Acute bacterial cystitis affects 8-10 million Americans each year. Occurring in otherwise healthy individuals with no neurological or structural abnormalities, acute, symptomatic, uncomplicated urinary tract infection (UTI) may be the most common infection after the common cold and flu.
An acute UTI will be experienced by 25 to 40% of females in their lives, and up to 6% of women will have one or more UTIs in a given year. When promptly treated, the period of discomfort can be shortened and the potential for more serious damage and recurrence is reduced. The risk of acquiring an acute infection is more than 3-fold among women with a previous infection compared to women with no history of UTI.
The largest risk factor for acquiring and developing an acute UTI is being female. This is because the short female urethra provides greater access to the bladder, and the nearby vagina provides a favorable environment for bacterial colonization and growth.
E. coli is responsible for more than 80% of all acute female bladder infections. However, S. saprophyticus is more often isolated from women using spermicide-coated condoms (74%) and diaphragms than is E. coli. Other bacteria such as Proteus, Klebsiella or Enterobacter are occasionally isolated from uncomplicated UTIs. Vaginitis and urethritis caused by sexually transmitted pathogens such as herpes simplex, chlamydia or gonorrhea may mimic cystitis.
Cystitis in Men
Cystitis is a common occurrence in women, but it is less common and a potentially more serious condition for men. For men the cause can be an underlying bladder or prostate infection, an obstruction or tumor, or an enlarged prostate. It’s not serious if treated promptly, but the discomfort can be chronic and disabling. Untreated bladder infections can cause kidney or prostate infections and damage.
Natural Defense Mechanisms
The greatest defense mechanism against bacterial inflammation and adherence to the bladder or urethral lining is urine: invading bacteria stimulate urination. Voiding washes out bacteria from the bladder and urethra and dilutes bacterial concentrations, preventing adherence. The surface cells of the bladder are coated with a special urinary mucus. This thin negatively-charged surface layer attracts water molecules and forms a barrier between the bladder and urine, preventing bacterial adherence. White blood cells will also move into the bladder and urine to kill the invading bacteria. The kidneys produce a protein which contains mannose residues that block the attachment points of some types of E. coli. This prevents their attachment to the bladder and encourages their excretion.
Sex and Cystitis
Once referred to as “honeymoon-cystitis”, many women acquire their first infection after their first sexual experience. A study has shown that, compared to women who have not been sexually active during the previous week, the relative risk of a UTI among unmarried women increases 2.6 times for women who have engaged in sexual intercourse 3 times per week, and 9.0 times for women who have had intercourse seven times during the previous week. New sex partners and intercourse methods introduce bacteria into the vagina and urethral area. If bacteria are not removed by voiding or cleaning, they will colonize in this area, posing a risk of infection.
Barrier methods of birth control can also increase the risk of acquiring a UTI. Condoms increase the risk of vaginal tears, allowing bacteria to invade and adhere. Contraceptive sponges, foams, creams, gels and condoms use nonoxynol-9 (N-9) as a spermicide. Lactobacilli, the normal flora of the vagina, provide protection from external bacteria overgrowth, but are eradicated by N-9. The removal of lactobacilli by N-9 or other antibiotics alters the vaginal pH and natural flora, allowing Escherichia coli (E. coli) and Staphylococcus saprophyticus to proliferate, colonize and adhere to the vaginal mucosa. The odds that a woman exposed to condoms coated with N-9 would get a UTI were found to be 3 times higher than for sexually active women who did not use coated condoms. Diaphragms that are worn for more than 24 hours or improperly fitted can harbor bacteria or irritate tissue. A cervical cap, however, may not be associated with an increased UTI risk; less spermicide is used inside the enclosed cap, causing less alteration of the vaginal flora. Using extra lubricant during sex to decrease friction and irritation can help prevent the development of an infection.
Conventional Treatment
Treatment is usually recommended because if the infection progresses and spreads to the kidneys it is then classified as a complicated infection. Signs and symptoms of a complicated infection include nausea, vomiting, flank pain, fever and chills. Treatment may require hospitalization and longer, more expensive antibiotic treatment.
In the past, the treatment of acute female cystitis with an antibiotic for 7-14 days was the standard procedure. Although very effective, the associated adverse events, poor compliance and unnecessary costs necessitated a re-evaluation. Single-dose therapy is generally less effective than the same antimicrobial used for 7-14 days, but most antimicrobials given for three days are as effective as the same antimicrobial given for 7-14 days.
