What Is a Chronic or Recurrent UTI?
A urinary tract infection (UTI) is a common type of bacterial infection that occurs in the urinary tract (the kidney, bladder, or urethra, the tube that carries urine from the bladder out of the body). Most UTIs are easily remedied with antibiotics.
Recurrent UTIs are defined as those that occur two or more times within a six-month period or three or more UTIs within a 12-month period. They may also be called persistent UTI, frequent UTI, or chronic UTI. Ultimately, recurrent UTIs can negatively affect your quality of life, so you should check in with a healthcare provider if you are experiencing chronic urinary tract infections.
How Common Are Chronic UTIs?
Approximately half of all women will experience at least one UTI during their lifetime, and half will develop recurrent or chronic UTIs within six months of treatment. Women are more likely to get UTIs than men because their urethras are shorter and are in closer proximity to the vagina and rectum. That makes it easier for bacteria to infect the bladder. Pregnant women are even more susceptible to UTIs due to hormonal changes, making the condition more common for them.
Potential Causes of Recurrent UTIs
Recurrent urinary tract infections are caused when bacteria that lives in your gastrointestinal ( esophagus, stomach, and intestines) or vaginal tract are transmitted from your rectum to your urethra and causes a new infection.
Risk factors for recurrent UTIs include:
- Age (the risk increases in middle age and after menopause)
- Pregnancy
- Being sexually active, especially if you have sex more than twice per week, have a new partner, or have multiple partners
- Weakened immune system
- Experiencing urinary incontinence, especially if you wear adult diapers
- Using a catheter
- Using forms of birth control that may prevent you from emptying your bladder completely
- Using vaginal douches, powders, sprays or other irritants
- Having structural problems in your urinary tract
- Having a personal history of multiple UTIs, especially if the first was before age 16
- Experiencing chronic diarrhea
- Being chronically dehydrated
Sex and Hygiene
Because sexual activity can introduce bacteria into your urinary tract, it is recommended that you urinate immediately after intercourse.
Washing your genitals and anal area with a clean cloth and gentle soap that prevents bacterial growth, taking showers instead of baths, and using tampons instead of sanitary pads during your period can help reduce your risks.
Additionally, if you’re using diaphragms or spermicide for birth control, you should discuss other options with your provider if they are related to frequent infections.
Anatomical Factors
Conditions that block the flow of urine between your kidneys and bladder, such as kidney stones, cysts, or congenital abnormalities, can increase your risk for recurrent UTIs.
Post-menopausal women, who have less estrogen, may have vaginal tissue that is thinner, and produce fewer good bacteria in their vagina, and experience pH changes. All these changes make it easier for bacteria to grow and enter the bladder.
As women age, bladder muscles tend to weaken, making it more difficult to fully empty the bladder, creating a more favorable environment for bacteria to grow.
Underlying Medical Conditions
Urinary retention, or the failure to fully empty the bladder, can be caused by vaginal prolapse, stroke, and neurologic disorders. Diabetes patients are more prone to recurrent UTIs due to both a weakened immune system and nerve damage that makes it more difficult to completely empty the bladder.
Medication for chronic conditions such as lupus or rheumatoid arthritis that suppress your immune system and the long-term use of antibiotics has also been associated with chronic UTIs.
Diagnosing Chronic UTIs
If your symptoms include an urgent and/or frequent need to urinate, pain or burning when you urinate, soreness in your lower abdomen, back, or sides, or urine that has a foul odor, is cloudy, or appears to contain blood, you may have a UTI. You may also experience fever, chills, fatigue, or back pain.
Your healthcare provider can diagnose UTIs using a urine sample, physical exam, your medical history, and information about your symptoms. If you are experiencing recurrent UTIs, it is recommended that you visit a specialist for additional testing to identify the cause.
Urinalysis and Urine Culture
With a urine sample, your healthcare provider can perform a urinalysis that tests for white blood cells, which fight infection, and the presence of bacteria. A urine culture may also be used to determine which bacteria are present and which antibiotics are best to treat your infection.
