Bladder Infections

Bladder Infections

Too Familiar
to Too Many Women

It's Tuesday morning and you're zipping through your to-do list with relative ease. Everything is going smoothly.

Until you take a break to visit the ladies room, that is. You start to urinate, but suddenly you feel a burning pain beyond belief. You know that feeling all too well, because you've felt it before. It's a bladder infection, and you'll have to pay a visit to the doctor, start taking antibiotics and get into that cranberry juice routine. You don't have time for this kind of hassle.

Most of us are all too familiar with bladder infections, frequently referred to as urinary tract infections (UTIs). Besides that burning feeling during urination, there can be a frequent need to urinate, pain in the lower back or pelvic area and pain during intercourse.

An estimated 25 to 35 percent of women between the ages of 20 and 40 have had at least one bladder infection. Men can get UTIs too, but they're much more common in women. They're the reason for an estimated seven million visits to the doctor and one million hospital admissions each year. These infections are not only painful and inconvenient, they can progress to more serious infections of the kidney if not stopped in time.

Why Us?

The bacteria that cause bladder infections--there are several kinds, but one common type is Escherichia coli--reside in the bowel, where they cause no problems. But if they migrate the short distance from the anus to the opening of a woman's urinary tract, they can lead to infection, says Grant Mulholland, M.D., chairman of the Department of Urology at Jefferson University Medical College in Philadelphia.

The lining of the vagina contains good bacteria called lactobacillus that can protect against the overgrowth of the bad bacteria. But when the bacterial balance in the vagina is disturbed, the bad guys can take over and ascend into the urinary tract. The result? A bladder infection.

What can throw off the balance? Wiping from back to front after a bowel movement, for one thing, because it can help bad bacteria get into position to multiply and wreak havoc.

Using diaphragms, spermicidal jellies or foams can also change the bacterial balance, says Dr. Mulholland. So can sexual intercourse, since bacteria can be forced up into the bladder. And the use of tampons may also play a role by disrupting the normal defense mechanisms within the vagina. "Women who use tampons may have a higher incidence than women who just use a pad," says Dr. Mulholland.

The hormonal changes that take place at menopause can also spur the development of UTIs. When estrogen levels drop, the pH level of the vagina changes and the number of good bacteria declines, says Kimberly Workowski, M.D., assistant professor of medicine in the Department of Infectious Diseases at Emory University in Atlanta. UTIs increase by 1 to 2 percent each decade after menopause.

Some Are Lucky

Not every woman will get a bladder infection, however--even if she's at risk. That's because some women have a natural defense against bacteria's ability to stick to the bladder wall and cause a raging infection. These women have special substances in their blood called antigens that act as shields, preventing the bacteria from latching on, says Dr. Mulholland. But most women don't know whether they have this substance in their blood, and this defense is not always foolproof, so it pays to practice good habits.

There are several types of bladder infections, although their symptoms are similar. Some women get what doctors call uncomplicated urinary tract infections--occasional bouts that are easily cured. Other women get complicated infections, which have an underlying cause such as an obstruction in the urinary tract, a malformation of the urethra or kidney stones, which are rare in women. And some women get recurring infections.

Most UTIs can be cured with antibiotics. Others--about 10 percent of total cases--progress into more serious infections of the kidney.

Getting to the Problem

You may have had a bladder infection or two, and you might get another. If you're plagued by bladder infections, here's what you need to know--both to prevent and treat this nuisance.

Go to the bathroom after sex. "It's been found to be helpful to urinate right after intercourse," says Dr. Mulholland. This washes out any bacteria that may have worked their way into the bladder.

Drink fluids. One of the folk remedies for bladder infections is to drink fluids when you feel the symptoms coming on, says Dr. Mulholland. "I suppose this helps because it tends to wash out the urinary tract."

Stick with cranberry juice. Most of us have heard we should drink cranberry juice for a bladder infection. This advice has been around for a long time, but scientific studies have finally lent credence to the claim.

Animal studies indicate that certain compounds found in cranberry and blueberry juices prevent the E. coli bacteria from sticking to the bladder wall. And a study of 153 elderly women, conducted by researchers at Harvard Medical School, provides further support for the cranberry argument. Women were asked to drink about ten ounces of cranberry juice or a placebo drink daily for six months. The women who drank cranberry juice had less bacteria in their urine than women who drank the placebo. While the study did not show that cranberry juice drinkers had fewer urinary tract infections, it indicates that cranberry juice may keep harmful bacteria at lower levels.

Skip sex just before your period. Women who find they are most vulnerable to bladder infections during certain phases of their menstrual cycle may want to avoid having sex then, says Dr. Mulholland. For many women, this susceptible time tends to be right before their period, when levels of estrogen, a hormone that maintains vaginal health, are low.

Switch contraceptives. If you are using contraceptive jellies and foams and experience recurrent infections, talk to your doctor about other contraceptives. "The jelly actually has a direct effect on the ease with which bacteria can get into the vagina and infect the bladder," says Dr. Mulholland. Contraceptive jelly is probably the reason that women who use diaphragms often have problems, he says. Whether the cervical cap carries the same risks is not known, he adds.

Get treated. Sometimes even if you do all the right things, you'll still get an infection. If you think you've got one, call your doctor immediately for an appointment. Some doctors will prescribe an antibiotic over the phone, but it's a good idea to get a urinalysis to confirm that it's a bladder infection. Antibiotics are used to treat UTIs, and there are now seven-day, three-day and one-day regimens available. Ask your doctor about the pros and cons of each.

While the one-day treatments can be effective, a significant number of women experience a recurrence, says Dr. Mulholland. Most doctors agree that the safest way to treat UTIs is with the three-day regimen, he says.

Self-treat. Women who get recurrent UTIs that are uncomplicated may get a supply of fairly low-dose antibacterial medication from their doctors, says Dr. Mulholland. Taking the prescribed dose after intercourse may prevent an infection.

Find the right doctor. If you get a lot of recurrent infections, say six to eight a year, work with your doctor to identify the problem, says Jerry G. Blaivis, M.D., clinical professor of urology at the New York Hospital-Cornell Medical Center in New York City. Find a health professional who will sit with you and outline a plan for diagnosis and treatment, including a review of a diary of your activities and symptoms. Talk about what seems to bring on the infection, how much you are having sex and what contraceptives you are using.he