A chronic urinary tract infection is an ongoing or recurring infection of the urinary tract. The infection may recur because the tract gets re-infected or because treatment did not clear the infection entirely. Symptoms may stop during treatment, but they may start up again after treatment.
A chronic urinary tract infection (UTI) might also be called a persistent or recurring UTI. According to one study, a doctor will diagnose a recurring UTI (RUTI) if a person has three positive urine cultures during a 12-month period or two infections during the previous 6 months.
According to the same 2013 study, UTIs are more common in women. The report noted that around 50-60 percent of females would develop a UTI in their lifetimes, but they will not always become chronic.
The National Institute of Diabetes and Digestive Kidney Diseases state that around 1 in 4 women will have recurring UTIs.
The symptoms of a UTI in the bladder or urethra include:
- needing to urinate often or urgently
- feeling the need to urinate even after emptying the bladder
- feeling pain, burning, or pressure when urinating
- producing urine that is bloody, cloudy, or smelly
- having lower tummy pain
- experiencing lower back pain
If the infection spreads to the kidneys, a person may experience:
The urinary tract is divided into the upper and lower urinary tract and is composed of a series of organs and tubes that take urine out of the body:
- the upper urinary tract includes the kidneys and ureters
- the lower urinary tract includes the bladder, urethra, and prostate
A UTI may affect any part of the urinary tract. However, infection typically occurs when bacteria enter the urinary tract through the urethra, which is the tube carrying urine from the kidneys to the bladder.
If the infection starts in the urethra and bladder, it is usually not serious and clears up with treatment.
However, if a UTI reaches the kidneys, it can be more serious. A person with an upper urinary tract infection may need to go to the hospital for treatment.
Females are more likely than males to get a UTI because of the position and shorter length of their urethras.
The female urethra is near the anus, which makes it easy for bacteria from the stool to get into the urethra. To prevent this, always wipe from front to back after going to the toilet.
Bacteria do not have as far to travel to infect the bladder because a female has a shorter urethra than a male. Because of this, bladder infections can happen more easily.
Having kidney stones, a weakened immune system, or being pregnant makes it more likely a person will get a UTI.
A 2014 review linked the following factors with RUTIs in otherwise healthy women:
- having sex
- prior history of UTI
- using a diaphragm during sex
- using oral contraceptives
- using spermicides
- hormonal changes during menopause
Some specific ways of having sex make getting a UTI more likely. If people have anal sex, it is essential they wash their genitals before engaging in other sexual activities to reduce the spread of bacteria.
Genetic factors and urinary tract abnormalities may also make getting a chronic UTI more likely.
Males rarely get UTIs. If they do, it may be because they have an enlarged prostate. An enlarged prostate may mean the bladder cannot empty fully, leaving bacteria to multiply.
A doctor may carry out the following tests to reach a diagnosis and understand why a UTI is recurring:
- Urine culture test: This checks for bacterial cultures in urine.
- Visual bladder and urethra exam: This is to check for any abnormalities.
- Computed tomography (CT) scan of the urinary tract: This allows the doctor to see the urinary tract in more detail.
Doctors normally treat chronic UTIs with antibiotics. They may suggest either:
- taking a low-dose, long-term course of antibiotics
- taking antibiotics prescribed in advance as a preventive measure after having sex or on the first onset of symptoms
The doctor may also prescribe pain-relieving medication to ease discomfort.
Home remedies for a UTI include:
- taking acetaminophen to relieve pain and reduce fever
- placing a hot water bottle on the lower stomach to ease discomfort
- drinking plenty of water to flush out the bacteria
- getting plenty of rest to help the body fight the infection
- avoiding sex to reduce discomfort
Drinking cranberry juice is a popular home remedy for UTIs. But there is little scientific evidence to suggest it is effective.
However, a sugar found in cranberries called D-mannose shows promise as a home remedy to treat a UTI. A 2014 study found that D-mannose powder reduced the risk of recurring UTIs and may be useful for UTI prevention. More research is needed to confirm these findings.
If a bladder infection remains untreated, it can spread to the kidneys, which is more dangerous. If a person has a kidney infection, they may need treatment in the hospital.
Without proper treatment, a kidney infection may lead to permanent kidney damage.
Rarely, chronic UTIs may cause sepsis (blood poisoning) if left untreated, which may be life-threatening.
Some lifestyle changes may make UTIs less likely to recur. These include:
- urinating before and straight after having sex
- cleaning genital and anal areas before and after sex
- drinking plenty of water to flush bacteria out of the bladder
- finding alternatives to diaphragms or spermicide for birth control
- wearing cotton underwear and loose clothing
- wiping front to back after going to the toilet
- avoiding scented body washes or douches
Chronic UTIs usually clear up with long-term antibiotics.
The doctor may prescribe antibiotics for self-directed use. Getting to know the early signs of infection will help a person take their antibiotics as soon as they are needed.
It is vital to work closely with the doctor and ask for further treatment if UTIs continue to recur.