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Chronic Urinary Tract Infection

A urinary tract infection (UTI) is a bacterial infection in your urinary tract. If you have two UTIs in a six-month period or more than three UTIs in a year, you have what doctors consider a recurrent or chronic urinary tract infection.

UTIs are relatively common, and while uncomfortable, most UTIs are easily treated with antibiotics.

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What Is a Chronic Urinary Tract Infection?

Doctors define a urinary tract infection (UTI) as a bacterial infection of any part of the urinary tract. A chronic or recurrent UTI is when you've had two UTIs in the past six months or more than three UTIs in the previous year. 

A UTI may develop in any part of your urinary tract, including the:

  • Bladder (the sac that holds urine).
  • Ureters (the tubes that transport urine from the kidneys to the bladder).
  • Kidneys (the organs that remove waste that becomes urine and filter blood).
  • Urethra (the tube that carries urine from the bladder).

UTIs occur most frequently in the bladder, so they're commonly referred to as “bladder infections.”

The experience of having a UTI may range from feeling uncomfortable to being in serious pain. Recurrent UTIs may affect your quality of life.

How common are chronic UTIs?

UTIs are the most common medical complaint in the U.S. Although anyone can get a UTI, they're especially common for people assigned female at birth (AFAB), because the urethra is shorter and located closer to the rectum in female anatomy. That means that bacteria from feces has less distance to travel to infect the bladder. 

Approximately 50% to 60% of all people AFAB will get a UTI at some point in their lives, and about 26% will develop recurrent UTIs within six months of treatment.

Recurrent UTIs are also common in pregnant people. Hormonal changes in pregnancy make it easier for bacteria to spread in the urinary system.

Is a recurrent UTI the same as a relapsing UTI?

Recurrent UTIs are different from relapsing UTIs.

A relapsing UTI persists or recurs within two weeks due to a resistance to antibiotics. Relapsing UTIs are often the result of an untreated condition, such as an abscess, urinary stone, or prostatitis. 

Recurrent UTIs, on the other hand, are new infections of the urinary tract by bacteria different than those that caused the previous infection.

A UTI also isn't the same thing as asymptomatic bacteriuria (ASB), which is when there's bacteria in the urine without symptoms of UTI.

What are the types of urinary tract infections?

There are two types of UTIs based on the location of the infection:

  • Lower tract UTI — The most common type of UTI, it affects the bladder or urethra.
  • Upper tract UTI — A more serious problem, it affects the ureters or kidneys. 

What causes recurrent urinary tract infections?

The most common cause of UTIs is bacteria, especially E. coli bacteria from the intestines. E coli accounts for about 75% of recurrent UTIs. In rare instances, a fungus can enter the urinary tract and cause a UTI.

Chronic urinary tract infection risk factors and complications

Recurrent urinary tract infection risk factors

You’re more likely to have recurrent UTIs if you:

  • Are a person assigned female at birth (AFAB).
  • Are older. The risk increases in middle age and after menopause.
  • Are pregnant.
  • Are sexually active. Intercourse makes it more likely that feces can get into your urinary tract.
  • Are unable to empty your bladder completely, such as from nerve damage around the bladder.
  • Don't drink enough water to flush harmful bacteria from your body. People who are well-hydrated have light yellow to clear urine; people who are dehydrated have dark yellow to light brown urine.
  • Had your first UTI when you were younger than 16 years old.
  • Have a family history of frequent or recurrent UTIs, especially in a mother or sister.
  • Have a new sexual partner or multiple sexual partners.
  • Have a personal history of five or more UTIs. 
  • Have a weakened immune system. Diseases such as diabetes and HIV can lower your body’s natural immunity and make you more susceptible to bacterial infections.
  • Have chronic diarrhea.
  • Have fewer friendly bacteria in your vagina. Beneficial bacteria help control harmful bacteria and keep them out of your urinary tract.
  • Have sex more than twice a week.
  • Have structural problems with or blockages in your urinary tract, such as an enlarged prostate, stones in your ureter, atrophic vaginitis, bladder or urethral diverticula, bladder fistula, or cystocele.
  • Have urinary incontinence (leak pee), especially if you wear adult diapers.
  • Use a catheter to drain urine from your bladder.
  • Use certain types of birth control, such as diaphragms and spermicides, which may prevent you from emptying your bladder completely.

