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Urinary tract infection - chronic or recurrent
Alternative namesUTI - chronic or recurrent
DefinitionThis is a disorder involving repeated or prolonged bacterial infection of the bladder or lower urinary tract (urethra).
Causes, incidence, and risk factors
Most urinary tract infections (UTI) occur in the lower urinary tract, which includes the bladder and urethra. Cystitis (lower urinary tract infection) is caused when the normally sterile lower urinary tract is infected by bacteria and becomes inflamed. Cystitis is very common.
In young girls, recurrent urinary tract infections may be an indication of a urinary tract abnormality, such as vesicoureteral reflux, and should be evaluated by a medical care provider. (In boys, even a single urinary tract infection indicates the necessity for evaluation, because urinary tract infections in boys are extremely uncommon in the absence of urinary tract abnormalities.)
Also, lack of adequate fluids, bowel incontinence , immobility or decreased mobility, having a Foley catheter, and placement in a nursing home, all place the person at increased risk for developing cystitis.
Signs and tests
Chronic or recurrent urinary tract infection means one of the following is true:
Tests that may be done include:
TreatmentMild cases of acute cystitis may disappear spontaneously without treatment. However, because of the risk of the infection spreading to the kidneys ( complicated UTI ), treatment is usually recommended. Also, due to the high mortality rate in the elderly population, prompt treatment is recommended.
Antibiotics may be used to control the bacterial infection. It is imperative that you finish the entire course of prescribed antibiotics. Commonly used antibiotics include:
Phenazopyridine hydrochloride (pyridium) may be used to reduce the burning and urgency associated with cystitis. In addition, acidifying medications, such a ascorbic acid may be recommended to decrease the concentration of bacteria in the urine.
Surgery is generally not needed to treat urinary tract infections.
Preventive measures may reduce symptoms and prevent recurrence of infection. Keeping the genital area clean and remembering to wipe from front to back may reduce the chance of dragging bacteria from the rectal area to the urethra.
Urinating immediately after sexual intercourse may help eliminate any bacteria that may have been introduced during intercourse. Refraining from urinating for a long period of time may allow bacteria time to multiply, so frequent urination may reduce the risk of cystitis in those who are prone to urinary tract infections.
Increasing the intake of fluids (2000 to 4000 cc per day) encourages frequent urination that flushes the bacteria from the bladder. Avoid fluids that irritate the bladder, such as alcohol, citrus juices, and those containing caffeine.
Follow-up urine cultures may be necessary to ensure that bacteria are no longer present in the bladder.
Expectations (prognosis)Most cases are cured without complication after adequate treatment. The treatment may be prolonged.
Calling your health care providerCall for an appointment with your health care provider if symptoms of cystitis persist after treatment, or recur more than 2 times in 6 months.
Call your health care provider if symptoms worsen or new symptoms develop, especially persistent fever, back pain or flank pain , and vomiting.
PreventionCleanliness of the genital area may help reduce the chances of introducing bacteria through the urethra. The genitals should be cleaned and wiped from front to back to reduce the chance of "dragging" bacteria from the rectal area to the urethra.
Increasing the intake of fluids may allow urination to "flush out" the bacteria from the bladder.
Refraining from urinating for long periods of time can give bacteria time to multiply, so those prone to urinary tract infections, should urinate frequently to help reduce the risk of developing cystitis.
Long-term use of prophylactic (preventative) antibiotics may be recommended for some people who are prone to chronic or recurrent urinary tract infections.
Update Date: 1/16/2004Daniel Levy, M.D., Ph.D., Infectious Diseases, Greater Baltimore Medical Center, Baltimore, MD. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT