Obstetrics and Gynecology

Chronic Urinary Tract Infections

A chronic urinary tract infection is a repeated or prolonged bacterial infection of the bladder or urethra, the tube that carries urine from the bladder out of the body.

While urinary tract infections are common, some women suffer from repeated or recurrent infections (also known as a recurrent bladder infection, or cystitis).

Women suffering from chronic urinary tract infections may have:

  • Two or more infections in a 6-month period and/or 3 or more infections in a 12-month period
  • Symptoms that don't disappear within 24 to 48 hours after treatment begins
  • A urinary tract infection that lasts longer than 2 weeks

Chronic urinary tract infections can be a painful and frustrating disorder, but effective treatment is available.

What are the symptoms of chronic urinary tract infections?

Symptoms may include:

  • Urgent need to urinate
  • Frequent need to urinate
  • Pain or burning when urinating (known as dysuria)
  • Soreness in the lower abdomen, back or sides
  • Need to urinate at night
  • Urine that has a strong or foul odor, is cloudy, or tinged with blood

If the bacteria in the lower urinary tract (bladder and urethra) enter the ureters and spreads to the kidneys (upper urinary tract), additional symptoms may include:

  • Back pain
  • Nausea and vomiting
  • Chills
  • Fever
  • Fatigue
  • Mental changes or confusion, particularly in the elderly

Kidney infections are serious and require prompt treatment. If you have any of these symptoms, contact your doctor immediately.

What causes chronic urinary tract infections?

Possible causes include:

  • Bacteria from the rectum and vagina
  • Bacteria entering the urethra during sexual intercourse
  • Urinary tract problems
  • Problems emptying the bladder completely due to blockage, muscle or nerve problems
  • Kidney or bladder stones
  • Altered estrogen levels during menopause
  • Genetic predisposition

Women are at an increased risk of getting urinary tract infections if they:

  • Have had a UTI before
  • Have had several children
  • Have diabetes
  • Are obese
  • Have reached menopause
  • Have decreased mobility

Additional factors that can increase the risk of chronic infection are:

  • Young age at first UTI
  • Spermicide use
  • Diaphragm use
  • New sexual partner

How are chronic urinary tract infections diagnosed?

Prompt diagnosis is key to treating chronic urinary tract infections. Testing may be performed to help rule out other conditions. Diagnostic testing may include:

  • Urinalysis. To look for the presence of bacteria and red or white blood cells
  • Urine culture. To determine which bacteria are present and possibly test different antibiotics (sensitivity test)
  • Imaging. To view the health of the urinary tract (kidneys, ureters, bladder and urethra), including CT scan, ultrasound, and x-ray: a special dye is used in some cases to aid in imaging
  • Cystoscopy. Use of a scope to view inside the bladder and urethra and check for abnormalities

How are chronic urinary tract infections treated?

Chronic urinary tract infections are treated with antibiotics. Long-term, low-dose preventative antibiotics may be recommended after the symptoms of the infection have subsided.

How can I prevent chronic urinary tract infections?

Prevention strategies include:

  • Keep your genital area clean
  • Wipe from front to back after a bowel movement
  • Drink plenty of fluids, particularly water, to flush bacteria out of your urinary system
  • Urinate immediately after intercourse to help eliminate any bacteria
  • Use forms of birth control other than a diaphragm and spermicides
  • Avoid douches, powder, and deodorant sprays
  • Wear un-dyed, full cotton underwear

Other prevention measures being studied include drinking cranberry juice and, for women past menopause, the use of estrogen cream or pills.