Complications of recurrent UTIs

In rare cases, a UTI that affects the kidneys may lead to a kidney infection. A UTI during pregnancy can present serious complications for the mother but also can cause complications for the baby, such as preterm birth or low birth weight.

How can I reduce my risk of recurrent urinary tract infection?

While it’s impossible to prevent every UTI, there are things you can do to reduce your risk of getting one or having it recur.

You can:

  • Avoid certain physical activities that can increase your risk of infection, such as prolonged or excessive bicycle, motorcycle, or horseback riding.
  • Avoid having sex more than twice a week.
  • Boost levels of friendly bacteria and protect against harmful bacteria in your vagina by using estrogen or probiotic vaginal suppositories, especially if you're postmenopausal.
  • Consider alternative forms of birth control if you use diaphragms or spermicide.
  • Drink at least eight glasses of water each day to flush bacteria from your urinary tract. 
  • Drink cranberry juice. Cranberry juice has been found to prevent UTIs, although there's no conclusive evidence suggesting it can prevent recurrent UTIs.
  • Practice good hygiene. For AFAB people, wipe from front to back after using the toilet, make sure your hands are clean before wiping, wash your genitals and anal area with a clean washcloth and gentle, liquid soap to prevent bacterial growth, and take showers instead of baths.
  • Take vitamin C to increase the body’s resistance to infection. Excess vitamin C is released in the urine, preventing bacterial growth in the urinary tract.
  • Go pee immediately after engaging in sexual activity.
  • Urinate regularly, at least every four hours. Holding urine in the bladder can lead to bacterial growth.
  • Use tampons instead of sanitary pads for periods.
  • Wear cotton underwear. Cotton is a breathable fabric that doesn’t trap moisture and bacteria. 
  • Wear loose-fitting clothing that allows air to circulate, especially around the vaginal area.

An oral vaccine, MV140, has shown promising results in preventing recurrent UTIs, but it's still under development and not yet approved for use in the U.S.

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What Are the Signs and Symptoms of Chronic Urinary Tract Infections?

UTIs most commonly affect the bladder, which is why they're often called bladder infections. But rarely, they can affect the kidneys, too.

Bladder infection symptoms

Once bacteria enter your urethra and settle in the bladder, you may experience: 

  • Bad-smelling urine.
  • Cloudy urine or urine that's pink from blood.
  • Pressure or cramping in your lower abdomen.
  • Pain or a burning sensation when you pee (dysuria).
  • The urge to pee frequently.
  • The urge to pee but then not being able to “go.”

Kidney infection symptoms

Less commonly, a UTI may affect your kidneys. A kidney infection can become life-threatening if bacteria from the infection enter the bloodstream.

Symptoms of a kidney infection include:

  • Chills.
  • Diarrhea.
  • Fever.
  • Nausea or vomiting.
  • Pain in your lower back or sides.

Older adults and UTIs

Older people may experience different symptoms with a UTI, including confusion, lethargy, and/or anxiety.

When should I see a doctor about my chronic UTI symptoms?

If you're having symptoms of a kidney infection for the second time in six months, or for the third time in a year, you should see your health care provider.

If you suspect you may be suffering from a kidney infection, you should talk to your doctor right away.

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How Do You Diagnose Chronic Urinary Tract Infection?

Your doctor will ask you about your medical history, review your symptoms, and take a urine sample to diagnose a UTI. This urinalysis lets them look for the presence of bacteria and white blood cells, which fight infection.

If you have recurrent UTIs, your doctor may refer you to a specialist called a urologist for further testing.

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How Do You Treat a Chronic Urinary Tract Infection?  

An antibiotic is typically needed to treat a UTI. But if you have recurrent UTIs, your doctor may recommend that you take a low-dose antibiotic for six months to two years.

Sometimes, your body may become resistant to antibiotics taken over prolonged periods of time. Your doctor will help you to decide if using low-dose antibiotics is right for you.

Your doctor may also recommend other more aggressive preventative options, such as over-the-counter (OTC) supplements or probiotics, or vaginal estrogen for postmenopausal people. Occasionally, they may prescribe pain medicine to offer relief from your UTI symptoms.

Certain foods and drinks may aggravate UTI symptoms. You may want to avoid caffeine, coffee, tea, alcohol, spicy foods, aspartame, chocolate, cola drinks, oranges, and bananas until your UTI clears up.

Last reviewed by a UPMC medical professional on 2024-09-05.