Chronic urinary tract infections (UTIs) are infections of the urinary tract that either don’t respond to treatment or keep recurring. They may either continue to affect your urinary tract despite getting the right treatment, or they may recur after treatment.
Your urinary tract is the pathway that makes up your urinary system. It includes the following:
- Your kidneys are the organs that filter your blood and generate body waste in the form of urine.
- Your ureters are the tubes that carry urine from the kidney to the bladder.
- Your bladder is the organ that collects and stores urine.
- Your urethra is 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 only affects your bladder, it’s usually a minor illness that can be easily treated. However, if it spreads to your kidneys, you may suffer from serious health consequences and may even need to be hospitalized.
Although UTIs can happen to anyone at any age, they’re more prevalent in women. In fact, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) estimates that one in five young adult women have recurring UTIs.
The symptoms of a chronic UTI affecting your bladder include:
- frequent urination
- bloody or dark urine
- a burning sensation while urinating
- pain in your kidneys, which means in your lower back or below the ribs
- pain in your bladder region
If the UTI spreads to your kidneys, it might cause:
- a high fever (over 101°F)
- mental disorientation
A UTI is the result of a bacterial infection. In most cases, the bacteria enter the urinary system through the urethra, and then they multiply in the bladder. It’s helpful to break down UTIs into bladder and urethral infections to better understand how they develop.
The bacteria Escherichia coli almost always cause infections of the bladder, or cystitis. E. coli is a type of bacteria that normally live 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 or even microscopic bits of feces get into the urinary tract. This might happen during sex. For example, this can happen if you switch between anal and vaginal sex without cleaning in between. Anal sex increases your UTI risk significantly. Bladder infections can also develop from toilet water backsplash or by improper wiping.
Also known as urethritis, infections of the urethra could be due to bacteria such as E. coli, but can also be the result of a sexually transmitted infection (STI) 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’s 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 learned how to wipe properly just yet.
Second, a woman’s urethra is shorter than a man’s. This means that bacteria have a shorter distance to travel to get to the bladder, where they can multiply and more readily cause infection.
There are 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 doesn’t empty 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, then you’re 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 of chronic UTIs.
If you have a chronic UTI, you probably had a UTI in the past.
Performing lab tests on a sample of urine is the most common method doctors use to diagnose UTIs. A medical professional will examine the sample for signs of bacteria in the urine using a microscope.
In a urine culture test, a technician places a urine sample in a tube to encourage the growth of bacteria. After one to three days, they’ll look at the bacteria to determine the best treatment measure.
If your doctor suspects kidney damage, they may order X-rays and kidney scans. These are imaging devices that take pictures of parts of your body.
If you have recurring UTIs, your doctor may want to perform a cystoscopy. In this procedure, they’ll use a cystoscope, which is a long, thin tube with a lens at the end, to look inside your urethra and bladder. Your doctor will look for any abnormalities or issues that could cause the UTI to keep coming back.
A course of antibiotics delivered over one week is the primary treatment for UTIs.
However, if you have chronic UTIs, your 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 in which you take antibiotics after each time you have intercourse.
In addition to antibiotics, your doctor will want you to monitor your urinary system more closely. For example, they may ask you to perform regular home urine tests to check for infections.
If your chronic UTIs occur with 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. More research needs to be done, but it can’t hurt if you enjoy the taste. However, talk to your doctor first if you take blood-thinning drugs.
If you’re currently infected, you may experience burning while urinating. Your doctor may prescribe pain medication to numb your bladder and urethra. This will reduce the burning sensation. Placing a heating pad or hot water bottle on your bladder may also ease the pain.
People who suffer from chronic UTIs may experience complications. Recurring urinary tract infections may eventually cause:
- kidney infections, kidney disease, and other permanent kidney damage, especially in young children
- sepsis, which is a life-threatening complication due to infection
- septicemia, which is a condition in which bacteria have entered the bloodstream
- an increased risk of premature delivery or of having babies with low birth weight
Urinary tract infections are uncomfortable and painful. However, symptoms usually go away with treatment. People with UTIs should monitor their bodies and seek immediate treatment with the onset of a new infection. Early treatment of infection decreases your risk for more serious, long-term complications.
If you’re susceptible to recurring UTIs, make sure to:
- urinate as often as needed (especially after intercourse)
- wipe front to back after urinating
- drink plenty of water to flush bacteria out of your system
- drink cranberry juice daily
- wear cotton underwear
- avoid tight-fitting pants
- avoid using diaphragms and spermicides for birth control
- use lubrication during sex, if necessary
- avoid bubble baths
- wash foreskin regularly if you’re uncircumcised