Tiktok

Getting a urinary tract infection (UTI) sucks. You know what sucks even more? Getting a UTI over and over again. Recurrent UTIs can make you feel like you spend half your life speeding to the bathroom. If that sounds like you, there are a few things you should know about what qualifies as a chronic UTI, why they happen, and what you can do about them. And, of course, there’s the hopefully helpful advice on what you can do to prevent them from coming back.

What is a UTI?

Before we talk about recurrent UTIs, let’s talk about UTIs in general.

A UTI is an infection in any part of your urinary tract, the Mayo Clinic explains. The infection usually starts when bacteria normally found in your bowels get into the urethra, where pee exits from. Instead of urine flushing out the bacteria or your immune system fending it off like it’s supposed to, the bacteria begin to colonize the urinary tract, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Most UTIs stay in the urethra (called urethritis) and bladder (called cystitis), per the Mayo Clinic.

Sometimes a UTI keeps coming back, which is called a recurrent UTI or a chronic UTI. “Most people would say a true recurrent UTI is either two within six months or three within a year,” Sandip Vasavada, M.D., urologic director of the Center for Female Urology and Reconstructive Pelvic Surgery at the Cleveland Clinic within the Glickman Urological Institute, tells SELF.

Recurrent UTI Symptoms

UTIs—including chronic UTIs—can cause the following symptoms, according to the Mayo Clinic:

A strong, constant urge to pee
A burning sensation when you pee
Peeing often, in small amounts
Cloudy pee
Pee that appears red, bright pink, or brown
Strong-smelling pee
Pelvic pain, especially in the center of the pelvis and around the pubic bone

If the infection moves up your urinary tract and results in a kidney infection, it can cause symptoms like a high fever, chills, nausea, vomiting, and flank pain, the Mayo Clinic says.

Causes of Chronic UTIs

A whole slew of things can cause chronic UTIs, but these are some of the biggest causes.

1. Having a vagina.

Basic anatomy in itself may be the single biggest risk factor for UTIs, urologist Elodi Dielubanza, M.D., assistant professor of surgery at Harvard Medical School and associate surgeon at Brigham and Women’s Hospital, tells SELF.

The reason is simple: The bacteria E. coli, which causes the majority of UTIs, is naturally present in your GI tract (and poop), but it can cause an infection if it gets to your urinary tract. The genital anatomy of someone with a vagina is conveniently set up in a way that makes this trip very quick and easy for that bacteria. Basically, the distance between the anus and the urethra is extremely short (seriously, have you ever looked?), as is the length of the urethra, which basically acts as a ladder that E. coli can climb up into the bladder, Dr. Dielubanza says. In comparison, people with penises tend to have a greater distance between their anus and their urethra, which makes these infections less likely (but still possible).

2. Being sexually active.

Being sexually active is a UTI risk factor, the Mayo Clinic explains.

Sex can jostle around the bacteria down there and make it more likely that the wrong ones will end up in the wrong place (your urethra). “Vaginal penetration can push some bacteria around [the anus or vagina] up into the urethral area,” Dr. Vasavada says. Sexual activity involving “fingers, toys, or anything that causes movement of bacteria” can increase the odds you’ll develop a UTI, Sovrin M. Shah, M.D., an assistant professor and attending physician in the Department of Urology at the Icahn School of Medicine at Mount Sinai, tell SELF.

3. Going through menopause.

Because UTIs are sometimes thought of being a problem for young people, older people may be surprised to find they start getting more UTIs after they go through menopause, Dr. Vasavada says. This is thanks to a postmenopausal decline in estrogen. This estrogen deficiency alters the urinary tract in a way that can increase the risk of UTIs, according to the Mayo Clinic.

4. Having certain medical conditions.

While there are a “variety of anatomic and functional scenarios that put you at risk,” for UTIs, the most common ones involve urinary retention, meaning you have an impaired ability to empty your bladder fully and frequently, Dr. Vasavada says. This results in stagnant urine, which can let infection-causing bacteria linger.

That includes someone with a spinal cord injury or nerve damage around the bladder who might have trouble emptying their bladder, or someone with a kidney stone that blocks the flow of urine, according to the NIDDK.

Another common example is diabetes, where several factors can make recurrent UTIs more likely, Dr. Vasavada explains. First, nerve damage in the bladder can reduce the sensation of having to go and the ability to fully empty the bladder, per the NIDDK. A weaker immune system, which can happen with diabetes, also makes people generally more susceptible to infections, per the Mayo Clinic. Plus, bacteria can feed on the excess amounts of sugar that spill out into the urine when someone has high blood sugar, Dr. Vasavada explains.

5. Just being prone to UTIs.

“Even if someone doesn’t have any of these factors, they may just keep getting UTIs,” Dr. Vasavada says. Their increased susceptibility may come down to inherited and genetic factors. “Certain people have cells with receptors that bacteria can ‘stick’ to more easily,” Doreen Chung, M.D., a urologist at NewYork-Presbyterian/Columbia University Medical Center, tells SELF. “We say the lining of their bladder and ureter is more like Velcro,” Dr. Vasavada says.

A 2015 review in Current Opinion in Infectious Diseases suggests that susceptibility to UTIs depends on specific immune system signaling pathways and expression of the genes that govern these pathways. These types of factors can then run in families.

