What is a bladder infection?
A bladder infection, also known as cystitis is the inflammation of the bladder wall. It is usually caused by bacteria. Bladder infections are common in women. More than half of the women develop a bladder infection at some stage of their life. Bladder infections are very rare in males. However the risk of bladder infection in men increases as they age due to the increase in their prostate size.
The exact reason why women are more affected than men is not known but they think it is because women have a shorter urethra, the tube carrying urine out of the bladder. In women, the urethra is short about one and a half inches long. Therefore the bacteria can easily enter the bladder as it is only a short distance to travel. In addition, the urethra is found close to the woman’s vagina and anus. Therefore bacteria from those areas can easily gain access to the urethra.
Cystitis is common. It is not a serious infection if treated early and accurately. However, it is common to get number of recurrences during their lives. Rarely, the infection can ascend up to the kidneys causing kidney infections. This can result in damage to kidneys permanently. Therefore it is important that you get your bladder infection treated as early as possible and take precautions to avoid future recurrences.
A bladder infection can occur all of a sudden, known as an acute infection or it could keep recurring for a long period of time known as a chronic infection.
What are the causes of bladder infection?
Bladder infections are usually caused by bacterial organisms. They can travel through the urethra into the bladder causing an infection. Normally, the body removes bacteria from the urinary tract by the flushing action during urination. In men, the prostate secretions help to eliminate bacteria. However, sometimes these bacteria can cling on to the walls and multiply. The increasing bacterial population overrides the body’s ability to destroy them thus leading to bladder infections.
The commonest organism that is responsible for bladder infections is Escherichia coli (E. coli). This is a naturally occurring bacterium found in the large intestine. Bladder infections can result if the E.coli number is increased or if they are not eliminated through urination.
Other causative organisms include Chlamydia and Mycoplasma. Unlike E.coli, these organisms are transmitted through sexual intercourse and therefore can affect your reproductive system as well. Frequent sexual intercourse makes it easier for bacteria to enter the urethra. Such infections are termed as Honeymoon cystitis.
Other causes of bladder infections include:
- Use of diaphragms and condoms also increase the chance of bladder infections.
Spermicides used in diaphragms and condoms can suppress the normal healthy bacteria in the vagina and allows the bad bacteria to cause an infection.
- Rectovaginal fistula
Rarely, cystitis can recur due to an abnormal connection between the vagina and the anus.
- Prostate infection
In males, the commonest cause of cystitis is the bacterial infection of the prostate. Even though antibiotics have the ability to quickly clear off bacteria in the bladder, they do not have the ability to reach the prostate. Therefore to cure a prostate infection, weeks of antibiotics has to be taken.
- Bladder or urethral stones
Stones in the bladder or urethra will obstruct the flow of urine which will result in collection of urine in the bladder. This provides a good environment for the bacterial organism thus leading to an infection.
- Strictures or narrowing of the urethra
- Prostate enlargement which may cause kinking of the urethra and therefore results in bladder outflow obstruction.
- Insertion of a catheter or any other instrument to the urinary tract.
What are the risk factors of bladder infections?
Females have an increased risk of developing bladder infections than men. The reason for this is that women have shorter urethras, thus making it easier for the bacteria to reach the bladder. In addition, the female urethras are in close proximity to the anus, where many bacteria are found therefore there is a shorter distance for bacteria to travel.
Other risk factors include:
- Elderly people
- Reduce fluid intake
- Insertion of a urinary catheter
- Blockage of the bladder outflow tract
- Abnormalities of the urinary tract, which is caused by birth defects or injuries.
- Urinary retention
- Narrowing of the urethra
- Enlarged prostate
- Fecal incontinence
- Diabetes mellitus
What are the symptoms of bladder infection?
Signs and symptoms may not be the same in each and every person. It may also depend on the severity of the infection. Typically, the initial symptoms you may notice are changes in the urinary tract. As the condition worsens, pain may develop.
The following signs and symptoms can occur:
- Dysuria – Burning sensation during urination.
- Frequent urination
- Urgent need to urinate
- Urinary urge incontinence – Uncontrollable loss of urine. It is a common occurrence in elderly people.
- Fever is rare but may occur
- Lower abdominal pain
- Nocturia – Frequent urination at night
- Cloudy or blood stained urine
- Strong foul smelling odor with urine
- Back pain on either side – This is usually the kidney pain that you will feel. This indicates that the infection has spread to the kidneys.
How is a bladder infection diagnosed?
A doctor can make a diagnosis based on the symptoms you experience. However, the diagnosis can be confirmed by performing a urine analysis. This test is done to test a sample of your urine for the presence of:
- White blood cells
- Red blood cells
- Other chemicals
For this test, you have to provide a mid-stream or a clean catch sample of urine. This is to make sure that the urine sample is not contaminated with bacteria from the vagina or the tip of the penis.
The presence of nitrites in urine can be detected by dipping a testing strip into the urine. Nitrites are usually not found in urine. It is a substance released by the bacterial organisms. In addition, the sample is tested under the microscope to look for white blood cells, red blood cells and bacteria.
If during this test, it is confirmed that you have a bladder infection, then your doctor may order further tests such as a urine culture to identify the number and type of bacteria causing the infection. Together with this, they will also order an antibiotic sensitivity test (ABST) to find out what antibiotics will help clear off the bacteria soon. The results of these investigations will help your doctor to plan your management effectively.
What is the treatment for bladder infections?
The aims in the treatment of bladder infections are to kill the bacteria and to relieve the pain and burning sensation. Therefore the treatment includes:
Since bacteria are the usual cause, antibiotics are used. Before prescribing antibiotics, your doctor will find out if you have an underlying condition that may worsen the cystitis such as diabetes mellitus, weakened immune system or a structural abnormality. Such conditions will need more powerful antibiotics for a longer duration. This is because the infection is likely to return again after stopping the antibiotic treatment. People with such conditions, may also have infections caused by other organisms such as fungi or atypical bacteria. They will require different medications other than antibiotics.
The usual duration of treatment is just 3 days for women with uncomplicated bladder infections. However, if the infection does not seem to go away, the treatment may be continued up to 7 to 10 days. In men, the usual underlying cause is prostatitis and thus needs antibiotic treatment for weeks.
Your symptoms may disappear within a few days after starting treatment but it is important that you continue to take your drugs as prescribed.
A common analgesic drug used in bladder infections is Phenazopyridine (Pyridium). This does not treat the infection but provides analgesia to the urinary tract. It will help you to bear the pain while you wait for antibiotic treatment to take its effect. This drug can be bought over the counter but speak with your doctor before you take them.
Topical estrogen for postmenopausal women with recurrent bladder infections.
If you have a physical obstruction or a structural abnormality in the urinary tract that makes infections more likely, you will need to undergo surgery.
How can you prevent bladder infections?
If you have experienced 3 or more bladder infections within the past year, then these preventive measures may help you:
- Drink more water; Drink at least 6 to 8 glasses of water a day.
- Wear cotton underwear.
- Urinate as soon as you feel the need to.
- Urinate soon after sexual intercourse
- Avoid using condoms and diaphragms with spermicides in them; Change to an alternative form of contraception.
- If you are a female, wipe from front to back after urinating.
- Prophylactic antibiotic treatment – Your doctor may prescribe you low dose antibiotics to be taken daily or when you feel the symptoms of bladder infection. You may also be given a single dose of antibiotic drug after sexual intercourse.