Recurrent cystitis consists of at least 2 infections of the bladder in 6 months, or 3 infections in 1 year. It is confirmed by tests that show the growth of bacteria in the urine. See also urinary tract infection.

Recurrent cystitis is most often caused by a type of bacteria called E. coli, the leading cause of all urinary tract infections. About 25-50% of all young, healthy women who suffer their first infection will develop a second one within 6 months. Although the risk for cystitis increases with age, the incidence of recurrent infections is only about 10-20% for people over 60.

Risk factors for recurrent infections include sexual intercourse with multiple partners, use of spermicidal agents, genetic factors including a family history of recurrent infections, first infection at a young age, and certain anatomic abnormalities of the female pelvis. Diabetes is a well-known risk factor for the development of urinary tract infections and may contribute to their reappearance.

Patients who do not empty their bladder completely may also be at risk for developing repeated infections.

Some large kidney stones are also associated with repeated infections. Other foreign objects in the urinary system, such as a JJ stent placed because of obstruction, may also cause recurrent infections.

The symptoms of recurrent infections are the same as for first episodes and include:

• Painful or burning urination
• Urinary frequency and urgency
• Dark, foul-smelling urine
• Bloody urine (rare)

Analysis of the urine shows the presence of white blood cells, occasionally red blood cells, and the type of bacteria that is responsible for the infection (usually E. coli). A urine culture can also determine the type of bacteria that is in the urine, as well as which antibiotics will work against that bacteria.

If an infection is severe, lasting for more than a few days, and accompanied by fevers and back pain, your doctor may also order an ultrasound or CT scan, as well as other blood tests, to make sure there is no infection of your kidneys.

If some physical abnormality is suspected as the cause of the infections, other tests may be ordered, including an intravenous pyelogram, a study using dye to trace the flow of urine through your kidneys and bladder.

Patients are encouraged to drink large amounts of fluid to help increase the flow of urine and "wash out" the bacteria. For infections believed to be associated with bacteria, antibiotics may be started immediately. Alternatively, your doctor may wait for the results from the urine culture (usually 36-48 hours).

Surgery is rarely necessary, unless a serious underlying anatomical problem is the source of recurrent infections.

If an underlying problem is identified, it will need to be corrected. If a kidney stone is found, it may need to be removed. Foreign objects in the urinary system must also be removed.

If infections persist despite no obvious cause, a longer course of antibiotics may be necessary.

If symptoms are mild, patients should expect to have relief of symptoms within 2-3 days with the use of antibiotics or supportive care.

Possible complications include infection of the kidney and bloodstream, resulting from spread of the bacteria from the bladder into the blood. The occurrence of these complications may be suggested by fevers, back pain, chills or symptoms lasting more than a few days.

If infection travels to the kidneys, they may be at risk for scarring, especially if antibiotic treatment is delayed.

A physician should be contacted if any of the symptoms of cystitis last more than 2-3 days, if they are particularly severe, or if they include fever, chills, or back and abdominal pain, which might suggest a more serious infection.

If patients have recurrent infections despite the altering of habits that might lead to infection, several methods may help prevent recurrences. These include taking an antibiotic after sexual intercourse, taking an antibiotic when symptoms of cystitis arise, or taking an antibiotic on a daily basis even when healthy.

A physician should direct care in these circumstances, as the use of antibiotics can lead to resistance of bacteria to medication over time. Patients should note that certain antibiotics used to treat cystitis also make birth control pills less effective.