Additional Diagnostic Testing
If you are experiencing recurrent UTIs, your provider may also use a CT scan, ultrasound, or x-ray to capture imaging of your kidneys, ureters (the tubes that carry urine from the kidney to the bladder), bladder, and urethra and assess the health of your urinary tract. Your provider may recommend a cystoscopy, a procedure where a small camera (a cystoscope) is used to look into your bladder, to check for conditions that cannot be determined with other imaging.
Recurrent UTI Treatment Options
The recommended treatment options for chronic UTIs will vary depending upon your medical history and the reasons contributing to your condition, and include medication, behavioral and surgical interventions.
Prophylactic Antibiotic Therapy
With antibiotic prophylaxis, or prophylactic antibiotic therapy, a healthcare provider will prescribe antibiotics before an infection has occurred to kill or prevent the growth of bacteria that cause the infection.
For those with chronic UTIs, a healthcare provider may prescribe a daily, low-dose antibiotic to prevent the recurrence of a urinary tract infection. They may be prescribed for three to 12 months or longer. If the UTIs are caused by sexual activity, the antibiotic may be prescribed for use only after sexual activity.
Non-Antibiotic Prophylaxis
There are several types of non-antibiotic interventions that have been shown to help prevent chronic UTIs without creating significant negative side effects.
Cranberry extract supplements and D-mannose can help prevent bacteria from attaching to the bladder wall, while probiotics can help create a healthy bacteria balance in the urinary tract. An antibacterial antiseptic medication called methenamine hippurate can make your urine more acidic, which can help kill dangerous bacteria.
Before using any supplements or therapies for your UTIs, you should consult with your healthcare provider to determine the right strategy for you.
Vaginal Estrogen Therapy
For perimenopausal or postmenopausal women, vaginal estrogen therapy is a safe and effective treatment. Available as a cream, ring, or tablet, this therapy increases the pH of your vagina, making it more resistant to the bacteria that can cause UTIs. The localized nature of this treatment means that very little hormone enters your bloodstream.
Behavioral Modifications
Reducing risk factors for recurrent UTIs through simple lifestyle changes is an effective strategy to use in combination with other interventions. Having clean hands when you go to the bathroom and being sure to wipe from front to back will also prevent the spread of bacteria. Regularly drinking water to help flush your urinary tract or keeping your bladder fully empty by urinating regularly can also help prevent UTIs.
Surgical Interventions
For women who have underlying anatomic issues contributing to recurrent UTIs that are not resolved through other treatment options, surgical intervention may be an option. Minimally invasive surgery to remove bladder obstructions or address pelvic organ prolapse may provide more long-term relief.
Risks of Untreated UTIs
Untreated and chronic UTIs can increase your risk of kidney problems, blood infection, sepsis, chronic bladder pain, and antibiotic resistance. UTIs during pregnancy can increase the risk of low birth weight and preterm birth. It is important to finish any medications prescribed for your UTI and follow up with a healthcare provider if your condition worsens or fails to improve.
Pyelonephritis (Kidney Infection)
While some of the symptoms may be similar, a kidney infection (pyelonephritis) is more serious than a lower UTI. It typically occurs when an untreated UTI spreads to one or both kidneys and can lead to dangerous complications. If you have nausea, vomiting, blood in your urine, fever, or pain, you should seek medical attention.
Urosepsis (Severe Infection in the Bloodstream)
Urosepsis occurs when a UTI spreads to your kidneys (pyelonephritis) and leads to sepsis, a life-threatening reaction to infection that can progress to extensive inflammation, tissue damage, and organ failure. It is caused by untreated or undertreated UTIs and requires immediate medical treatment.
How Advantia Health Can Help
Through their professional backgrounds, combined with dedication to patient-focused, personalized care, Advantia Health providers can help you identify the best solutions for your recurrent urinary tract infections or related conditions.
Book An Appointment!
To discuss your symptoms, diagnostic recommendations, and treatment options, schedule your appointment with an experienced Advantia Health provider through the online link or by calling our office today.
