The classic symptoms of a urinary tract infection (UTI) are pain with urination, increased frequency, and increased urgency to urinate, says Virtua urogynecologist Joseph Maccarone, MD. And many women will experience a UTI at some point in their lives. But is that all we need to know about these infections? As it turns out, no. If you’re among the smaller group of women that find UTIs especially troublesome or frequent, keep reading.

Are you sure it’s an infection?

This may seem like a simple question, but if the answer is no, then you need to head to the doctor’s office as opposed to just requesting a prescription over the phone. A urinary tract infection is caused by a bacteria that’s not supposed to be in the urinary tract (usually E. coli), which generally finds its way there through sexual contact. It is, however, still possible to get a UTI in the absence of sexual activity, and this is especially more likely as women age, because the hormonal shift of perimenopause causes a change in the pH level inside the vagina. When the vagina becomes less acidic, there’s less ‘good bacteria’ to fight off the ‘bad bacteria.’

What complicates the matter is that the symptoms of a UTI and the symptoms for another common condition called interstitial cystitis (IC) are identical. “The only way to know for sure that you have a true infection is to have your urine tested,” says Dr. Maccarone. “Interstitial cystitis is what we call an abacterial infection, meaning there are no bacteria to blame for the infection-like symptoms. In that case, an antibiotic will not relieve your symptoms.”

Are you experiencing frequent repeat infections?

If yes, you’ll want to return to your doctor to discuss why this is happening and what you can do about it. There are a couple of reasons for repeat infections.

• If you’re an older woman, the hormonal imbalance described above could be the culprit. “In that case, we can talk about starting a topical hormone treatment, which can be very effective in preventing future infections,” says Dr. Maccarone. Oral probiotics or even plain yogurt applied intravaginally have also helped many women.

• Your anatomy might be to blame. The distance between the anus and the urethra is the distance the ‘bad bacteria’ needs to travel to cause a UTI. Because every woman’s body is unique, in some women this distance is shorter than in others, increasing the likelihood of repeat UTIs. “For these women, we might have to use an antibiotic as a prophylactic (preventive measure),” says Dr. Maccarone. “This may mean a regular once-a-day dose, or, if sexual contact is to blame, a dose with every instance of intercourse.”

Have you had surgery?

“Anyone with a history of surgery or hospitalization needs to be evaluated differently when presenting with UTI symptoms,” says Dr. Maccarone. “For example, if you’ve had bladder surgery, or a hysterectomy, or a sling procedure, if you’ve been hospitalized with a catheter, these are special considerations that your doctor needs to know about.”