UTIs in six months, or three UTIs within one year. Recurrent UTIs are more common in women and can be caused by a rapid reinfection or a relapsed infection. 

A reinfection is when there is a new UTI caused by a different bacteria than what was identified in a previous UTI. A reinfection occurs more than two weeks following a previous infection. 

A relapsed infection is when there is bacterial persistence, or the recurrent UTI is caused by the same bacteria as a previous infection that was treated with antibiotics within a two-week period. Relapsed infections may require further evaluation with specialized urological imaging or referral to a specialist. 

Why do my UTI symptoms come and go? 

There are several underlying medical conditions that may predispose you to UTIs. These may include:

• Changes to the anatomy of the urinary tract system 
• Thinning and drying of the vaginal walls (atrophic vaginitis) are often associated with menopausal hormone changes
• Pouches in the bladder wall (bladder diverticula)
• Weakness of the wall between the bladder and vagina (cystocele)
• Prolapse of the pelvic organs 
• Overactive bladder
• Loss of bladder control (urinary incontinence)
• Kidney or bladder stones
• Indwelling catheters
• Narrowing of the urethra preventing urine from exiting (urethral stricture)
• Vesicoureteral reflux (when urine flows backward from the bladder to ureters and kidneys)
• Tumors on the urinary tract system 
• Chronic diarrhea 
• Diabetes

Additional factors that can contribute to recurrent UTIs may include:

• Genetic predisposition (mother or sister with a history of recurrent UTIs)
• When the infecting bacteria does not respond to the prescribed antibiotic (antibiotic resistance)
• Inadequate dosing or duration of the prescribed antibiotic course
• Not completing or taking an antibiotic course as directed

Treatment of recurrent UTIs

To tackle recurrent UTIs effectively, it’s important to dig deeper and investigate what’s going on.

If you’re experiencing UTI symptoms again, getting a urine culture is a good first step. This helps identify the specific bacteria at play. Once you have those results, your doctor can choose the right antibiotic treatment tailored to your needs.

The first-line therapies typically include:

• Nitrofurantoin
• Trimethoprim/sulfamethoxazole
• Fosfomycin 

Antibiotic therapy for a recurrent UTI is generally recommended for no longer than seven days. If someone is experiencing persistent fever, severe pain, or is unable to take oral antibiotics, hospitalization may be necessary for more intensive treatment. 

It’s important to address UTIs promptly, as leaving them untreated can lead to serious complications, including permanent kidney damage, abscess formation, or sepsis.

Lifestyle habits and personal hygiene 

Certain lifestyle habits like having new or multiple sexual partners, or having sexual intercourse more than twice a week, can increase susceptibility to recurrent UTIs for some people.

Routine habits and personal hygiene practices that may help reduce the risk of recurrent UTIs for those who are more susceptible can include: 

• Avoiding the use of spermicide or spermicide-coated condoms
• Clean your hands before when wiping the vaginal area 
• Wiping the vaginal area front to back after urinating or having a bowel movement.
• Choose a shower rather than a bath if possible
• When washing, use a clean washcloth, and gentle soap to clean the urethral area.
• Avoid reusable sponges and loofahs
• Use a gentle liquid soap without perfumes, astringents, creams or irritating chemicals 
• Do not use feminine hygiene sprays, perfumes, cosmetics, or medicated towelettes in the vagina or urethral areas
• Tampon use is preferred to sanitary pads during menstruation as they can maintain better hygiene and reduce bacterial growth 

Preventing recurrent UTIs

When someone has experienced recurrent UTIs or is at risk for recurrent UTIs, there are preventative measures that can be taken to help avoid ongoing recurrences. Optimizing personal hygiene, and supportive care measures are recommended as first steps to prevention. 

Although not yet available in North America, some countries have approved an under the tongue (sublingual) vaccine that is promising for preventing or reducing the risk of recurrent UTIs.

While we await for Health Canada’s approval of this novel vaccine, anyone prone to recurrent UTIs may want to consider:

• Practice good personal hygiene as mentioned above
• Stay well hydrated, drinking plenty of water can help flush your urinary tract system. The total amount may vary from person to person, aim to drink enough so you empty your bladder every few hours.
• Keep the area clean and dry – wear breathable fabrics like cotton and looser fitting clothing that are more breathable and avoid wearing tight-fitting clothing like pantyhose or swimsuits for prolonged periods of time 
• Supplement with cranberry pills or drink cranberry juice. It’s thought cranberries contain a compound that stops a common UTI culprit, E. coli, from binding to the cells in the urinary tract, and can reduce the risk of recurrent UTIs by 26%. 
• Consider changing your diet to limit or avoid consuming food that can irritate the bladder or mimic UTI symptoms such as caffeine, alcohol, hot spices, aspartame, chocolate, or cola beverages
• If postmenopausal, take estrogen vaginal creams as directed by your healthcare provider
• Take your antibiotics as they are prescribed

If the non-antibiotic measures haven’t been working, or if someone finds themselves dealing with multiple UTIs, it may be time to consider antibiotic prophylaxis. This means prescribing antibiotics not just to treat an active infection, but to help prevent future ones. 

Research shows that this approach can reduce the risk of recurrent UTIs. However, it’s important to approach prophylactic antibiotics thoughtfully, as they can carry potential risks, including the development of antibiotic resistance.

Other medical conditions that cause urinary symptoms

When it comes to urinary symptoms like painful urination, frequent trips to the bathroom, or even blood in your urine, UTIs are often the first thing that comes to mind. But it’s good to know that there are other conditions that can cause these symptoms, especially if they keep coming back.

Some of these include:

• Sexually Transmitted Infections (STIs)
• Interstitial cystitis (which is inflammation or irritation of the bladder wall)
• Urethral syndrome (irritation of the urethra)
• Vaginitis (inflammation of the vagina)
• Benign Prostatic Hyperplasia (enlarged prostate)
• Endometriosis
• Stones in the urinary tract
• Certain skin conditions
• Some cancers
• Trauma
• Certain medications (like cyclophosphamide or ketamine)

Experiencing urinary symptoms is pretty common, and most people will face them at least once in their lives. While UTIs are the usual culprit, if your symptoms keep coming back or just won’t go away, it’s important to take that seriously. Recurrent UTIs can pose significant health concerns, but the good news is that with the right diagnosis and treatment, most people recover fully without any long-term issues.

If you’re struggling to find an appointment with your family doctor, there are options. A membership on Maple allows you to speak with a primary care provider, like a doctor or nurse practitioner, 24/7/365 over secure text, audio, or video call in minutes. Primary care providers on Maple can talk to you about any symptoms you may have, offer advice on having safe sex or talking to a partner about STI testing, and help you find a place to go for testing.

Whether it’s through lifestyle changes, preventive measures, or appropriate medical treatment, there are ways to manage and reduce the risk of UTIs. Don’t hesitate to seek help, especially if your symptoms persist or worsen.

The information presented here is for educational purposes and is not meant to replace the advice from your medical professional. Virtual care is not meant for medical emergencies. If you are experiencing an emergency like chest pain or difficulties breathing, for example, please call 911 or go to your nearest emergency room.