Not all recurring UTI symptoms in women are caused by bladder infections, study finds

Not all recurring UTI symptoms in women are caused by bladder infections, study finds - Urinary tract infections disproportionately affect women. (Photo: File)

A urinary tract infection occurs when bacteria enter and multiply in the urinary system, which includes the bladder and the tubes that carry urine out of the body.

For women who repeatedly experience a burning sensation when passing urine, frequent trips to the toilet and discomfort in the lower abdomen, antibiotics may seem like the only solution. But when symptoms keep returning despite treatment, the problem may not always be a urinary tract infection (UTI).

New research suggests that hormonal changes and problems with the muscles around the bladder may cause symptoms that are often mistaken for recurrent UTIs, leaving some women trapped in a cycle of medication and temporary relief.

The study examined 253 women diagnosed with recurrent UTIs. Researchers found that only 15 per cent had evidence of problems limited to the bladder or urinary tract. The remaining 85 per cent showed signs of inflammation around the vulva linked to hormonal changes, while 75 per cent had pelvic floor dysfunction.

A urinary tract infection occurs when bacteria enter and multiply in the urinary system, which includes the bladder and the tubes that carry urine out of the body. Symptoms commonly include pain or burning when urinating, frequent urination, a strong urge to use the toilet and discomfort in the lower abdomen.

A recurrent UTI is generally defined as having at least two infections within six months or three within a year. For some women, repeated episodes mean taking antibiotics several times, only for the symptoms to return weeks or months later.

However, similar symptoms can develop even when a bacterial infection is not the cause. When treatment fails to provide lasting relief, doctors may need to investigate other conditions rather than automatically prescribing another course of antibiotics.

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One possible cause is genitourinary syndrome of menopause (GSM), a condition linked to declining levels of oestrogen during menopause. Oestrogen helps maintain healthy tissues around the vagina, vulva and urinary tract. As hormone levels fall, these tissues can become thinner, drier and more sensitive.

The resulting irritation can cause burning, discomfort, frequent urination and a sudden urge to use the toilet. These symptoms can resemble a UTI, making it difficult for women to determine the cause without proper assessment.

“Hormonal changes can also affect the protective bacteria in the vaginal area, increasing the risk of genuine urinary infections. This means a woman may experience hormone-related symptoms and bacterial UTIs at different times or even have both conditions,” the researchers said.

Another possible cause is pelvic floor dysfunction. The pelvic floor muscles support organs such as the bladder and help control urination. When these muscles become too tight or fail to relax properly, they can cause pelvic pain, urinary urgency and difficulty emptying the bladder.

In some women, incomplete bladder emptying may increase the risk of infection. In others, muscle tension can cause symptoms similar to those of a UTI even when no bacterial infection is present.

The distinction matters because the treatments are different. Antibiotics can treat bacterial infections, but they will not resolve hormone-related irritation or relax tight pelvic floor muscles. Unnecessary antibiotic use can also contribute to antimicrobial resistance, making infections harder to treat when they do occur.

Women whose symptoms keep returning should speak to a healthcare professional about further assessment. Depending on their symptoms and medical history, a clinician may recommend urine testing, an examination for other possible causes, or a referral to a urologist, gynaecologist or pelvic health specialist.

Treatment may include pelvic floor physiotherapy for muscle-related problems or vaginal oestrogen for suitable women experiencing menopause-related symptoms. Drinking enough water and avoiding holding urine for long periods may help reduce the risk of some infections, but these measures will not treat every cause of urinary discomfort.

The study does not mean that most recurrent UTIs are misdiagnosed in every population. Its findings are based on 253 women and should not be taken as a measure of how often misdiagnosis occurs among all women. Instead, they highlight the importance of considering other explanations when symptoms persist or return despite treatment.

Women should not stop prescribed antibiotics or assume that their symptoms are hormonal without medical advice. Fever, chills, pain in the back or side, vomiting or feeling seriously unwell alongside urinary symptoms may indicate a more serious infection and require urgent medical attention.