Q. I have diabetes, and I suffer from chronic urinary tract infections. The antibiotics just don’t seem to help. Could these infections be related to my diabetes? Is there any treatment that would be effective?
A. A urinary tract infection (UTI) is usually caused by bacteria and can occur anywhere in the urinary tract, which includes the kidneys, bladder, ureters, urethra, and, in men, the prostate gland. Most UTIs occur in the bladder, however, the organ that stores urine.
Women are 10 times more likely to get a UTI than men. It’s estimated that more than 50% of women will have a UTI at some point in their lives, and about 25% of women have recurrent UTIs. Women with Type 2 diabetes may have an even higher risk, according to two recent studies. In one study, 9% of the subjects with diabetes had UTIs compared to 6% of those without diabetes. And the second study showed that the people with diabetes had a 60% higher risk of getting a UTI compared to those without diabetes.
Why are people with diabetes more prone to UTIs? There are likely several reasons. First, people with diabetes may have poor circulation, which reduces the ability of white blood cells to travel in the body and fight off any kind of infection. Second, high blood glucose levels can also raise the risk of a UTI. And third, some people with diabetes have bladders that don’t empty as well as they should. As a result, urine stays in the bladder too long and becomes a breeding ground for bacteria.
As far as recurrent or chronic UTIs go, there are several possible explanations, ranging from bladder or kidney stones; changes in estrogen levels due to menopause; bacteria entering the urethra from sexual intercourse; bacteria that thrive in the urinary tract; the use of a diaphragm, spermicides, or douches; and even a genetic predisposition to having UTIs (meaning, they can run in the family!). In addition to these factors, uncontrolled blood glucose levels may contribute to recurrent UTIs.
Your doctor needs to determine the underlying cause of your UTIs. This usually involves providing a urine sample to check for bacteria, and may include a CT scan of the urinary tract and/or a cystoscopy, which allows the doctor to look inside your urethra and bladder.
Treatment of recurrent UTIs often involves taking a long-term (anywhere from six months to two years) course of low-dose antibiotics. Alternatively, your doctor may recommend that you take antibiotics after having intercourse or right when you start to get UTI symptoms. If you are postmenopausal, you may benefit from vaginal estrogen therapy.
You can also take measures on your own to help prevent UTIs: Try to keep blood glucose levels within your target range; drink plenty of water; consider drinking pure cranberry juice or taking cranberry supplements; eat yogurt, which contains good bacteria called probiotics (or talk to your doctor about taking a probiotic supplement Lactobacillus rhamnosus or Lactobacillus reuteri); wear cotton underwear; urinate after intercourse; wipe from front to back after using the toilet; urinate when you have to go rather than “holding” it; and if you use birth control, talk to your provider about methods other than a diaphragm or spermicides.
Want to learn more about diabetes and urinary tract health? Read “What Is Your Urine Trying to Tell You?” “Diabetes and Your Bladder,” “What You Need to Know About UTIs,” and “Resolving Diabetes-Related Bladder Problems.”