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.

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)

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.

Other tests may also be ordered including a pyelogram, a study using dye to look at the flow of urine through your kidneys and bladder, if some anatomic abnormality is suspected as the cause of the infections.

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 or are particularly severe, or if a patient has had complications of cystitis in the past (including kidney infections or bloodstream infections), antibiotics are used.

Surgery is rarely necessary unless a serious underlying anatomical problem is the source of recurrent infections.

If symptoms are mild, patients 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 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.

A physician should be contacted if any of the symptoms of cystitis last more than 2-3 days, if they are particularly severe, or if they include fever, chills, or back and abdominal pain, which might suggest a more serious infection.

If patients have recurrent infections despite the altering of habits that might lead to infection, several methods have been used successfully to prevent recurrences. These include taking an antibiotic after sexual intercourse, taking an antibiotic when symptoms of cystitis arise, or taking an antibiotic on a daily basis even when healthy.

A physician 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.