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The question: I'm a 28-year-old woman and I've had four urinary tract infections in the past year. Why does this keep happening to me and what can I do?

The answer: You're not alone in your struggle with urinary tract infections (UTIs). An estimated 50 per cent of women will experience a UTI at some point in their lifetime. For those who have had one, the risk of having another rises with each additional infection. The reassuring news, however, is that by being aware and making some small changes, you can prevent UTIs.

The urinary tract includes the urethra, bladder, ureters and kidneys. Infections typically occur if bacteria enters the urinary tract through the urethra and into the bladder. Most UTIs occur in the lower part of the tract, but in more serious cases they can migrate up to the ureters and kidneys.

Classic signs of a UTI can include:

  • a strong urge to urinate
  • passing frequent, small amounts of urine
  • lower abdomen pain
  • blood in urine.

If the infection spreads up from the bladder to the kidneys, these symptoms can be accompanied by fever, chills, back pain and nausea.

The cells lining the urinary tract have natural defences to protect against bacteria, but when they weaken or break down, an infection can occur. Defenses can decrease due to any irritation or injury to the cells in the urethra or vagina from activities such as sexual intercourse, douching or use of irritants such as those found in spermicides. The thinning of tissues in the urinary tract in women after menopause can weaken the barrier of defence and increase UTI risk as well.

Another risk occurs when bacteria remains in the urinary tract for long periods of time, which causes them to multiple. This can occur from any obstruction of the tract that blocks the flow of urine out of the body - kidney or bladder stones, anatomical abnormalities in the urinary tract, ineffective muscles in the bladder, and in men an enlarged prostate. Not drinking enough water to allow the body to flush out the bacteria can also lead to an increased risk of infection.

It is important to understand that being female is a risk factor in itself for UTIs. The key reason is that women have a shorter urethra than men, which cuts down on the distance bacteria must travel to reach the bladder.

Fortunately, most UTIs are not serious and are easily treated. If you have symptoms, start drinking more liquids to flush out the bacteria and call your doctor. He or she may be able to prescribe antibiotics to rid yourself of the infection quickly and safely.

Recurrent UTIs are defined as more than two documented infections in six months or three in a year. As you are having more than this number, I would recommend that you check in with your doctor. He or she may choose to do some simple urine tests and some imaging of the kidneys, ureters and bladder to ensure that there is no anatomical abnormality.

If you have recurrent infections, consider taking the following precautions to prevent UTIs:

  • drink plenty of water to flush out the system
  • urinate when the need arises (don’t resist the urge)
  • urinate after sex to flush any bacteria that may have entered during sex
  • if you use diaphragms or spermicides for birth control, consider a different form as these can block drainage of urine and cause irritation to tissue
  • wipe from front to back to prevent bacteria from getting into the urethra.

If these techniques don't work, your doctor may consider prescribing a small dose of antibiotic to take daily to prevent recurrence. If you notice that the UTIs occur after having sex, a small dose taken after intercourse can also help prevent an infection from setting in.

Send family doctor Sheila Wijayasinghe your questions at She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.

The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.