Urinary tract infections (UTIs) or bladder infections are the most common bacterial infection encountered in the ambulatory care setting in the United States, accounting for about 8.6 million visits.
“Urinary tract infections are very common conditions in women and can produce significant discomfort very quickly,” said Salil Khandwala, MD, FPMRS, a Female Pelvic Medicine and Reconstructive Surgery specialist with Oakwood Healthcare.
The typical complaints include dysuria (burning or discomfort while urinating) with or without frequency, urgency, lower pelvic pain, blood in the urine and possibly backache.
About 12 percent of women present urinary tract infection symptoms every year, and, by the age of 32 years, half of all women report having had at least one urinary tract infection. Among healthy young women with cystitis (bladder infection), the infection reoccurs in about 25 percent of women within six months after the first urinary tract infection and recurs more frequently after that.
However, it is very important that the diagnosis of a urinary tract infection is made correctly, according to Dr. Khandwala. Many times, women are treated with an antibiotic for presumed urinary tract infection even though they do not have a true infection, he said. They may in fact have a relatively common condition called Bladder Pain Syndrome (BPS). Unfortunately, the clinical symptoms and complaints are very similar to that of a bladder infection.
“In my practice, I see many women who have been treated for bladder infections with antibiotics for several years—if not for decades,” Dr. Khandwala said. “They continue to have symptoms suggestive of urinary tract infection without actually having a bacterium or a true bladder infection”.
It is therefore important for patients to ask their doctors to send urine samples for culture, especially if they have not noticed improvement in their symptoms within a few days of starting the antibiotic. It is possible that she may actually not have a true bladder infection. This is even more likely if the patient has had so-called repeated bladder infections back-to-back within a few months of each other.
“Communication with your doctor is very important,” Dr. Khandwala said. “Ask the doctor’s office to send the urine for culture and find out the results.”
Recurrent or frequent bladder infections are usually defined as three or more infections in a calendar year with at least one being proven by urine culture. In those cases, patients may be asked to see a specialist who most likely will perform some type of diagnostic workup such as an in-office cystoscopy, which is looking inside the bladder, and also possibly assessing the kidneys.
Simple strategies have been recommended to decrease the risk of frequent bladder infections. These should be considered, particularly in women who have frequent documented bladder infections, Khandwala said.
Behavioral counseling
· Abstinence or reduction in frequency of intercourse: Sexual intercourse is the strongest risk factor for uncomplicated UTIs. (Often this strategy is not feasible.)
· Spermicides: If spermicides are used, recommend changing to another method for contraception for prevention of infection. Spermicide use, including use of spermicide-coated condoms, is a strong risk factor, especially if used with a diaphragm. Spermicides alter the vaginal flora and favor the colonization of uropathogens (bladder infection promoting bacteria).
· Simple techniques: Recommend that the patient urinate soon after intercourse, drink fluids liberally, not routinely delay urination, wipe front to back after defecation, avoid tight-fitting underwear, avoid douching. Though none of these strategies have been studied, however, it is reasonable to suggest them to patients, since they pose a low risk and might be effective.
Biologic mediators
· Cranberry juice, capsules or tablets. It is thought that cranberry inhibits the bacteria from sticking to the bladder wall. However, in clinical studies this has not been found to be effective.
· Topical estrogen In some postmenopausal women, topical estrogen normalizes the vaginal flora and reduces the risk of recurrent UTIs. Oral estrogens are not effective
· Adhesion blockers (D-mannose) UTIs caused by E. coli are initiated by adhesion of the bacteria to receptors in the bladder wall; theoretically, mannose could block adhesion; however, D-mannose has not been evaluated in clinical trials.
“A lot can be done to treat this very simply,” said Dr. Khandwala. “Moreover, it is important to make sure that the diagnosis is correct. If you keep getting repeated symptoms and the antibiotics are not working, you must reconsider the diagnosis of painful bladder syndrome and make sure that you see a specialist.”
