About Chronic Urinary Tract Infections (UTI)
Chronic urinary tract infections (UTIs), also called recurrent UTIs, are infections of the urinary tract that either don't respond to treatment or happen multiple times in a year. The UTIs may 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, including your kidneys, ureters, bladder, and urethra. UTIs 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 happen more in women.
The most common cause of UTIs is bacteria entering the urinary system through the urethra and multiplying in the bladder. This can happen when fecal matter enters the urinary tract, such as during improper wiping or through sexual activity.
Non-modifiable risk factors (risk factors that can’t be changed) for chronic or recurrent UTIs include:
- Age: The incidence of UTIs increases with age, especially in women over 65 years.
- Female sex: Women are more prone to UTIs than men in all age groups.
- Urinary tract abnormalities: Conditions like urinary retention, incontinence, and prostatic hyperplasia can increase the risk of UTIs.
- Genetic predisposition (inherited)
- Being in menopause
Modifiable risk factors (risk factors that can be changed) for chronic or recurrent UTIs include:
- Sexual intercourse: Engaging in sexual activity increases the risk of UTIs, especially in older individuals
- Urinary catheterization: Urinary catheters can introduce bacteria into the urinary tract
- Urinary incontinence: Not fully emptying the bladder when urinating
- Not drinking enough fluids or infrequent urination
- Use of spermicides or certain contraceptive devices such as diaphragms
- Having kidney or bladder stones
- Uncontrolled diabetes
It's important to note that these factors may increase the likelihood of developing UTIs, including chronic UTIs, but individual circumstances may vary. Consult with a healthcare professional for personalized advice.
The most common early symptoms of chronic or recurrent UTIs may include:
- Pain or discomfort during urination
- Increased frequency of urination
- Urinary urgency (a strong, sudden urge to urinate)
- Cloudy or strong-smelling urine
As chronic UTIs progress or become more severe, additional symptoms may occur. These can include:
- Hematuria (blood in the urine)
- Lower abdominal pain or pressure
- Fever
- Fatigue
- Back pain or flank pain
- Nausea and vomiting
It's important to note that older adults may experience confusion, delirium, or behavior changes in addition to the typical UTI symptoms. If you suspect you have a chronic UTI or are experiencing any of these symptoms, it is important to seek medical attention for proper diagnosis and treatment.
To diagnose chronic or recurrent UTIs, doctors may perform the following examinations, tests, and procedures:
- Urine sample analysis: A urine sample will be sent to a laboratory to be examined under a microscope to look for signs of bacteria.
- Urine culture test: This involves placing a urine sample in a tube to encourage bacterial growth. After one to three days, the bacteria are examined to determine the best treatment.
- X-rays and kidney scans: If kidney damage is suspected, these imaging tests can provide detailed pictures of the urinary tract.
- Cystoscopy: This procedure involves using a thin tube with a lens at the end (cystoscope) to examine the urethra and bladder for abnormalities that could contribute to recurring UTIs.
To determine the stage or severity of chronic UTIs, additional examinations, tests, and procedures may include:
- Intravenous pyelography or computed tomography (CT) scan: These imaging tests show an outline of the urinary tract on X-rays.
- Ultrasound: This test uses sound waves to create images of the urinary tract.
- Urodynamics: This procedure assesses how well the urinary tract stores and releases urine.
- Tissue biopsy: A sample of tissue from the bladder lining may be collected to rule out cancer.
Remember, it's important to consult with your doctor about which specific examinations, tests, and procedures are appropriate for your individual situation.
The goals of treatment for chronic or recurrent UTIs are to eliminate the infection, alleviate symptoms, and prevent future occurrences. Here are the different treatment approaches and how they work:
- Medications:
- Antibiotics are the primary treatment for UTIs. A course of antibiotics delivered over one week is usually prescribed. In cases of chronic UTIs, long-term, low-dose antibiotics may be recommended after the initial symptoms subside to prevent recurrence. In some cases of recurrent UTIs, antibiotics may be taken after each instance of intercourse as a preventive measure.
- Estrogen: For individuals with recurrent UTIs during menopause, vaginal estrogen therapy may be considered. This treatment can help reduce the risk of future UTIs but should be discussed with a doctor due to potential trade-offs between potential benefits and potential side effects.
- Pain medication may be prescribed to alleviate burning sensations during urination.
- Health behavior changes: Monitoring the urinary system more closely is important. Regular home urine tests can help check for infections. Drinking plenty of water and urinating frequently can also be beneficial.
It's important to consult with a healthcare professional for personalized advice on medication dosing and potential side effects. Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Medication side effects can occur. Check with your health care professional or read the information provided with your medication for additional sides effect information.