Bladder Trouble

Recurrent Cystitis (Urinary Infection)

The urinary infection in women occurs to due to the close proximity of the urethra to the back passage and short urethra. There is passage of bacteria from the back passage and perineum through the urethra into the bladder causing bacterial infection and inflammation of the bladder. Patients with urinary infection can present with a burning sensation while passing urine and lower abdominal discomfort over the bladder area. The other symptoms are that of increased frequency of having to the go the toilet and rushing to pass urine (urgency). If the infection is severe there may be other associated symptoms of fever and feeling unwell. The urine can have a foul smelling odour during urinary tract infections

What are the predisposing factors for recurrent urinary tract infections?

In the majority of patients, there is no underlying cause for the urinary infections however the most common predisposing cause factors are postmenopausal oestrogen deficiency, any conditions affecting bladder emptying, obstruction at the level of the urethra , presence of stones in the bladder or urethra, diabetes and other immune comprised states can predispose to urinary tract infections.

How are the urinary infections diagnosed?

The confirmation of urinary infection should be made by sending a urine sample for culture and sensitivity. A urine dipstick examination also can give a quick diagnosis of urinary infection if there is a presence of leukocytes and substance called nitrates in the urine dipstick examination. Such urine samples which are positive for white cells and nitrates should be sent for laboratory culture and sensitivity to identify the bacteria causing the infection. More importantly it is necessary to rule out other conditions, sometimes even significant and sinister conditions could present with similar symptoms of urinary infections. These conditions should be ruled out first. Therefore it is necessary to investigate these patients who have recurrent urinary tract infections. They may require a bladder examination (cystoscopy) to rule out any other conditions like bladder tumours, any pouches in the bladder or urethra (diverticulum) and also bladder pain syndrome.

How are urinary tract infections treated?

The urinary infections can be treated by conservative measures by keeping a fairly high fluid intake and cranberry juice supplements. For post menopausal women it would be helpful to use oestrogen supplements in the form of topical oestrogen treatment by using vaginal pessaries or cream or to use systemic hormone replacement treatment.

At the time of bladder examination with a camera (cystoscopy) a urethral dilatation can be performed as a surgical procedural under general anaesthetic or a local anaesthetic as a day case. Though it is not clear how this procedure helps, about 60-70% of women with recurrent urinary tract infections do find significant improvement in terms of frequency of infections following this procedure.

Low dose continual antibiotic prophylaxis (preventive use) can be used with the principle of preventing the growth of bacteria to a significant level for them to cause inflammation and infection. This is done by prescribing a low dose of an appropriate antibiotic which was proven to be active against infection for a few months. In patients who have very frequent recurrence of infections, low dose antibiotics do help to reduce the frequency of infections. Other lifestyle and preventative measures would include keeping a good genital hygiene and also to wipe the perineum and pelvis from front to back after going to the toilet.

Women are advised to go to the toilet more frequently and avoid going very long periods. It would be healthy to urinate at least once every four hours.

Moderation of fluid intake, aiming for at least 1½ to 2 Litres of drinks per day which include 6 – 8 glasses of water, cranberry juice and other non-fizzy juices.

Avoid bathes with a preference given to showers and also to avoid any hygiene sprays and scented douches.

Some women may report a link of occurrences of urinary infections after sexual intercourse. It is advisable to empty the bladder after sexual intercourse. They may also benefit from using single dose of antibiotic just before sexual intercourse which is helpful in preventing infection in some women.