Bladder Infections in Women: 12 Ways to Keep Cystitis at Bay

May 6, 2019

Bladder infections (a.k.a., cystitis) are common among women. Acute cystitis is a bladder infection that typically causes the following symptoms:

  • Pain/burning
  • Frequent urination
  • Urinary urgency (“gotta go”)

Additional symptoms that may occur include: urinating small volumes, bleeding, and urinary incontinence (leakage).

Microscopic inspection of urine usually shows bacteria, white blood cells and red blood cells.  80-90% of cystitis is caused by Escherichia coli, 5-15% by Staphylococcus and the remainder by less common bacteria including KlebsiellaProteus, and Enterococcus.

The occasional occurrence of cystitis is a nuisance and often uncomfortable, but it is usually easily treated with a short course of oral antibiotics. When bladder infections recur time and again, it becomes important to fully investigate the source of the recurrence.

Bladder infections occur when bacteria gain access to the urinary bladder, which normally does not have bacteria present. The short female urethra and the proximity of the urethra to the vagina and anus are factors that predispose to cystitis.

For an infection to develop, the vagina and urethra usually have to be colonized with the type of bacteria that can cause an infection (not the normal healthy bacteria that reside in the vagina). These bacteria must ascend into the bladder and latch onto bladder cells.

Bladder Infections in Young Women

Women aged 18-24 years old have the greatest prevalence of bladder infections and sex is usually a key factor. The most common risk factors include:

  • A new sexual partner.
  • Recent sexual intercourse.
  • Frequent sexual intercourse.
  • Spermicides, diaphragms and spermicide-coated condoms (which can increase vaginal and urethral colonization with E. Coli).

Bladder Infections in Older Women

Cystitis is common after menopause, based upon the following factors:

  • Female hormone (estrogen) deficiency, which causes a change in the bacterial flora of the vagina such that EColi replaces Lactobacilli.
  • Age-related decline in immunity.
  • Incomplete bladder emptying.
  • Urinary and fecal leakage (incontinence), often managed with pads, which remain moist and contaminated and can promote movement of bacteria from the anal area towards the urethra.
  • Diabetes (particularly when poorly controlled, with high levels of glucose in the urine that can be thought of as “fertilizer” for bacteria).
  • Neurological diseases that impair emptying or cause incontinence.
  • Pelvic organ prolapse.
  • Obesity.
  • Poor hygiene.

12 Ways to Help Keep Cystitis at Bay:

  1. Stay well hydrated to keep the urine diluted.
  2. Wipe in a top-to-bottom motion after urination or bowel movementsAt minimum, urinate every four hours while awake to avoid an over-distended bladder.
  3. Maintain a healthy weight.
  4. Urinate after sex.
  5. If infections are clearly sexual-related, an antibiotic taken before or right after sex can usually preempt the cystitis.
  6. If you are diabetic, maintain the best glucose control possible.
  7. Seek urological consultation for recurrent infections to check for an underlying and correctable structural cause.
  8. Cranberry extract. Cranberries contain proanthocyanidins that inhibit bacteria from adhering to the bladder cells. There are formulations of cranberry extract available to avoid the high carbohydrate load of cranberry juice.
  9. Probiotics such as lactobacillus. These bacteria promote healthy colonization of the vagina, production of hydrogen peroxide that is toxic to bacteria, maintenance of acidic urine, induction of an anti-inflammatory response in bladder cells, and inhibition of attachment between bacteria and the bladder cells.
  10. D-MannoseThis sugar can inhibit bacteria from adhering to the bladder cells.
  11. Estrogen creamApplied vaginally, this can help restore the normal vaginal flora as well as uro-genital tissue integrity and suppleness.
  12. Vaccination. Currently in the research phase, the concept is an oral vaccine or vaginal suppository capable of providing immunity against the typical strains of bacteria that cause infections.

Written by Dr. Andrew Siegel

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