Recurrent UTI’s? Why they keep coming back and what to do about it

Updated: Apr 5

One condition that I see frequently in the office is recurrent urinary tract infections (UTI’s), leading to far too many rounds of antibiotics. For women, it is not uncommon to get an occasional urinary tract infection, especially with a new sexual partner, occasional dehydration or being run down. If caught early, these infections can usually be treated naturally with excellent response.

What can happen and does happen quite frequently, is that the urinary tract infection comes back 1-2 months later with the same symptoms, and sometimes comes back repeatedly every couple of months.

Why does this happen?

Several theories include:

1. Antibiotic resistance of bacteria

The development of antibiotic resistance of bacteria is certainly not news, but women are often surprised when it is happening to them. E. coli, the main strain of bacteria responsible for urinary tract infections can be difficult to treat, and in an estimated 10% of time these bacteria display antibiotic resistance (1)(2). For example, from 2000 to 2010, the proportion of UTI’s resistant to the antibiotic Cipro went from 3 percent to 17.1 percent (3).

Researchers suspect that these extremely antibiotic resistant strains are coming from our food source, as their resistance patterns are the same as those from meat animals given antibiotics (2,3). Frightening thought, and if you do eat meat regularly, a very good reason to choose high-quality, antibiotic-free meats.

2. The infection was not fully cleared with the first treatment, meaning some pathogenic bacteria remain

In some cases, the first treatment (either antibiotic or natural), was not long enough or strong enough to fully treat the overgrowth of bacteria, and a small amount will remain in the bladder. This can flare-up again later if the immune system becomes run down. Another reason for bacteria remaining can have to do with incomplete voiding of the bladder. If you are holding your urine, rushing bathroom breaks, or more commonly have a pregnant uterus, or uterine fibroid pushing on the bladder, it can prevent you from fully voiding and create an environment for bacteria to grow.

3. Biofilm formation by the bacteria

Biofilms are an accumulation of microorganisms and their extracellular products that attach to a surface, such as the lining of the urogenital tract. They very simply make the infections more difficult to treat, and are estimated to be up to 1000 times more resistant to antibiotics than the bacteria alone (3). The presence of a biofilm is highly suspected in recurrent UTI’s, and this needs to be addressed in the treatment plan, not simply increasing the antibiotics or natural antibacterial treatment. There are some natural substances that tackle biofilms, and there is ongoing research in this area too (4).

4. Tension in the pelvic floor

A lesser-known cause of recurrent UTI’s is related to a tight pelvic floor, which can cause the bladder not to empty properly, so it can get infected and cause a repeated cycle. This tension can build up in response to many things – endometriosis, bowel issues, chronic stress, or improper use of the pelvic floor muscles after childbirth. The best treatment for tight pelvic floor muscles is to work with a Pelvic Health Physiotherapist who can assess, and provide treatment for this condition.

5. Damp-heat pattern in traditional Chinese medicine

The most common pattern of imbalance causing urinary tract infections is called “Damp Heat”. From a Chinese perspective, damp heat accumulation can arise due to consumption of hot and spicy foods, excess alcohol, meals high in fats and sweets, illness, aging, menopause, emotional stress, lack of hygiene, sexual intercourse during menstruation, or even direct attack by microorganisms like bacteria. The symptoms of are also similar to UTI infections: thick yellow-whitish coating on the tongue, rapid pulse, pain in back and lower abdomen, frequent desire to urinate but not producing much urine, alternating cycles of fever and chills, and bitter taste in the mouth. When an overall symptom picture matches from a Chinese Medicine perspective, it will often respond very well when treated with acupuncture and Chinese herbs.

If you are not treating the cause of the recurrent infections, they will just keep coming… and the types and doses of antibiotics continue to increase. If you or someone you know is dealing with this painful, disruptive condition please share this article.


  1. Bryce A et al. Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: Systematic review and meta-analysis. BMJ 2016 Mar 15; 352:i939.



  4. Tenke P, Koves B, Nagy K, Uehara S, Kumon S. “Clinical Management of Complicated Urinary Tract Infection”, book edited by Ahmad Nikibakhsh, September 6, 2011.

  5. Soto SM. Importance of Biofilms in Urinary Tract Infections: new therapeutic approaches. Advances in Biology. 2014

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