Chronic UTI in women – why do I keep getting urinary tract infections?

For some women these symptoms never let up, instead they're a constant unwelcome presence. So could it be a chronic – or long-term – UTI?

First thing’s first – chronic UTI is different from recurrent UTIs (RUTI). "Recurrent UTIs in women are a well-known condition where you get 2 or more UTIs in 6 months, or 3 or more UTIs in a year. What’s less well understood is when the infection never goes away completely, or when a UTI comes right back after antibiotics, but is hard to pick up on tests. The theory behind chronic UTI is starting to get more attention and it might help explain the symptoms that some women experience," says doctor and Healthily expert, Dr Adiele Hoffman.

"We don't yet have ideal diagnosis processes or treatments for chronic UTI because it’s not yet fully understood. But the good news is that more research is being carried out and world-renowned organizations are starting to acknowledge it. For example, the NHS in the UK recognised chronic UTIs in 2022 as a separate condition to UTIs."

Read on to find out what we know about chronic UTI so far, what women say it feels like and where to get support and treatments that are available.

What is chronic UTI?

The theory around chronic UTI causes is that it happens when bacteria from a UTI are not completely cleared. This could be for many reasons and experts aren’t exactly sure why. One theory is that some bacteria stays in your pee and moves from there into the cells of your bladder wall. Here, they’re sheltered from antibiotics and they become harder to kill. Your body’s response is inflammation, which is what leads to those persistent symptoms.

This is different from RUTI which is when your UTI comes back after being cleared.

If you’re prescribed antibiotics to clear your UTI (read more about treatment for UTIs) but you find that antibiotics don’t work, or that urine tests don’t pick up a UTI even though you have symptoms, you might have a chronic UTI.

Why might antibiotics not work for a UTI?

It’s thought that the short courses of antibiotics that are usually given to treat UTIs aren’t effective against chronic UTIs. Here are some possible theories on why:

• antibiotic resistance – where antibiotics don’t kill the bacteria – is common in UTIs
• bacteria might protect themselves against antibiotics and your body’s immune system by hiding inside the cells of your bladder wall
• it may not be enough to prescribe a single antibiotic for UTIs as it’s thought that chronic UTIs may be caused by several different types of bacteria

Why your chronic UTI may not show up in a urine test

There are several reasons why your UTI could escape detection on urine tests that are used to diagnose UTIs:

• like all medical tests, the dipstick – a plastic strip that is placed in your pee to check for signs of infection – and urine culture tests (where you give a pee sample and growth-promoting substances are added in a lab. If there are bacteria in your pee, they multiply) don’t pick up all infections
• drinking too much water before a test can dilute bacteria in your pee
• taking a current course of antibiotics may lead to a false negative – where the urine test doesn’t pick up signs of infection even though they are there

Chronic UTI symptoms

The symptoms are usually the same as any UTI but with chronic UTI, they come back quickly after treatment or they don’t go away completely. Symptoms can vary from person to person. To find out about the symptoms of a UTI, read our article "Urinary tract infections (UTI) in women – how to treat them."

What do women with chronic UTI say it feels like?

Chronic UTI can be debilitating. It can affect your quality of life, leaving you feeling drained and isolated. Some women have described being in so much pain that they’re unable to do anything – leave the house, work, sleep. For others, the constant discomfort leaves them unable to have sex. "Your social, family, work and love lives can all take a hit under the strain of chronic urinary symptoms," says Dr Adiele. "These symptoms can be tricky to get to the bottom of and can mean you may need to take time off work or feel too unwell to go out. As well as having your symptoms properly investigated, it can help to talk to other women who are in a similar situation."

See below for where to find support for chronic UTI.

