From the Guidelines
The most common cause of recurrent Urinary Tract Infections (UTIs) in 40-year-old females is bacterial colonization from the gastrointestinal tract, particularly Escherichia coli (E. coli), which can migrate from the rectal area to the urethra due to the female anatomy's shorter urethral length. This is supported by the European Association of Urology guidelines on urological infections, which state that E. coli is the most common organism causing UTIs 1.
Risk Factors
Some key risk factors for recurrent UTIs in this population include:
- Sexual activity, which can introduce bacteria into the urinary tract
- Incomplete bladder emptying
- Hormonal changes approaching perimenopause
- Genetic factors affecting bacterial adherence to urinary tract cells
Prevention Strategies
For prevention, women should:
- Urinate before and after intercourse
- Wipe from front to back after using the toilet
- Stay well-hydrated
- Avoid irritating feminine products
- Consider using vaginal estrogen cream, especially postmenopausal women, to improve urogenital tissue integrity 1
- Consider using cranberry products, although the evidence is low and contradictory, to prevent bacterial adherence to the urinary tract lining 1
Treatment Options
In cases of recurrent UTIs, defined as 2+ infections in 6 months or 3+ in a year, prophylactic antibiotics might be prescribed, such as:
- Low-dose nitrofurantoin (50-100mg) or trimethoprim-sulfamethoxazole (40/200mg) daily or post-intercourse
- Methenamine hippurate to reduce recurrent UTI episodes in women without abnormalities of the urinary tract 1
- Continuous or postcoital antimicrobial prophylaxis to prevent recurrent UTI when non-antimicrobial interventions have failed 1