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Chronic Urinary Tract Infection (UTI)

What is a chronic urinary tract infection?

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 filter your blood and generate body waste in the form of urine.
  • Your ureters are tubes that carry urine from the kidneys to the bladder.
  • Your bladder 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 1 in 5 young adult women have recurring UTIs.

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Symptoms

What are the symptoms of a chronic urinary tract infection?

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 your ribs
  • pain in your bladder region

If the UTI spreads to your kidneys, it might cause:

  • nausea
  • vomiting
  • chills
  • a high fever, over 101°F (38°C)
  • fatigue
  • mental disorientation

Causes

What are the causes of chronic urinary tract infections?

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.

Bladder infections

The bacteria E. coli is a common cause of infections of the bladder, or cystitis. E. coli 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. Foamy urine can also signal an issue.

Urethral infections

Also known as urethritis, infections of the urethra could be due to bacteria such as E. coli. Urethritis can also be the result of a sexually transmitted infection (STI), however, this is rare. STIs include:

  • herpes
  • gonorrhea
  • chlamydia
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Risk factors

Who is at risk for a chronic urinary tract infection?

Women

Chronic UTIs 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.

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.

Lifestyle

There are lifestyle factors that can put you at extra risk of developing a chronic UTI, like using a diaphragm during sex. 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. This can increase your risk of developing a chronic UTI. If you regularly use any of the following products, then you’re changing your vaginal bacteria:

  • vaginal douches
  • spermicides
  • certain oral antibiotics

Men

Men are much less likely than women to get a UTI, either acute or chronic. The most common reason men develop chronic UTIs is an enlarged prostate. When the prostate is enlarged, the bladder does not empty completely which can cause bacteria to grow.

Both men and women that have problems with bladder muscle function, known as neurogenic bladder, are also at risk for chronic UTIs due to retention of urine. This condition can occur as a result of injury to the nerves to the bladder or injury to the spinal cord.

Menopause

Menopause can cause similar problems in some women. Menopause causes hormone changes that can cause changes in your vaginal bacteria. This can increase your risk of chronic UTIs. There are also other risks for UTIs in older adults.

Diagnosis

How is a chronic urinary tract infection diagnosed?

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 of urine under a microscope, looking for signs of bacteria.

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.

If your doctor suspects kidney damage, they may order X-rays and kidney scans. These imaging devices take pictures of parts inside your body.

If you have recurring UTIs, your doctor may want to perform a cystoscopy. In this procedure, they’ll use a cystoscope. It’s a long, thin tube with a lens at the end used 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.

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Treatment

How is a chronic urinary tract infection treated?

Medications

A course of antibiotics delivered over one week is the primary treatment for UTIs.

However, if you have chronic UTIs, your doctor may 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.

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.

Natural remedies

According to some studies, 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. Talk to your doctor first if you take blood-thinning drugs.

Another natural remedy that can help treat a UTI is to drink plenty of water. Drinking plenty of water can help dilute your urine and flush out the bacteria in your urinary tract.

Placing a heating pad or hot water bottle on your bladder may ease the pain. There are also more ways of treating a UTI without antibiotics.

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Complications

What are the complications of a chronic urinary tract infection?

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
  • increased risk of premature delivery or of having babies with low birth weight
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Outlook

What is the long-term outlook?

Urinary tract infections are uncomfortable and painful. Most chronic UTIs will resolve with a prolonged course of antibiotics, but monitoring for further symptoms is important since the chronic UTIs usually recur. 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.

Prevention

How can I prevent a chronic urinary tract infection?

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
  • avoid drinking fluids that may irritate your bladder (like coffee, citrus fruit drinks, soda, alcohol)
  • use lubrication during sex, if necessary
  • avoid bubble baths
  • wash foreskin regularly if you’re uncircumcised
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