Less commonly, the infection can travel to the kidneys causing an upper UTI or kidney infection (pyelonephritis). Recurrent UTIs are when you keep experiencing UTIs over a period of time, such as two UTIs in 6 months or three UTIs in a 12 month period.
Symptoms vary but can include burning or stinging when passing urine, needing to pass urine frequently and urgently but often in small amounts, lower tummy pain and cloudy or smelly urine. Kidney infections can cause fevers, severe abdominal or back pain, vomiting and feeling very unwell. Risk factors for UTIs include inadequate hydration, delaying urination, sexual activity, certain contraception (diaphragms and spermicides), use of urinary catheters and menopause.
How are UTIs diagnosed?
UTIs are typically diagnosed by sending a urine sample away to be looked at under a microscope and then ‘cultured’, where the urine is incubated to allow any bacteria to grow and multiply. It can be helpful to wait for the result before taking antibiotics to confirm that there is an infection present and also to determine which antibiotic is more likely to be effective. However, sometimes treatment may be given based on symptoms alone depending on the circumstances. Also, there can be some variability in the results and a bacteria may not always be grown even when an infection is present.
A healthcare professional may prescribe a course of antibiotics that are most likely to kill the bacteria. It is important to complete the course otherwise the risk of the infection remaining increases as well as the risk of the bacteria becoming resistant to the antibiotic. Type of antibiotic and duration of treatment depends on a number of factors including local prescribing guidelines, the individual affected by the UTI and what their symptoms are.
Why does menopause increase the risk of UTIs?
UTIs can occur in anyone but they are more prevalent in women, particularly during and following menopause. This is due to the fall in oestrogen levels in the body which causes thinning and fragility of the genital, urethral and bladder tissues. This can lead to a number of changes including a weakened pelvic floor, prolapse, incomplete bladder emptying and an altered microbiome. All of these changes increase the risk of bacterial growth and the development of UTIs. As well as UTIs, hormonal changes can cause other genital symptoms including vaginal dryness, discomfort or pain, discharge and pain during sex or smears. These symptoms can have a significant impact on day to day life as well as sexual activity.
“UTIs can occur in anyone but they are more prevalent in women, particularly during and following menopause”
How can recurrent UTIs be treated?
Recurrent UTIs can be painful, distressing and exhausting. If this is happening to you, seek medical advice as there are many things that can be done to manage them. It is important to consider what is causing the UTIs and how you might be able to help. Increasing water intake, passing urine at regular intervals and after sex, avoiding douching, wiping front to back and treating underlying conditions such as pelvic floor weakness and prolapse can all help.
Supplements
There is no strong evidence to support the use of certain supplements including over the counter cranberry products, D-Mannose or urine alkalising agents (such as potassium citrate, sodium citrate, or sodium bicarbonate) but some people feel that they help.
Local oestrogens
If a menopausal person is experiencing recurrent UTIs, it is recommended that local or topical oestrogens are used to improve the health of the genital and bladder tissues and the urogenital microbiome. They will also help vaginal dryness and discomfort, urinary frequency and urgency and can help with sexual enjoyment through improving the health and sensitivity of the genitals.
Local oestrogens come in a variety of options including creams, gels, pessaries and a ring. The most common products to use are a cream inserted with a syringe or a small pessary that is inserted with an applicator. A typical dose is nightly for two weeks then twice weekly as a maintenance dose. It can take up to three months to see the full effect on symptoms and prevent further UTIs.
When topical oestrogens are applied, only minimal amounts of oestrogen are absorbed into the body and this reduces further over time. This means that there is little risk of harm with no increased risk of blood clots, strokes or cancers. These treatments can be considered in certain circumstances even when patients have a history of breast cancer as research suggests that it does not have an impact on survival rates following breast cancer. Symptoms and UTIs are likely to return if local oestrogens are stopped and therefore, they can be used long term and many patients use them indefinitely.
If self-care measures and local oestrogens have not reduced the recurrent UTIs, other medications can be considered.
Post-coital antibiotics
If you find that your UTIs are triggered by sex then it may be an option to take a one-off dose of an antibiotic each time there is sexual activity. However, this may not be practical or effective if you have frequent sexual activity or forget to take the medication.
Hiprex (methenamine hippurate)
This oral medication is taken twice daily and rather than being an antibiotic, it works more like an antiseptic in the bladder. It makes the urine more acidic which helps stop bacteria from growing and preventing UTIs from developing.
Prophylactic antibiotics
This is when a dose of antibiotic is taken daily for a number of weeks or months with the aim of preventing UTIs from developing. Antibiotics have often been used to treat and prevent UTIs but guidelines have changed around their usage. The use of antibiotics either frequently or for long periods of time can increase the risk of antibiotic resistance which means that bacteria can survive the effect of antibiotics, making infections harder to treat. Additionally, antibiotics kill ‘good’ as well as ‘bad’ bacteria, disrupting the microbiome of the gut and vagina. This can lead to side effects such as nausea, diarrhoea, vaginal dryness and discomfort, thrush and bacterial vaginosis. There may also be longer term consequences to this. That is not to say that antibiotics should not be used as they can be very effective, but careful consideration is needed and other ways of preventing UTIs are recommended first.
If an underlying cause for the recurrent UTIs is suspected or you haven’t responded to treatment, you may be referred to a specialty such as Urology for further assessment and investigations. This may involve an ultrasound scan of the bladder and kidneys and a camera investigation into the bladder called a cystoscopy.
If you are experiencing recurrent UTIs or genital symptoms, it is important to contact your healthcare provider to discuss it further as there are many options to help.
Last updated April 2026.
