Recurrent cystitis

Alternative names

Cystitis - recurrent; Urinary tract infection - recurrent; UTI - recurrent

Definition

Recurrent cystitis consists of at least 2 infections of the bladder in 6 months, or 3 infections in 1 year, marked by painful or burning urination, urinary frequency and urgency, and (occasionally) blood in the urine. It is confirmed by demonstration of the growth of bacteria in the urine. See also urinary tract infection.

Causes, incidence, and risk factors

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 recurrence.

Symptoms

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)
  

Signs and tests

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).

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 and other blood tests to make sure there is no infection of your kidneys.

If some anatomic 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.

Treatment

Patients are encouraged to drink large amounts of fluid to help increase the flow of urine and "wash out" the bacteria. If symptoms do not resolve within a few days, are particularly severe, or if the patient has had complications of cystitis in the past (including kidney infections or bloodstream infections), antibiotics will be used.