UTI Diagnosis

A chronic UTI is diagnosed the same way as a “regular” UTI. In addition to getting your medical history, your doctor will probably want to do the following, according to the Mayo Clinic:

A urinalysis: Your doctor will probably ask for a urine sample to look for the presence of white blood cells, red blood cells, or bacteria, all of which can indicate a UTI.
A urine culture: Sometimes your doctor will want to do a urine culture, which lets your doctor know what bacteria is behind your UTI and which medications will be best to treat it.
Imaging tests: In the case of recurrent UTIs, your doctor might want to do an ultrasound, a computerized tomography (CT) scan, or magnetic resonance imaging (MRI). Your doctor might also use a contrast dye to highlight parts of your urinary tract.
A cystoscopy: When you have chronic UTIs, your doctor may want to do a test called a cystoscopy. That uses a long, thin tube with a lens (called a cystoscope) to see inside your urethra and bladder.

Treatment for Recurrent UTIs

You can typically get rid of a “simple” UTI with antibiotics, the Mayo Clinic explains. But, when you have chronic UTIs, your doctor may recommend the following, per the Mayo Clinic:

Low-dose antibiotics, for six months but maybe longer
Self-diagnosis and treatment, if you stay in touch with your doctor
A single dose of an antibiotic after sex, if your recurrent UTIs are related to sex
Vaginal estrogen therapy, if you’re postmenopausal

Chronic UTI Prevention

Some of the prevention methods overlap with treatment options mentioned above. If you’ve even gotten one UTI before, then you’ve probably heard these tips: Drink a lot of water, don’t hold your pee in, and wipe front to back. “These are simple measures and maneuvers that may or may not help [prevent your UTIs],” Dr. Vasavada says. “But we generally recommend them because [they’re] not too onerous and they’re good habits anyway.”

Drinking enough water and emptying your bladder frequently (and after sex) are helpful for preventing bacteria in stagnant urine from colonizing, the NIDDK explains. And wiping from front to back helps stop fecal matter (which contains UTI-causing bacteria) from making its way from the anus to the urethra.

Peeing after sex is also such common UTI-prevention advice, in case any bacteria has gotten up there. “That can help flush the contaminated urine out,” before bacteria get the chance to colonize, Dr. Vasavada says. (And yes, you can have sex while you have a UTI that’s being treated with antibiotics, although you may not want to if it’s uncomfortable.)

If you’re postmenopausal, topical estrogen is one option to reduce the likelihood of recurrent UTIs, Dr. Vasavada says. So if you’ve gone through menopause and keep battling UTIs, it’s definitely worth talking to your doctor about.

Prophylactic antibiotics are another preventive method to know about if you have recurrent UTIs. Prophylactic antibiotics is basically a fancy way of saying preventive antibiotics. The idea is to nip any UTI-causing bacteria in the bud before they can even think of colonizing your urinary tract.

“If someone’s had multiple culture-proven infections and we have no other sources or factors we can find, then we will consider prophylactic antibiotics,” Dr. Vasavada says. There are a few ways to go about this, depending on the doctor and the patient, he says.

One option is low-dose antibiotics taken for daily for something like six months, per the Mayo Clinic. However, doctors are increasingly cautious to prescribe routine antibiotics unless all other options are exhausted, because of side effects and the potential for developing antibiotic resistance, Dr. Vasavada says.

Another route is a single dose of the antibiotic that you take every time you have sex. “That’s often enough to prevent the infection from settling in,” Dr. Vasavada says. Another method is basically self-started or self-directed treatment using a standing prescription. Whenever you think you may have a UTI, you reach out to your doctor, who may want you to drop off a urine sample or may just tell you to go ahead and take the meds if you’ve recently tested positive and are feeling the symptoms again, Dr. Vasavada explains.

Finally, you might be wondering about cranberry juice for UTI prevention. Let’s be really clear here: According to the National Center for Complementary and Integrative Health (NCCIH), cranberry juice will not treat an existing UTI. And although there is research suggesting cranberry juice could help prevent UTIs in the first place, according to the NCCIH, the evidence is a pretty mixed bag.

The thinking is that an ingredient in cranberry juice (and cranberry supplements) called proanthocyanidins, or PACs, may help prevent bacteria from sticking to the lining of the urinary tract and bladder, Dr. Vasavada says. But the science here isn’t solid enough to say that cranberry juice or supplements can definitely prevent recurrent UTIs.

For instance, a 2012 JAMA Internal Medicine meta-analysis of 13 randomized controlled trials (RCTs) including more than 1,600 people found evidence of a link between cranberry-containing products and a protective effect against UTIs. However, the authors cautioned that there was significant heterogeneity across the studies, in terms of both variables like the dosages used and the size of the results, so “this conclusion should be interpreted with great caution.”

And a 2012 Cochrane review of 24 studies including 4,473 women found that although some smaller studies suggest that cranberry products have a preventive effect against UTIs, particularly in women with recurrent UTIs, the body of evidence as a whole doesn’t suggest a statistically significant difference. “So it’s sort of up to you,” Dr. Vasavada says. “If someone takes it and they think it benefits them, great.”

When to See a Doctor

It’s always a good idea to reach out to a doctor if you’re experiencing those UTI symptoms, because remember, UTIs can affect the kidneys without prompt treatment. But this is especially important if you’re susceptible to recurrent UTIs. As you can see, there are various treatment options—and potential preventive methods—that may be able to keep that terrible burning to a minimum.

Additional reporting by Laura Adkins.

Sources:

Related: