Content caching has limitations on achieving cache gains (e.g., cache hit ratio) in small cell networks, due to limited storages of small base stations (SBSs) and inherent user demand patterns (i.e., initial content preferences). Two effective approaches have been proposed to exploit the potential of content caching: SBS cooperation to utilize cache storage, and proactive content recommendation to shape user demand. In this paper, we investigate cooperative content caching and recommendation to maximize cache gains, while guaranteeing users’ satisfaction by recommending appealing content items. We propose a generic framework for cooperative content caching and recommendation, based on which we propose an online and distributed scheme by designing a continuous-time Markov chain (CTMC). In particular, online content caching (a.k.a., content replacement) is implemented by hopping from one cache state to another in the CTMC, while content recommendation is performed heuristically through sequential fixing at each cache state. Besides, we characterize the performance gap between our proposed scheme and the theoretical optimum in terms of cache hit ratio. Simulation results demonstrate that the proposed scheme achieves better cache hit ratios than other schemes in single-BS scenarios, and provides a competitive solution in multiple-BS scenarios.