When to see your doctor

You should make an appointment with your doctor if you have:

• UTI symptoms that don't go away completely or come back very frequently, even if your urine tests are negative, it could be a sign you have chronic UTI. Your doctor may suggest further tests or refer you to a specialist
• new urinary symptoms and you feel unwell

Use our free Smart Symptom Checker to help you work out your next steps.
Get a same-day doctor’s appointment or urgent care if you have:

• any symptoms of a kidney infection. Symptoms include fever or chills, nausea and vomiting, and pain in your back

Useful tips on communicating with your doctor

If you’re dealing with the frustration and anxiety of chronic UTI, here are some tips for smooth communication with your doctor to help you get a diagnosis and the right treatment:

• keep a log of your symptoms. It’s really useful to record timings of your symptoms, and whether you notice symptoms more after sex or when you don’t drink enough
• it’s also worth noting down your urine results, any other test results and treatments – whether they worked and how long for
• ask your doctor for a urine sample pot you can keep at home. You can then do a sample when you get symptoms and drop it into your doctor’s office without needing an appointment
• talk to your doctor about getting a referral to a specialist center. You usually need to see a specialist team for treatments for chronic UTI – it’s an emerging condition so the best treatments are still being researched. If you’re prescribed long-term antibiotics (see below for chronic UTI treatment) your doctor will consider the risks versus the benefits, so your treatment plan will be discussed and usually monitored. Be aware that wait times for specialists can be long

How is a chronic UTI diagnosed?

Depending on what specialist center you visit, you may have:

• a dipstick test: this is the most common test and looks for the levels of white blood cells, red blood cells, protein and nitrites – these are produced by bacteria so are a marker of bacteria – in your pee. Your doctor can use this to assess whether you have bladder inflammation or an infection
• a mid-stream urine culture (MSU): this sample will be checked at a local or hospital lab. The dipstick will be reapplied and another check is made to look for other components in your urine, plus your urine pH
• specialist bacterial testing such as PCR (polymerase chain reaction), broth culture or fresh urine microscopy: these tests aim to identify the bacteria strains and the numbers of the strain, to indicate whether you have an infection in cases where it’s suspected that regular tests aren’t picking up infection. We're still learning which of these tests are useful and if they could help diagnose chronic UTIs

Chronic UTI treatment

Chronic UTI treatment has not been fully studied in research so at the moment, we don’t have scientific proof of exactly what works, any licensed treatments or any national guidelines on the condition. Your specialist may recommend treatment based on their experience and what experts know so far, for example, a combination of:

• long-term or short-term antibiotics
• Methenamine hippurate – this is a urinary antiseptic and non-antibiotic alternative, which has shown some promise in studies for recurrent UTIs, so it’s thought it might help with chronic UTIs, too

Natural and home remedies for chronic UTI

Alongside the treatments mentioned above, natural remedies that are sometimes used for preventing regular UTIs, include:

• D-mannose: this is a nutritional supplement that comes as a powder or pills. It’s a type of natural sugar found in some fruits and it's thought to stop bacteria sticking to your urinary tract
• cranberry products such as juice, tablets or capsules. But although cranberry remedies are a popular choice, there isn’t much evidence that they reduce the risk of getting UTIs

Our health stories are designed to give women's voices more space and time to really share their experiences and tips with you. If you don't have time to watch the whole of Danni's video right now, you can:

• just listen to the audio while you go about your day
• bookmark this page to come back to when you've got a few minutes

Where to find support for chronic UTI

When you have ongoing symptoms that impact your life, it can leave you feeling confused, frustrated and like no one understands what you’re going through. So it’s useful to know where you can turn to for support. You might find it helpful to discuss your symptoms with friends and family you trust, or there are support groups out there. You could try:

• Chronic UTI Info has information on online support groups and information on US and UK specialists who may be able to help treat your chronic UTI
• Chronic Urinary Tract Infection Campaign (CUTIC) is a UK-based campaign group run by people with chronic UTI and parents of children with chronic UTI. They campaign for improved testing and treatment of the condition, and also have information on US specialists who treat chronic UTI
• Live UTI Free is a platform run by a woman who has experienced recurrent UTIs. You’ll find lots of information on chronic UTI, too
• Bladder Health UK is a charity which runs a telephone support line if you’re dealing with chronic UTI