Recurrent cystitis is a bladder infection that occurs at least twice in 6 months, or three times in a year.

See also: Urinary tract infection

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

Risk factors for recurrent infections include:

• Certain anatomical problems of the female pelvis
• Certain large kidney stones
• Diabetes
• Family history of recurrent infections
• First infection at a young age
• Sexual intercourse with multiple partners
• Stents used to treat urinary obstructions
• Use of spermicides

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

The symptoms of recurrent cystitis include:

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

Recurrent cystitis is confirmed by tests that show the growth of bacteria in the urine.

Urinalysis also shows white blood cells, occasionally red blood cells, and the specific type of bacteria causing the infection (usually E. coli).

A urine culture can help your doctor determine the specific bacteria and which antibiotics will best treat the infection.

If you have a severe infection, fever, and back pain that lasts for more than a few days, your doctor may also order the following tests to rule out a kidney infection:

• Additional blood tests
• Kidney CT scan
• Kidney ultrasound

If a physical problem is believed to be cause of the infections, an intravenous pyelogram will also be done.

Persons with recurrent cystitis are encouraged to drink large amounts of fluid to help increase urination and remove the bacteria from the body.

Antibiotics may be given if the infection is caused by bacteria. Your doctor may wait for the results from the urine culture. This usually takes 36 - 48 hours.

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

Surgery is rarely necessary, unless a serious underlying problem is found. Kidney stones may need to be removed.

If symptoms are mild, you 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.

Call your health care provider if your symptoms last more than 2 - 3 days, if they are particularly severe, or if you have fever, chills, or back and abdominal pain, which might suggest a more serious infection.

If you have recurrent infections despite the changing habits that might lead to infection, your doctor may recommend taking an antibiotic after sexual intercourse, when symptoms of cystitis arise, or a daily basis even when healthy. Talk to your doctor about your options.

A health care provider 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.

Foster RT Sr. Uncomplicated urinary tract infections in women. Obstet Gynecol Clin North Am. 2008 Jun;35(2):235-48, viii.

Norrby SR. Approach to the patient with urinary tract infection. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 306.