What Causes Chronic or Recurrent UTIs?

Dealing with a recurrent UTI can be as debilitating as it is confusing. Read on to learn more about the condition and hear what our expert, Dr. John S. Young, professor of Translational Healthcare at Teeside University, has to say about it. 

Many people suffer frequently with symptoms of a Urinary Tract Infection (UTI). Although common, this is not normal, and it is very important that UTI symptoms are investigated and treated. 

Much of the confusion surrounding recurrent UTI stems from the fact that different organisations use slightly different terms when describing frequent UTIs, with the terms ‘chronic’ and ‘recurrent’ being the most commonly used.  

A recurrent UTI is defined by three episodes of a UTI in a 12-month period, or two episodes in a 6-month period. A recurrent UTI is likely to be the same infection coming back again and again, but it may also be a continuous infection which ‘flares up’ periodically. In both cases, this likely to be because of ineffective initial treatment of a UTI. 

A chronic UTI is a long-lasting, persistent infection. It’s likely that treatment does not completely remove the bacteria causing the infection so, given a little time, the bacteria become re-established, and symptoms return. 

We spoke with John S. Young, Professor of Translational Healthcare at Teesside University. He said: “The overlap between these two definitions is confusing and suggests similarities in the underlying cause or our body’s response.” 

Symptoms of recurrent UTI are similar to acute or ‘one-off’ UTI, and include: 

• Frequently passing urine 

• A constant sensation of the need to pass urine (‘urinary urgency’) 

• Pain passing urine (dysuria ) 

• Pain: in the lower abdomen (below the belly button) and / or down into the legs 

• Blood in the urine or darkly-coloured urine 

• A burning or painful sensation while urinating (dysuria) 

• Pain in the lower back or sides of the back 

• In an individual who still has periods, these symptoms can often be worse prior to the period. 

Professor John said: “Symptoms will differ from person to person. If someone has one or more of these symptoms, irrespective of the cause, it’s important to speak to your GP. That’s because while most recurrent UTIs don’t spread beyond the bladder, it’s essential to begin treatment as soon as possible to avoid the risk of damage to the kidneys”. 

The symptoms of this condition can be varied, and include: 

• More frequent urination 

• Urge incontinence 

• Burning or stinging in the urethra when passing urine 

• Changes in urine colour and even smell 

In many cases when a patient has a UTI, antibiotics are effective. After a few days of antibiotics, impactful symptoms (listed in our article on UTIs) go away. In the case of a Recurrent UTI, treatment with antibiotics offers only temporary relief – for a week or so – before symptoms return. 

Recurrent UTI is particularly difficult to diagnose because of limitations of the tools available to most healthcare practitioners. To better explain this, it’s necessary to explain that there is growing evidence that a recurrent UTI has a different basis than to an acute, ‘one-off’ UTI.  

Professor John explains: “In the case of a recurrent UTI, we believe that bacteria become ‘embedded’ – either forming a colony on the lining of the bladder or within the cells that make up the bladder wall. By being embedded in this way, very few bacteria find their way into the urine itself where they’d be detected using the methods used for an acute UTI.” 

There are new tests becoming available which aim to detect indicators of bacteria having become embedded. 

Until we understand how the condition is caused, it is not possible to prevent it. It is certainly not the case that lifestyle choices are responsible. There is no convincing evidence that making simple changes to what we eat, drink or clean ourselves will prevent recurrent UTIs. 

Recurrent UTIs can be effectively treated but for many people, it can take some time and it’s often necessary to try several treatment options before symptoms are fully resolved. One of the main recurrent UTI treatments involves taking a longer course of antibiotics at a lower dosage. 

It’s key to see a specialist to understand all the treatment options available, as they will different depending on the suspected underlying cause of your condition. Within the NHS, you can request to be referred to a specialist, so do ask your GP for help arranging this. We’ve provided a link below to explain the process, including the NHS e-Referral Service. 

Men with an enlarged prostate experience recurrent UTIs, though overall, they are much more common in women than men. 

Recurrent UTIs affect women of all ages and is usually more common in women than men due to their increased chance of experiencing UTIs in general. 

Getting the right diagnosis and treatment for recurrent UTIs can take time, and the symptoms could leave you feeling uncomfortable or limited. TENA has a range of products to help you lock in urine leakage. Try our incontinence pads for women and men so you can stay confident and in control, or learn more about urinary incontinence in adults.