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Thread: Reoccurring UTIs

  1. #1

    Reoccurring UTIs

    Hi all!

    My SO is struggling with reoccurring UTIs and feeling very frustrated. He finished 10 days of antibiotics on Tuesday (again), and then had an appointment, his urine was tested and negative. Now it's Sunday and his urine is cloudy again. Since Tuesday he's been taking the following, which was recommended by someone on Reddit.

    D-Mannose (500mg tablet morning)
    Probiotic (Mixed tablet, morning)
    Methanamine (1g powder, night)
    Vitamin C (500 mg tablet night)

    We're thinking about adding cranberry onto that.

    He's avoiding caffiene, but might have two beers here and there. One thing I'm not so sure about is this leaf powder he's taking for pain sometimes, called 'kratom'. It's a diuretic. Could this be a concern, if it's overworking his kidneys?

    He's on Flomax, no other medications. I'll also add that he doesn't cath that often, he was able to void all at his urodynamics and the Urologist said to cath once in the night. When he starts getting a UTI though, he will only cath, since it makes it much harder to urinate. It seems to be his first symptom, having difficulty urinating.

    He uses an 'easy' catheter, a fresh one each time. The urine collection bag he uses again throughout the day, so replaces it each new day. He keeps this on the floor beside the table, even though I told him to keep it sterile. He's so stubborn! He uses fresh gloves each time, anti-septic spray, and cotton pads.

    He has a bottle of water with him generally that he sips on throughout the day.

    Does anyone have any advice, or see something he should change with his program? Thanks so much!
    Last edited by sweettangerine; 07-07-2019 at 05:49 AM.

  2. #2
    Quote Originally Posted by sweettangerine View Post
    Hi all!

    My SO is struggling with reoccurring UTIs and feeling very frustrated. He finished 10 days of antibiotics on Tuesday (again), and then had an appointment, his urine was tested and negative. Now it's Sunday and his urine is cloudy again. Since Tuesday he's been taking the following, which was recommended by someone on Reddit.

    D-Mannose (500mg tablet morning)
    Probiotic (Mixed tablet, morning)
    Methanamine (1g powder, night)
    Vitamin C (500 mg tablet night)

    We're thinking about adding cranberry onto that.

    He's avoiding caffiene, but might have two beers here and there. One thing I'm not so sure about is this leaf powder he's taking for pain sometimes, called 'kratom'. It's a diuretic. Could this be a concern, if it's overworking his kidneys?

    He's on Flomax, no other medications. I'll also add that he doesn't cath that often, he was able to void all at his urodynamics and the Urologist said to cath once in the night. When he starts getting a UTI though, he will only cath, since it makes it much harder to urinate. It seems to be his first symptom, having difficulty urinating.

    He uses an 'easy' catheter, a fresh one each time. The urine collection bag he uses again throughout the day, so replaces it each new day. He keeps this on the floor beside the table, even though I told him to keep it sterile. He's so stubborn! He uses fresh gloves each time, anti-septic spray, and cotton pads.

    He has a bottle of water with him generally that he sips on throughout the day.

    Does anyone have any advice, or see something he should change with his program? Thanks so much!
    What antibiotic did he take for the urinary tract infection? Did he have a culture and sensitivity (C&S) test of the urine to determine which antibiotic should be prescribed or did his doctor prescribe an antibiotic without a C&S?

  3. #3
    Senior Member
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    First, HE needs to be the one seeking advice because taking advice from you is a burden on your relationship. I know- I am married.

    yes, kratom can be problematic to liver and kidneys. It depends on the general condition of those organs plus how much a person uses the supplement. Lots of people swear by using cranberry but research shows it offers no protection.

    He should be keeping track of his water consumption to ensure he is drinking at least 3 quarts a day. This is the absolute most important prevention item. We ave to rink a lot to flush the bladder and kidneys of bacteria before it can accumulate. I set out 3 quarts in the morning so I know if I'm keeping up. This also makes it easier to pee naturally.

    lastly, I've moved to using herbal remedies from Traditional Chinese medicine. They have worked for me, though the cost is significant. I first found help using Akebia Moist Heat, but other possibilities can be explored with an acupuncturist who is a certified herbalist. The good thing about the herbal formulae is they seem not to allow antibiotic resistance. They include too many complex molecules for bacterial defense mechanisms to work against.

    It does get frustrating when antibiotics cease to work, but it's a wakeup call. Time to get very serious about survival.

  4. #4
    Senior Member Oddity's Avatar
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    My early SCI experience was quite similar. I was tested with Urodynamics and was told I voided completely, at relatively safe pressures, so only needed to cath before bed, ostensibly to avoid involuntary voiding while sleeping. This was right after injury, ~2 months out of rehab.

