Embed from Getty ImagesAre you one of those women who get cystitis very often? Well, you are not alone! It is estimated that at least 50 % of women will get a urinary infection in their lifetimes; of those, about 30% will get another episode after a short period of time….

Let’s try to understand the problem and learn how to reduce the chances of repeated infections…

What is cystitis?

Cystitis is an inflammation of the bladder, usually caused by a bacterial infection. There is sometimes confusion between urinary infection and cystitis.

Urinary tract infection comprises 3 types of infection:

• Urethritis: inflammation of the urethra (the tube from where we urinate)
• Cystitis: inflammation of the bladder (by far the commonest)
• Pyelonephritis: inflammation of the kidneys

We consider recurrent cystitis at least three episodes of urinary tract infection in one year, or two episodes in 6 months.

Symptoms of cystitis

The symptoms of cystitis include:

• Persistent urge to urinate
• Intense burning when urinating
• Passing small amounts of urine
• Usually a small amount of blood while wiping, more rarely red or brown (cola-like) urine
• Low abdominal pain
• Cloudy or funny-smelling urine

Many times cystitis may be asymptomatic, especially in postmenopausal women.

It should be stressed that cystitis does not cause fever. If you get fever, flank or high abdominal pain, nausea, vomits, then you may have a pyelonephritis and you should seek medical attention.

 Causes of cystitis

The most common cause of cystitis is Escherichia coli, a bacterium that belongs to the normal intestinal flora. This means that most of the times, we do not get the bacterium from somewhere or someone else, but from our own body.

But why this happens?

• Just because we are women! We have a much shorter urethra than men, which is much closer to the anus. This anatomical disadvantage makes much easier for the bacteria to reach the bladder.
• Sexual intercourse. The great majority of women will get cystitis after intercourse. Although several explanations have been proposed for the link between cystitis and sex, most likely it has to do with some micro traumatisms of the urethra, which allow bacteria to go upward.
• Not enough fluids, not frequent visits to the toilet. We do it many times: we forget to drink water and we hold back the urine! Both factors predispose to cystitis as they favor bacterial replication inside the bladder.
• Menopause. Cystitis tends to be less symptomatic in menopausal than in younger women; thus, the infection may be noticed only when it became pyelonephritis. The lack of the hormone estrogen is responsible for this predisposition, as the genital area becomes very dry and gets traumatised very easily. Occasionally, a relaxation of the pelvic organs may cause urinary incontinence or retention, burdening further the situation.
• Pregnancy. Hormonal shifts, together with the pressure of the womb on the bladder and ureters (the tubes that connect the kidneys with the bladder) affect the function of the urinary system.
• Other reasons. Urinary tract abnormalities, diabetes, low immune system, etc.

But why do I get cystitis so often?

Most of the recurrent cystitides occur in otherwise healthy women, without urinary tract abnormalities or immune system problems. It is not clear why this happens, though many theories have been proposed: changes in the pH, lower antibodies levels in the genital area, greater adherence of the bacteria to the bladder, anatomical differences (such as shorter distance between the urethra and the anus).

What can I do to prevent recurrences?

Sometimes, making some changes to our life style will be enough to reduce the risk of repeated cystitis. Keep in mind the following:

• Drink plenty of fluids: ideally, more than 2 liters per day, especially with warm weather.
• Dot hold back the urine: you should try to urinate at frequent intervals, drinking plenty of fluid will help!
• Urinate after intercourse: this simple act will reduce the chances of cystitis by washing any bacteria that may be present in the urethra, making more difficult for them to reach the bladder
• Wipe from front to back: when you urinate, but especially when you pass stools, remember to wipe yourself from the front to the back, and not the other way around, to avoid transferring bacteria from the anus to the urethra.
• Avoid constipation. Many women will feel that being constipated make them more susceptible to cystitis. This may be due to a higher concentration of bacteria in the genital area. Be sure then, to eat plenty of fibers, drink fluids and exercise regularly.
• Be careful with the hygiene of the area, but don’t overdo it! It is important to wash the genital area with a mild soap, but avoid antiseptics, bidet use, vaginal douching or excessive washing. We have a normal flora that protects us against the “bad” bacteria. All the above mentioned may affect the normal flora and predispose us to repeated urinary and genital infections.
• Avoid excessive heat, humidity and pressure on the area. Tight clothes, synthetic underwear will favor bacterial proliferation. It is also recommended to change your bathing suit after swimming.
• Consume cranberries. Both the juice and the extract (the tablet) seem to reduce the episodes of cystitis. According to some studies, the effect seems to be stronger in women with repeated urinary infections.

When nothing works…

• Discuss the problem with your physician. If you haven’t done it so far, a urine analysis and culture should be done, to confirm the diagnosis. Urethritis and vaginitis may mimic the symptoms of cystitis.
• For the same reason, your doctor may prescribe a vaginal – cervical culture.
• In order to rule out any anatomical problem, an ultrasound of the urinary system may be considered. A consultation with an urologist may be needed to run some more sophisticated tests, such as cystoscopy.
• A long term therapy with a low dose of antibiotic is sometimes prescribed. If the episodes are clearly linked to intercourse, then a single dose of antibiotic may be used every time within 2 hours of love making.
• In menopausal women, a vaginal estrogen therapy may be helpful.

References

http://www.aafp.org/afp/2010/0915/p638.html

http://www.nhs.uk/Conditions/Cystitis/Pages/Introduction.aspx