By Mary Antoinette Burns, M.D.
Most women reading this title know what I mean by bladder infection!
It is pretty common! It is estimated that half of all women will experience at least one urinary tract infection (UTI) in her lifetime. According to the American Urological Association, UTIs account for more than 8 million medical office and emergency room visits annually. Both sexes are affected but women are four times more likely to have a UTI than men. (Unfair I know! Men don’t have to deal with childbirth, PMS, or cramps either. )
What is a UTI? This typically occurs when bacteria colonizes in the vagina and seeds into the urethra and ascends into the bladder. It may ascend further up into the ureters and kidneys causing a more serious condition. Luckily, it typically remains in the bladder.
UTI is a general term we use. Your doctor may use more specific terms such as urethritis, cystitis, pyelonephritis, or nephritis depending on the location of the infection.
Most infections occur following sexual activity. Maybe you have heard of the term “honeymoon cystitis.” Typically our body does a good job of preventing infections–valves keep urine from flowing toward the kidneys and bacteria is flushed out during urinating. However sex presents an ideal opportunity for bacteria around the rectum and in the vagina to seed into the urethra and migrate up into the bladder.
What the symptoms? As I said most of you already know. Typically one feels pelvic pain or burning or stinging with urinating. A strong urge to urinate frequently occurs without relief. One may notice a strong odor or blood in the urine. One may have fever, chills or back pain. Elderly women may not have the typical symptoms, but instead feel fatigued or even mentally confused. Basically, you feel miserable!!
Think you have a UTI- what to do next?
First – as everything else in medicine it always makes sense to seek medical advice. Since UTI are so prevalent your doctor may initially treat you with a short course of antibiotics.
However, for high risk patients–those with neurological disorders (such as Multiple Sclerosis, Diabetes), the immunocompromised, elderly, history of renal disease, patients with prior uti in the past 6 months, presence of vaginal discharge, blood in the urine, fever or back pain, uses a urinary catheter, at risk for STD etc.–it is important to first obtain a urine specimen to analyze for infection and a physical exam may be indicated to check for STD infection and other abnormalities.
The good news is most cases are easily treated with short course of antibiotics (3-5 days typically) and one starts to feel better within 24-48 hours.
Other Helpful Natural Tips for dealing with a UTI:
- Drink penty of water- this helps cleanse the urinary tract of the bacteria.
- Avoid coffee, alcohol, and spicy foods – to prevent dehydration or irritate the bladder lining. Over the counter Prelief® contains calcium glycerophosphate which helps neutralize the acid in the bladder.
- Heating pad and pain relief medication are helpful. Prescription and over the counter products such as AZO® and Uristat® contain phenazopyidine which exerts a topical analgesic effect on the surface of the bladder and urethra. These are especially helpful in the first 24 hours of starting an antibiotic.
- Cranberry pills or juice- effective or not? It is questionable if cranberry is helpful. There is mainly antecdotal evidence (see below).
What can you do to prevent another UTI? Luckily there are some natural prevention tips that make sense, but have little proven scientific evidence.
- Drink plenty of water. It is good for your health to drink 64 ozs daily with water being the main beverage.
- Urinate after sex. This will help flush any bacteria that seeded into the urethra during sex.
- Good hygiene. Wiping front to back after urination or bowel movement will help keep the area around the urethra clean and avoid seeding.
- Avoidance of spermicidal jelly containing Nonoxynol 9. This medication decreases vaginal lactobacillus colonization (good bacteria) and increases bacterial adherence (bad bacteria is able to stick to the walls of the vagina better–not a good thing). HOWEVER, one has to weigh the benefit of reducing risk of UTI with risk of STD and pregnancy. Speak to your doctor if seriously considering changing your spermicide.
- For women in menopause the use of vaginal estrogen cream may be an effective preventive measure. Talk to your doctor to see if you are a candidate.
- Cranberry juice/tablets. It has long been thought that cranberry juice and vitamin C (ascorbic acid) supplements inhibit the growth of some bacteria by acidifying the urine. Its benefits have been antecdotal. In 2000, a review of clinical trials reported scientific studies were poorly performed and conflicting. Recently the Journal of the American Medical Association (JAMA) November 2016 published an excellent prospective double blind study (the best type of scientific study to perform). This trial studied 187 nursing home female residents for 1 year. Half of the residents ingested a standardized high dose of cranberry capsules (72 mg of the active ingredient proanthocyanidin which is equivalent to 20 ounces of cranberry juice) and half received placebo pills. They found no reduction of infection in the group taking daily cranberry. The conclusion was, at least in the older population, that cranberry is probably of no benefit in prevention of UTI.
- Lastly, for patients with recurrent UTI (meaning three episodes in 1 year or two episodes in 6 months documented by cultures), suppressive antibiotics may be of benefit. If sexual activity brings on infections- your doctor may prescribe a low dose antibiotic pill to take after sex. If recurrent UTIs are not correlated with sex, daily low dose antibiotic prophylaxis can be given for three to six months.
Let’s all raise our glass of cranberry juice and hope none of us ever have another UTI. Although the odds are against us!
Dr. Mary Burns is a board-certified obstetrician gynecologist with subspecialty board certification in Female Pelvic Medicine and Reconstructive Surgery. Dr. Burns completed fellowship training in Urogynecology/Female Pelvic Medicine and Reconstructive Surgery at Wayne State University. This is specialized training in treating disorders of the genitourinary system such as urinary incontinence, Interstitial Cystitis, and prolapse (bulging) of the vagina, bladder and/or the uterus. Dr. Burns practices full time at Virginia Beach Obstetrics & Gynecology, with offices in Virginia Beach and Norfolk, VA.