    Fast forward a year and a half, after spending most of that time chasing chronic UTIs, culminating in a resistant one that nearly took me, they repeated Urodynamics and Ultrasounds only to then discover I was NOT voiding completely, as they first had concluded. I was leaving ~25cc of urine behind without cathing. That amount was enough for bacteria to build up and cause my chronic infections.

    I started cathing almost exclusively, ~4-6 times during the waking day, once during the night most nights, as well as using a bladder flush routine one week per month. That kept me UTI free for the next 10 years. (I've since had 2 more, treated orally).

    I would consider discussing cathing more often with his Urologist as well as bladder irrigation (lots of threads here about this).
    "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

    "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

    "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

  5. #5
    Senior Member McDuff's Avatar
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    I had a "session" of 5-6 Uti's right in a row, finish the antibiotic(sourced by C&S), and boom it would be right back. Long story short, I had an infected kidney stone that wasn't getting cleared by the antibiotic, just kept at bay, as soon as no antibiotic it would start the uti clock again.

    They "blasted" the stone by going thru the urethra up into the kidney and lasered it apart and removed it. Boom! no more uti's.

    Something to discuss with your Urologist maybe...
    "a T10, who'd Rather be ridin'; than rollin'"

  6. #6
    Your bladder can change quite a bit in the first year after injury. At our center, we never did urodynamics for at least 3-6 months after injury since the long-term pattern of neurogenic bladder is rarely established that early. Given that sweettangerine's SO was injured in Feb. of this year, I suspect that his bladder is continuing to evolve.

    Regardless, rarely is reflex voiding chosen as the preferred bladder management method any more in the USA. This is because so many people with a reflex bladder void with very high pressures (which can increase risks for both UTIs and kidney damage long term), and often don't empty effectively, leaving behind a residual urine that harbors bacteria.

    I assume you mean he is reflex voiding and using a condom catheter? And straight cathing only once daily? If he can cath himself, doing intermittent cath 5-6X daily, with a new straight catheter each time, stopping the Flomax, and if necessary taking an anticholenergic medication to decrease bladder spasms and leakage between caths would generally be the preferred bladder management method.

    It is also important that what you call a UTI is actually what would be classified as a UTI in someone with a SCI/D. Colonization, which is a positive urine culture without significant symptoms (fever, chills, flank pain, AD, severe urine leakage, severe malaise) should generally not be considered a UTI, and not treated with antibiotics. Many people with SCI/D are chronically colonized. Antibiotics should be reserved for use with a true UTI, and then used as appropriate for a complex UTI, meaning 10-14 days of use of an oral antibiotic chosen on the basis of a urine C&S (culture and sensitivity).

    Other causes of UTIs such as urinary stones or prostatitis can be a factor in people with SCI/D, but rarely this early post-injury, but should be ruled out by urinary ultrasound and a rectal prostatic exam and PSA test.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  7. #7
    Thanks so much for the reply and info. His injury was April 2nd, and the bladder issue is retention. L1 incomplete. He doesn't have reflex voiding, he's voiding on his own.. BUT by pushing on his abdomen. The Urologist he had seen recently told him it was okay as long as he isn't pushing 'too hard', and put him on Tamsulosin. He had under 25ml residual. He had seen a GD about the last UTI, and he didn't do a culture test, and the antibiotic was Ofloxacin, for 10 days. His urine has now cleared up actually, so maybe he doesn't need more. He's going to go back to the Urologist next time if having any symptoms, as the GD probably isn't exactly the right person for this. The GD is public (free), the Urologist private (paid). He doesn't leak any urine at all (at the moment), so no condom cath and the Uro. said he won't put him on any bladder spasm meds. He also told him to come back for another urodynamics in about 3 months. Oh, and he also has had a renal ultrasound done.
    Last edited by sweettangerine; 07-08-2019 at 11:45 AM.

  8. #8
    He is not voiding on his own. He has an areflexive bladder (most probably) and is pushing urine out with Crede's maneuver and/or Valsalva (straining), which is frowned upon now days because it can cause reflux (backflow) of urine up the ureters toward the kidneys, and rarely fully empties the bladder. Keep in mind that his bladder may change after he is fully out of spinal shock (6 months post injury).

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  9. #9
    Okay thanks! I looked at his urology sheet, he does have 'areflexia detrusor'. Although, he can feel when he needs to empty.

    Is it possible to have neuropathic pain in his penis and anus? He feels a strange burning sensation there sometimes, but was tested negative for an infection yesterday. He has this pain nowhere else.
    Last edited by sweettangerine; 07-11-2019 at 08:07 AM.

  10. #10
    Unfortunately, yes. Neuropathic pain in the "saddle"area is common in lumbar SCI. Is he taking medication specifically for neuropathic pain such as gabapentin?

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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