Chronic urinary tract infection (UTI) is a bacterial infection of the bladder or lower urinary tract (urethra) that lasts for a long time.

There are many different forms of UTIs. This article focuses on chronic infections.

See also:

• Catheter-associated UTI
• Urinary tract infection
• Recurrent UTI

Most urinary tract infections occur in the lower urinary tract, which includes the bladder and urethra. The condition occurs when the normally clean lower urinary tract is infected by bacteria and becomes inflamed. Urinary tract infections are very common.

Most of the time, symptoms of a urinary tract infection disappear within 24 - 48 hours after treatment begins. However, if the condition occurs more than twice in 6 months, lasts longer than 2 weeks, or does not respond to usual treatment, it is considered chronic.

The elderly are at increased risk for such infections because the bladder doesn't empty fully due to such conditions as benign prostatic hyperplasia, prostatitis, and urethral strictures.

The following increase your risk for chronic UTIs:

• Being in a nursing home
• Bowel incontinence
• Foley catheter
• Lack of fluids
• Limited or no movement

• Abnormal urine color -- cloudy
• Blood in the urine (hematuria)
• Foul or strong urine odor
• Frequent need to urinate (frequency)
• Need to urinate at night
• Painful urination (dysuria)
• Pressure in the lower pelvis
• Urgent need to urinate (urgency)

Other symptoms that can occur with this disease:

• Chills
• Fatigue
• Fever
• Mental changes or confusion
• Nausea and vomiting

In young girls, recurrent urinary tract infections may be a sign of a problem with the urinary tract (such as vesicoureteral reflux), and should be checked by a health care provider.

In boys, even a single urinary tract infection should be checked, because urinary tract infections in boys are very uncommon unless there are problems with the urinary tract.

Tests include:

• Abdominal ultrasound or abdominal x-ray
• Urinalysis
• Urine culture (clean catch) or catheterized urine specimen

A urine culture that is positive for more than 2 weeks, even with treatment, indicates a chronic UTI.

Chronic urinary tract infections should be treated thoroughly because of the chance of kidney infection (pyelonephritis). Antibiotics can help control the bacterial infection. You MUST finish the entire course of prescribed antibiotics. Your doctor will decide which antibiotic is best for you.

You might need to take antibiotics for long periods of time (as long as 6 months - 2 years), or you may need stronger antibiotics. Your health care provider may also recommend low-dose antibiotics after acute symptoms have gone away.

Medicines are available to help reduce the burning and urgency of cystitis. Ascorbic acid can decrease the amount of bacteria in the urine.

Increasing the intake of fluids (2000 - 4000 cc per day) encourages frequent urination, which flushes the bacteria from the bladder. Avoid fluids that irritate the bladder, such as alcohol, citrus juices, and drinks containing caffeine.

Follow-up urine cultures may be needed to make sure that bacteria are no longer in the bladder.

Most cases are cured after proper treatment. The treatment may continue over a long period of time.

• Kidney abscess
• Pyelonephritis
• Swelling of the kidneys (hydronephrosis)

Call for an appointment with your health care provider if symptoms of a urinary tract infection continue after treatment or come back more than 2 times in 6 months.

Call your health care provider if symptoms worsen or you have new symptoms, especially persistent fever, back pain or flank pain, and vomiting.

Keeping your genital area clean can prevent bacteria from entering through the urethra. Wipe the genital area from front to back to reduce the chance of "dragging" bacteria from the rectal area to the urethra.

Increasing your intake of fluids may allow urination to flush out the bacteria from the bladder.

Waiting for long periods of time to urinate can give bacteria time to multiply. If you are prone to urinary tract infections, urinate often to reduce your risk.

Long-term use of preventive (prophylactic) antibiotics may be recommended for some people who are prone to chronic UTIs.