Bladder infection, medically termed cystitis is one of the most common forms of urinary tract infection in women due to the fact that the urethra in women is short compared to the male urethra. For this reason it is much easier in women for bacteria to invade the bladder in a retrograde fashion. Another reason is that hormone changes with pregnancy lead to less peristaltic activity of the ureter, the bladder and the urethra. The end result is that infections in the bladder happen easier during pregnancy and happen more often in non pregnant women than in men.
Bladder infection symptoms
Infection of the bladder, or “cystitis” in medical terms, happens usually suddenly. The urine production is changed in that there is painful and frequent urination of small amounts (polyuria).
There is an urgency to urinate even when the bladder is empty. This is due to the irritation of the bladder wall from the inflammatory process, which leads to bladder spasms. There can be back pain and a pain above the lower pelvic bone (suprapubic pain). The patient often has to get up several times during the night to urinate. In about 1/3 of the patients the urine will have blood in it and all of the patients will show a degree of cloudiness (opaqueness) of the urine. In older patients, particularly a nursing home population, cystitis can be asymptomatic (Ref. 1, p.1889).
Urine is examined first with a diagnostic test stick to indicate whether or not white blood cells, blood or E.coli bacteria are present in the urine. The lab technician may decide whether a more thorough examination needs to be done with microscopy where bacteria and white blood cells can be stained and studied in more detail. The urine is usually also sent for culture and sensitivity testing. This takes two days.
In the meantime the physician will come to a clinical diagnosis based on the preliminary tests, even before the culture and sensitivity testing comes back. If there is anything more going on than a simple bladder infection, the physician may want to refer the patient to a urologist to do further investigations such as a cystoscopy (looking into the bladder with a fiberoptic instrument). This would reveal such things like benign bladder polyps, cancer of the bladder, chronic vesicoureteral reflux etc.
We know from follow-up studies that not every patient is compliant and takes the medicine that is prescribed. From retesting some of these patient who did not take their antibiotic, we know that some patients cured their bladder infection with increased fluid intake only. However, others got a cystitis, which was more more chronic and more difficult to eradicate. The generally accepted rule is that a simple bladder infection (cystitis) should be treated in women with a 3 day course of trimethoprim-sulfamethoxazole.
Men should be treated with this antibiotic for 10 days as bladder infections are otherwise recurring frequently. If a patient had recently another bout of bladder infection, the antibiotic course usually is taken for 14 days in an attempt to eradicate the infection. People with diabetes usually have to be treated longer due to the presence of sugar in the urine, which allows bacteria to grow better and requires longer antibiotic therapy to eradicate the infection.
If after this there is still a recurrent infection, this patient should be thoroughly investigated by a urologist to find out the cause for this. The underlying cause needs to be treated by the specialist. If resistant strains are found, the antibiotic may have to be switched around.
In nursing home patients where patients are more sessile and urinary retention is more common, recurrent bladder infections are common place. However, in this special subpopulation there is often a lack of fluid intake and it is a danger to overtreat this patient group. Increased fluid intake, more activity, cranberry juice are all simple measures that should be utilized. If there is a resistant strain found in a urine culture, but the patient has no clinical sign of bladder infection, the physician may elect to observe and to repeat the culture a few days or weeks down the road, provided the patient is stable (Ref.1, p.1890).
These are a few references that describe urinary tract infections in more detail.
1.The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 227.
2.The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 261.
3.The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 164.
4.James Chin et al., Editors: Control of Communicable Diseases Manual, 17th edition, 2000, American Public Health Association.
5. David Heymann, MD, Editor: Control of Communicable Diseases Manual, 18th Edition, 2004, American Public Health Association.
6. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008