For anyone who has experienced a urinary tract infection, the burning, urgency and discomfort can be difficult enough to deal with once. But for women who experience recurrent UTIs, preventing the next infection can become a constant concern.

Recurrent UTI is generally defined as two or more infections within six months, or three or more within a year.

While antibiotics remain an important part of treating bacterial UTIs, research is increasingly looking at ways to reduce recurrence and avoid unnecessary antibiotic use. Here are seven strategies with evidence behind them.

1. Drink more water

One of the simplest strategies may also be one of the most accessible. A randomised controlled trial found that women who regularly drank less than 1.5 litres of fluid a day and increased their intake by about 1.5 litres experienced fewer recurrent cystitis episodes and used fewer antibiotics over 12 months.

The European Association of Urology recommends discussing increased fluid intake with premenopausal women who experience recurrent cystitis, particularly those who have a low daily fluid intake.

This does not mean forcing yourself to drink excessive amounts of water. The evidence is particularly relevant to women who do not drink much to begin with.

2. Consider cranberry products

Cranberry has long been associated with UTI prevention, and there is now substantial research behind the idea.

A 2023 Cochrane review analysed 50 randomised controlled trials involving 8,857 people. Among women with recurrent UTIs, cranberry products reduced the risk of symptomatic, culture-confirmed UTIs compared with placebo or no treatment. The analysis of eight studies involving 1,555 women found a relative risk of 0.74.

Cranberries contain proanthocyanidins, compounds thought to make it more difficult for certain bacteria, particularly E. coli, to attach to the urinary tract.

However, researchers have not established one universally effective dose or product, so cranberry should be viewed as a prevention option rather than a treatment for an active infection.

3. If you are postmenopausal, talk to your doctor about vaginal oestrogen

Recurrent UTIs can become more common after menopause because declining oestrogen can change the vaginal and urinary environment.

Vaginal oestrogen, which may be prescribed as a cream, pessary, insert or ring depending on the product, can help restore the local tissues and vaginal flora.

The European Association of Urology strongly recommends vaginal oestrogen replacement for postmenopausal women to help prevent recurrent UTIs. The American Urological Association also recommends vaginal oestrogen for peri- and postmenopausal women with recurrent UTIs when there is no contraindication.

This is different from taking systemic hormone replacement therapy and should be discussed with a healthcare professional.

4. Ask about methenamine hippurate

For women who experience recurrent UTIs and want to reduce their reliance on antibiotics, methenamine hippurate is an option worth discussing with a doctor.

The ALTAR randomised controlled trial, published in the BMJ in 2022, compared methenamine hippurate with daily low-dose antibiotic prophylaxis in women with recurrent UTIs. The study found that methenamine was not inferior to daily antibiotic prophylaxis within the trial’s predefined margin.

The European Association of Urology now recommends methenamine hippurate as an option for preventing recurrent cystitis in women without abnormalities of the urinary tract.

It is not suitable for everyone, so it should be used under medical guidance.

5. Do not routinely delay urination

The bladder is designed to store urine, but regularly holding urine for long periods is generally discouraged, particularly for people who already experience recurrent urinary symptoms.

Guidelines advise women with recurrent cystitis to avoid habitual and post-coital delayed urination. However, it is important to distinguish this advice from stronger evidence-based interventions, because the research supporting behavioural measures such as not delaying urination is relatively limited.

In other words, it is a sensible habit, but it should not be presented as a guaranteed way to prevent UTIs.

6. Be cautious about relying on probiotics alone

Probiotics are often marketed as a solution for recurrent UTIs, particularly products containing Lactobacillus strains.

There is some promising evidence. Certain strains have been studied for their ability to restore or support the vaginal microbiome, and the European Association of Urology says probiotics containing specific strains may help prevent recurrent cystitis.

But the evidence is not yet consistent enough to say that every probiotic supplement will prevent UTIs.

A 2026 overview of systematic reviews found that the evidence for probiotics remains less certain than that for cranberry, methenamine and vaginal oestrogen.

If you are considering probiotics, look at the specific strains rather than simply choosing a product labelled “for urinary health”.

7. Get recurrent infections properly diagnosed

Perhaps the most important strategy is making sure a recurrent UTI really is a recurrent UTI.

Burning, urgency and frequent urination can have several causes, and repeatedly treating symptoms without confirming the infection can lead to unnecessary antibiotic use.

The European Association of Urology recommends diagnosing recurrent cystitis using urine culture.

Keeping a record of symptoms, treatments and confirmed infections can also help your healthcare provider identify patterns and decide whether prevention is appropriate.

For some women, particularly those whose UTIs are linked to sexual activity, post-coital antibiotic prophylaxis may be considered. Continuous low-dose antibiotic prophylaxis is another option when non-antibiotic approaches have not worked. Both approaches are supported by guidelines, but they require medical supervision because of potential side effects and antibiotic resistance.

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