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Urinary tract infection - chronic or recurrentDefinition Chronic urinary tract infection 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 or cystitis) occur in the lower urinary tract, which includes the bladder and urethra. Cystitis is caused when the normally sterile lower urinary tract is infected by bacteria and becomes inflamed. Cystitis is very common. Most of the time, symptoms of cystitis disappear within 24 - 48 hours after treatment begins. Chronic or recurrent urinary tract infection includes repeated episodes of cystitis (more than 2 in 6 months), or urinary tract infection that does not respond to the usual treatment or that lasts longer than 2 weeks. 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 should be evaluated, because urinary tract infections in boys are extremely uncommon in the absence of urinary tract abnormalities. The elderly population are at increased risk for developing cystitis due to incomplete emptying of the bladder associated with such conditions as benign prostatic hyperplasia (BPH), prostatitis, and urethral strictures. Also, lack of enough fluids, bowel incontinence, immobility or decreased mobility, having a Foley catheter, and placement in a nursing home, all put a person at increased risk for developing cystitis. Symptoms
Additional symptoms that may be associated with this disease:
Signs and tests Chronic or recurrent urinary tract infection means one of the following is true:
Tests that may be done include:
Treatment Mild cases of acute cystitis may disappear on their own 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 death rate in the elderly, prompt treatment is recommended. MEDICATIONS Antibiotics may be used to control the bacterial infection. You MUST finish the entire course of prescribed antibiotics. Commonly used antibiotics include:
Chronic or recurrent urinary tract infection should be treated thoroughly because of the chance of kidney infection (pyelonephritis). Antibiotics control the bacterial infection. They may need to be given for long periods of time (as long as 6 months to 2 years), or stronger antibiotics may be needed. As an additional precaution, low-dose antibiotics may be recommended after acute symptoms have subsided. Phenazopyridine hydrochloride (pyridium) may be used to reduce the burning and urgency associated with cystitis. In addition, ascorbic acid may be recommended to decrease the concentration of bacteria in the urine. SURGERY Surgery is generally not needed to treat urinary tract infections. OTHER THERAPY Preventive measures may reduce symptoms and prevent recurrence of infection. If you keep the genital area clean and wipe from front to back, you may prevent 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. Not urinating for a long period of time may allow bacteria time to multiply. Frequent urination may reduce the risk of cystitis in those who are prone to urinary tract infections. DIET Increasing the intake of fluids (2000 - 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 drinks containing caffeine. MONITORING Follow-up urine cultures may be needed to make sure 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. Complications
Calling your health care provider Call 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. Prevention Keeping your genital area clean may reduce the chances of introducing bacteria 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. Refraining from urinating for long periods of time can give bacteria time to multiply. If you are prone to urinary tract infections, urinate frequently to 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. Illustrations
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