How to tell if UTI is new or recurring

Dear Dr. Roach: I have a problem with chronic urine infections. I am 78 years old. I go to the bathroom five or six times during the night and feel pressure under my stomach. My doctor suggested a biopsy and found blood in my urine, which was later tested for cancer. I was told a week later that I do not have cancer.

My doctor is aware I cannot take antibiotics because I get side effects. He gave me Monurol. I still get recurrences of pressure, burning with urination and a burning sensation in my vaginal area. How can I treat this? — W.W.

Dear W.W.: Recurring symptoms of urine infections can come from a series of new infections or a single infection that is partially treated and then comes back. The doctor can settle this by getting cultures of the urine to see what bacteria are growing. If it’s the same strain, that is likely a persistent infection.

If it is recurring new infections, the bacteria are having an easy time getting into the bladder. Some women have this issue with sexual activity, but in a 78-year-old woman, one common reason is lower estrogen levels lead to thinning of the lining of the vagina and vulva. If this lining is thin, bacteria can get in through the urethra. It is normally treated by vaginal estrogen cream.

Persistent infections lead the doctor to suspect an abnormality in the kidney, bladder or ureters. A stone is a common source of infection, and would explain the blood.

Fosfomycin is a good choice for urine infections in people with multiple allergies or sensitivities. But chronic antibiotic use is a last resort. If your doctor hasn’t done a thorough job of investigating the possibilities, I would recommend consultation with a urogynecologist.