What Chronic UTIs Can Mean
Superficially, the obvious discernment between urinary tract infections (UTIs) and chronic UTIs is frequency, but the causes and impacts are actually quite different.
"As a definition, we consider three or more infections in a year to be abnormal," said Betsy Greenleaf, D.O., a women's health advocate and a board-certified urogynecologist. "To avoid overexposure to antibiotics, traditional medicine general practitioners are taught to treat UTIs with a minimum of three to five days of antibiotics. Sometimes we have to put patients on weeks to months [of antibiotics] to clear up infections that are stubborn or have gotten deeper into the tissue, and just won't clear up, [which] can be a sign of stones, masses/tumors, foreign objects or even fistulas (holes between organs).
"Diabetes generally increases the risk of infection [and] neurologic conditions that can affect the functioning of the urinary tract, such as multiple sclerosis and Parkinson's," she added.
A look at causes
Considering how specific and small the area affected is, the most commonly known sources of UTIs tend to be hygiene problems. Edwina Caito, a writer, sex expert and sufferer of chronic UTIs, outlines the most common causes, such as penetrative sex with unwashed hands, the use of lubricants not meant for sex or a poor wiping routine, to name a few.
"UTIs are caused by bacteria entering the urethra," she said. "Bacteria can easily enter the urethra due to a prolapsed urethra and/or bladder."
Greenleaf explores the biological gap in UTIs. The female reproductive system is more susceptible to them, while individuals born with penises are less vulnerable.
"Women have a shorter distance for the bacteria to get into the bladder. The rectum, vagina and urethra are very close together," she said. "It doesn't matter how clean a woman is, it is very easy for bacteria to pass back and forth. It has been quoted ranging from 14 to 30 times more likely than men. [In menopause], changes in vaginal pH and microbiome of the vagina from the drop in estrogen [mean] women lose the healthy bacteria that keep the 'bad guys' away."
Chronic UTIs can also develop if a patient and healthcare provider mishandle the initial UTI. Greenleaf explained that the medical field's understanding of UTIs has come a long way, but still has a ways to go.
Too often patients request antibiotics for fast relief, but blindly taking antibiotics increases your risk of incomplete or nontreatment of the UTI and a much higher risk of chronic infection.
"When I trained [to become a urogynecologist], any urine sample that had bacteria in it was considered an infection," she explained. "Due to advances in science, we now know you can have bacteria in the urine and it not be an infection. Urine is not necessarily sterile, like we once thought. It is really important for the urine to be tested for the type of bacteria that is causing the infection. Too often patients request antibiotics for fast relief, but blindly taking antibiotics increases your risk of incomplete or nontreatment of the UTI and a much higher risk of chronic infection.
"You never truly kill all of the bacteria," she continued. "There is always bacteria that evolve and become resistant to antibiotics. It can be these new strains of bacteria that take over and cause a new infection."
Antibiotic-resistant bacteria can evolve in any kind of infection, but especially in the porous and delicate epithelial tissue of the reproductive system. However, more obscure conditions can factor in. Caito's chronic UTIs came about because of a far less common condition with very serious ramifications.
"In my case, the recurrent UTIs were caused by pelvic organ prolapse (POP)," she said. "My bladder, cervix, uterus, anterior and posterior vaginal walls had all prolapsed. One of the first symptoms of POP is recurrent UTIs, dribbling after urinating or when you cough, sneeze or laugh. Younger women can also experience POP if they are weight-lifters, runners, have jobs where they are on their feet all day or are required to lift more than 50 pounds. If you've had children, especially with forceps or a fast vaginal delivery [or] women who unknowingly have connective tissue disorders, like myself, [we] are more prone to POP."
Drink more water
Beyond chronic UTIs acting as a telltale sign for potentially larger problems, Greenleaf reassures us that avoiding the majority of UTIs is a slug of water away.
"We don't drink enough fluids, and many people are walking around chronically dehydrated," Greenleaf said. "The more you drink—as long as the kidneys are functioning—the more urine you will make. The more urine that is diluted will wash away the bacteria when urinating and prevent it from taking hold of the bladder."
Chalking up all UTIs to poor hygiene is a mistake, but so is not taking a UTI seriously. The rate at which a urinary tract infection becomes a kidney infection is different for everyone and can take anywhere from weeks to just a few hours. Chronic UTIs may be situational if the first UTI wasn't properly treated or if a person is symptomatic of a larger condition. The only way to be sure is to meet with a healthcare provider and have your urine tested.
Given the urgency of talking to a doctor and getting your urine tested, you don't want to wait long to see someone. Telehealth might be the best way to begin. Video visits are a regular part of many physicians' practices, and they're a good way to see a doctor quickly, as many offer same-day appointments. In-person follow-up might be required for conditions such as UTIs, but the first step is the most important. Giddy telehealth is an easy-to-use online portal that provides access to hundreds of healthcare professionals whose expertise covers the full scope of medical care.