Chronic bladder infection: Is there a cure?

I have had a chronic bladder infection for the past four years. My doctor just keeps giving me antibiotics, but the infection keeps coming back. What can I do?

- Marina / Canada

Answer

You're not alone. It's estimated that as many as 20 percent to 30 percent of women will have at least one episode of bladder infection (cystitis), and about 2 percent to 4 percent of these cases will become a chronic condition.

There can be several causes of chronic bladder infections, such as:

• Kidney or bladder stones
• Bacteria entering the urethra during sexual intercourse
• Altered estrogen levels during menopause
• Abnormal urinary tract shape or function
• Genetic predisposition

In general, women who have two or more bladder infections in a six-month period should be evaluated by a urologist to determine the underlying cause. The evaluation may include:

• Urine culture obtained with a catheter
• Cystoscopy — looking into the bladder with a lighted scope
• Computerized tomography (CT) scan

Treatment is directed at the underlying cause, when possible. If no source of infection is found, lifestyle modifications combined with vaginal estrogen replacement is all you may need. Lifestyle modifications that may reduce your risk of bladder infection include:

• Drink plenty of liquids, especially water.
• Urinate frequently.
• Wipe from front to back after a bowel movement.
• Take showers rather than tub baths.
• Gently wash the skin around your vagina and anus on a daily basis using a mild soap and plenty of water.
• Empty your bladder as soon as possible after intercourse.
• Avoid using deodorant sprays or scented feminine products in the genital area.

Otherwise, long-term, low-dose, preventive antibiotics is the only treatment option. In such cases, you may need to take antibiotics for as long as six months to two years. Researchers are trying to develop a vaccine for some women who seem to be very prone to bladder infections without any identifiable cause other than a genetic predisposition.

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