Many women live for years with a diagnosis of “chronic cystitis,” believing that the disease is simply impossible to defeat. The pattern seems familiar: symptoms appear — a pill is taken — relief comes — and a month later everything starts again. In medicine, this condition is called recurrent cystitis, and most often the problem is not a “bad” medication, but the fact that the hidden causes of the disease remain unaddressed.
Treatment mistakes: why does cystitis come back again?
The most common mistake is treating each episode as a separate, random event. If cystitis returns more than 2 times within six months, this is a reason not just to take antibiotics, but to change the overall strategy. Another issue is cystitis after antibiotics, when medications are taken without proper control. Frequent antibiotic use alters the gut and vaginal microbiome, destroying protective lactobacilli. This creates conditions in which pathogenic bacteria (most commonly Escherichia coli) can more easily colonize the urinary tract. In addition, bacteria develop resistance, and familiar cystitis treatments stop working.
Recurrent cystitis: a new infection or the old one?
It is important to understand the difference between reinfection and recurrence (relapse):
• Reinfection (90% of cases): You were completely cured, but after two weeks or a month bacteria entered the bladder again from external sources (for example, from the intestinal or vaginal microbiota)
• Relapse (recurrence): Symptoms return less than two weeks after treatment with the same bacterial strain. This is a rare situation and suggests the presence of a “hidden focus” in the body — for example, a kidney stone or a structural abnormality where bacteria can “hide” from medications
Why are there symptoms, but the tests are “clean”?
Sometimes patients complain of persistent cystitis, but urine tests show no bacterial growth. In such cases, doctors look for non-infectious causes. Often, women mistake nonspecific or chronic bladder irritation symptoms for cystitis; these may be caused by other processes in the pelvis. There is also a hypothesis of “intracellular reservoirs”: bacteria may penetrate bladder epithelial cells and remain there in a dormant state, not detected by standard tests, yet still causing discomfort.
Cystitis and sexual activity: a direct connection
For many women, an important question is why cystitis occurs after sex. Sexual activity is one of the strongest risk factors. During intercourse, bacteria can be mechanically transferred into the urethra. If this is combined with the use of spermicides (in lubricants or diaphragms), the risk increases many times over, as they alter the chemical environment and destroy beneficial flora. In such cases, a doctor may suggest specific preventive strategies related directly to sexual activity.
Hidden causes: why it’s important to look deeper
If cystitis without treatment effect has been troubling you for years, the reasons may be deeper than simple infection exposure:
- Genetics: In some women, cells of the mucous membrane have specific receptors that allow bacteria to adhere more easily. This is a hereditary predisposition
- Hormonal background: In postmenopausal women, estrogen deficiency alters the tissues of the urogenital system, making them more vulnerable to infection
- Anatomy and physiology: Cystocele (bladder prolapse), incomplete bladder emptying, or urinary incontinence create conditions for constant bacterial growth
When is a more in-depth evaluation needed?
In most cases, a urologist needs only your symptoms and a standard urine culture. However, there are situations when expert evaluation (kidney ultrasound or CT scan) is necessary to rule out pathology:
• If the bacterium Proteus is constantly detected in urine (often associated with stones)
• If blood remains in the urine after treatment
• If you have a history of passing kidney stones
• If the infection is accompanied by high fever and lower back pain
How to break the vicious cycle?
Chronic cystitis, the causes of which often lie in lifestyle and biology, requires not “strong antibiotics,” but well-designed prevention. Increasing fluid intake to 2–3 liters per day, avoiding spermicides, and, in some cases, using local estrogen therapies (for menopausal women) can reduce the frequency of episodes by 50% or more.
Remember: recurrent cystitis rarely leads to long-term health problems such as kidney disease if there are no anatomical abnormalities. The main goal of the doctor is to restore your comfort and confidence in your own body.