ZocdocAnswersThickened bladder wall and chronic urinary tract infections. What should I do?

Question

Thickened bladder wall and chronic urinary tract infections. What should I do?

Hi since I was 15 (I'm now 25) I have been suffering from Utis. I get them a few times a month. I've literally had hundreds. I get one every time I have intercourse with my boyfriend and sometimes even when I don't, it's very painful and I have the constant urge to void even if I don't really have to. When I have them I urinate blood and what looks like pieces of tissue. I've tried everything from cotton underwear, unscented soap, peeing after sex. Nothing works!! And I wipe correctly so it's not that. I had a ultra sound done and it showed a thickening of my bladder wall. What could be causing this? I have an appointment with a urologist but that's not for another month. I thought maybe a narrow urethra? But would that cause the cystitis or could the cystitis simply be from the chronic infections? I just started college, I'm studying to be a PA at the moment and this issues has really taken a toll on my studies. Very distracting!

Answer

I am sorry to hear about your urinary tract infections; this sounds like a very frustrating problem. I am glad that you have an upcoming urology appointment, and would recommend that you continue to work with your physicians. Recurrent UTIs are relatively common among young women, although to truly have hundreds over the course of several years would be unusual. We know there there are certain biological and genetic factors that make some women more prone to UTIs than others, but there are also behavioral changes that can minimize the risk of becoming infected. It sounds like you have already been educated in these practices, but they generally include: avoiding the use of spermicides (especially with diaphragms), urinating early after intercourse, and drinking plenty of fluids. Finally, women with certain pelvic anatomies-- particularly those with a shorter distance from the urethra to the anus-- are more likely to get UTIs. In women who have recurrent UTIs such as yourself, it is reasonable to undergo further evaluation, including an ultrasound (which you have had), possibly a CT scan, and (if your urologist feels strongly) a test called excretory urography. This would be especially reasonable if you have had recurrent kidney infections. Because you have had so many UTIs, it would be a good idea to discuss preventative antibiotic usage with your urologist. There is good data to show that continuous, post-intercourse, or intermittent symptom-based antibiotics can be highly effective in preventing UTIs. I hope that this is useful food for thought, and I would again encourage you to discuss these ideas with your urologist. Best of luck!

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