Chronic urinary tract infections (UTIs) are infections of the urinary tract that do not respond to treatment. They may either continue to affect your urinary tract despite getting the right treatment, or may recur after treatment.
Your urinary tract is the pathway that makes up your urinary system. It includes your:
- kidneys: the organs that filter your blood and generate body waste in the form of urine
- ureters: tubes that carry urine from the kidney to the bladder
- bladder: the organ that collects and stores urine
- urethra: the tube that carries urine from the bladder to the outside of your body
A UTI can affect any part of your urinary system. When an infection is limited to your bladder, it is usually just an annoyance. However, if it spreads to your kidneys, you may suffer from serious health consequences.
Although UTIs can happen to anyone at any age, they are more prevalent in women. In fact, the National Kidney and Urologic Diseases Information Clearinghouse estimates that one in five young adult women suffer from recurring UTIs (NKUDIC).
UTIs are caused by a bacterial infection. In most cases of UTIs, the bacteria enter the urinary system through the urethra, and then multiply in the bladder. To understand how UTIs develop, it is helpful to break them down into two groups: bladder infections and urethral infections.
Infections of the bladder (also known as “cystitis”) are almost always caused by the bacteria Escherichia coli (E. coli). E. coli is a type of bacteria that normally lives in the intestines of healthy people and animals. In its normal state, it doesn’t cause any problems. However, if it finds its way out of the intestines and into the urinary tract, it can lead to infection.
This usually happens when tiny—even microscopic—bits of feces get into the urinary tract. This might happen during sex—for example, if you switch between anal and vaginal sex without cleaning in between. Anal sex increases your UTI risk significantly. But bladder infections can also develop from toilet water backsplash or by improper wiping.
Also called “urethritis,” infections of the urethra could be causes by bacteria such as E. coli, but can also be caused by a sexually transmitted infection such as herpes, gonorrhea, or chlamydia. STIs rarely cause bladder infections.
Chronic urinary tract infections are most common in women. This is due to two different aspects of basic human anatomy: first, the urethra is close to the rectum in women. As a result, it is extremely easy for bacteria from the rectum to reach the urethra—particularly if you wipe back to front instead of front to back. This is why young girls often get UTIs—they haven’t mastered the art of wiping just yet.
Second, in women, the urethra is shorter than men. So bacteria have a shorter distance to travel to get to the bladder, where they can multiply and more readily cause infection.
There are other lifestyle factors that can put you at extra risk of developing a chronic UTI. For example, using a diaphragm during sex can cause problems. Diaphragms push up against the urethra, making it harder to fully empty your bladder. The urine that is not fully emptied is more likely to grow bacteria. Another example is constantly changing the bacterial makeup of the vagina. If you regularly use antibacterial vaginal douches, spermicides, and certain oral antibiotics, you basically are changing your vaginal bacteria regularly. This can increase your risk of developing a chronic UTI.
Menopause can cause similar problems in some women. Menopause causes hormone changes that in turn can cause changes in your vaginal bacteria. This can increase your risk for chronic UTIs.
Symptoms of a UTI that is affecting your bladder include:
- frequent urination
- bloody or dark urine
- burning sensation while urinating
- pain in your kidneys (in your lower back or below the ribs)
- If the UTI spreads to your kidneys, it might cause:
- nausea and vomiting
- mental disorientation
If you have a chronic UTI, chances are that you have already been diagnosed with a UTI in the past.
UTIs are most commonly diagnosed through a lab test performed on a urine sample. A medical professional will examine the sample through a microscope , and will look to see if there is any bacteria in the urine .
In a urine culture test, a urine sample is placed in a tube to encourage the growth of bacteria. After one to three days, the bacteria will be looked at to determine the best treatment measure.
If your doctor suspects kidney damage, he or she may order X -rays and kidney scans. These are imaging devices that take pictures of parts of your body.
If you do have recurring UTIs, your doctor may want to perform a cystoscopy. In this procedure, he or she will use a cytoscope—a long, thin tube with a lens at the end—to look inside your urethra and bladder. Your doctor will be looking for any abnormalities or issues that could be causing the UTI to keep coming back.
UTIs are treated with antibiotics over the course of one week .
However, if you have chronic UTIs, y our doctor will likely prescribe long-term, low-dose antibiotics for more than one week after the initial symptoms subside. In many cases, this helps prevent symptoms from recurring . Your doctor may also recommend a course of treatment where you take antibiotics anytime after intercourse.
In addition to antibiotics, your doctor will want you to more closely monitor your urinary system. For example, he or she may ask that you perform regular home urine tests to check for infections.
If your chronic UTIs are related to menopause, you may want to consider vaginal estrogen therapy. This can limit your risk for future UTIs, although it does have some tradeoffs. Be sure to discuss it with your doctor.
Some studies have shown that drinking cranberry juice daily can help minimize recurrences among those who have chronic UTIs (Mayo Clinic, 2012). More research needs to be done, but if you enjoy the taste, it can’t hurt (unless you are on blood-thinning drugs—in which case, talk to your doctor first).
While infected, you may experience burning while urinating. Your doctor may prescribe pain medication to numb your bladder and urethra so it doesn’t burn as much. You may also want to try placing a heating pad or hot water bottle on your bladder to ease any pain.
If you are susceptible to recurring UTIs, you should be sure to:
- urinate as often as needed ( especially after intercourse). Don’t ever hold your urine!
- wipe front to back after urinating
- drink plenty of water (to flush bacteria out of your system)
- wear cotton underwear
- avoid tight-fitting pants
- avoid diaphragms and spermicides as birth control methods
- use lubrication during sex, if necessary
- avoid bubble baths
- wash sexual partner's penis foreskin regularly, if uncircumcised
People who suffer from chronic UTIs are at risk of experiencing complications. Recurring urinary tract infections may eventually cause:
- kidney infections, kidney disease, and other permanent kidney damage, especially in young children
- sepsis, a life-threatening complication due to infection
- septicemia ( a condition in which bacteria enter the bloodstream)
- increased risk of premature delivery or babies with low birth weight
Urinary tract infections are uncomfortable and painful. However, symptoms usually go away with treatment. Patients should monitor their bodies and seek immediate treatment with the onset of a new infection. Treating infections early decreases your risk for more serious complications in the long- run.