As a man, if you experience the symptoms of cystitis, you should see your doctor immediately. An analysis and culture/sensitivity of your urine will be performed which should identify the kind of bacteria causing the infection and the antibiotic most likely to help.
Signs, symptoms & indicators of Cystitis, Bacterial Bladder Infection
Minor/major fatigue for over 3 months or major fatigue for over 12 months
Having a high/having a moderate/having a slight fever
Urinary urgency
(Very) painful urination
Symptoms include painful, burning or itching sensations during urination.
Having blood in urine
(Very) cloudy urine
Strong-smelling urine
Cloudy, bloody or strong-smelling urine are symptoms of bacterial cystitis.
Counter Indicators
Absence of urine odor
Cloudy, bloody or strong-smelling urine are symptoms of bacterial cystitis.
Clear urine
Conditions that suggest Cystitis, Bacterial Bladder Infection
Risk factors for Cystitis, Bacterial Bladder Infection
Lupus, SLE (Systemic Lupus Erythromatosis) / Risk
Infections of the urinary tract are common in lupus patients.
Progesterone Excess
One mysterious effect in the progesterone intolerant women is bladder problems. Some women have either a great increase in urinary tract infections or a feeling like they are having an infection as soon as they try taking a “normal” progesterone dose. If bladder symptoms start and stop with starting and stopping progesterone, they may be related.
Vitamin A Requirement
Retinoic acid (an analogue of vitamin A) is needed for the differentiation of basal cells into mucus epithelial cells. A deficiency results in keratinization of mucus membranes that line the respiratory tract, intestines, urinary tract and epithelium of the eye. This in turn decreases the protective barrier role played by these membranes, resulting in an increased number of infections and other pathologies.
Bladder infections
Recommendations for Cystitis, Bacterial Bladder Infection
Probiotics / Fermented Foods
Dr. Andrew Bruce, Chief of Urology, and Dr. Gregor Reid, Director of Urology Research, at Toronto General Hospital have been studyed women with chronic bladder infections.”When we looked at the two groups of women, those who did
not have infections, had beautiful growths of lactobacilli,” Dr. Bruce commented in the Toronto Star (Apr13/92). “The lactobacilli seem to have a protective effect. A significant number of women who had repeated infections had a poor population of lactobacilli.”
As a result, Dr. Bruce and his research team developed an experimental vaginal suppository called Restoration Plus. It contains two key strains of lactobacilli called lactobacillus casei and lactobacillus fermentum. In the study, one group of 28
women with four proven bladder infections within the past 12 months, was treated with the acidophilus suppositories; the other group with inert suppositories. Another arm of the study treated 40 women with acute bladder infections with a three-day course of antibiotics followed by a three-month course of Restoration Plus, and compared it to results with 20 women treated with antibiotics followed by three months of placebo.The results of this study have shown Restoration Plus to be a very effective preventative treatment for bladder infections. The treatment is given once a week for six to 12 months.
This experimental product does not appear to be available to the public at this time. A similar product, Urex-Cap-5, developed by Urex Biotech Inc., seems poised for marketing but does not yet appear to be available either.
Urea
Urea can be used to treat urinary infections without renal lesions, such as pyelonephritis or glomerulonephritis, as urea possesses interesting bacteriostatic and antibacterial activities [Urology, vol. 86, 1961]
Cranberry Juice
There is evidence to suggest that drinking cranberry juice in addition to water can help fight a bladder infection. Since the mid-1800s, cranberry juice has been associated with urinary antibiotic properties. The juice does not appear to work by acidifying the urine, but rather contains compounds that have a mild antibacterial quality or help prevent E. coli from adhering to tissues. The most widely accepted dose is 3 ounces of 33% pure cranberry juice daily to prevent an infection and 12-32 ounces per day for treatment.
It has been reported that cranberries contain more mannose than any other food. This sugar, D-mannose, blocks E. coli attachment. Since the mannose content in cranberries is relatively low, many natural doctors now use supplemental D-mannose to deal with the most common form of cystitis, an E. coli infection. D-mannose can be used for preventive purposes also, for example, just before and after sexual contact which increases the risk of E. coli infection. The usual dose for powder is 2 1/2 grams stirred into water every 2 to 4 hours during an infection. If the infection is not substantially better within 24 hours, it is probably not being caused by E.coli. Different powders seem to have different concentrations, so read the label for more specifics.
Consumption of 240 mL (1 cup) of cranberry juice cocktail prevented adhesion activity in E. coli isolated from the urine of women with culture-confirmed urinary tract infections. Anti-adhesion activity was evident within 2 hours and lasted up to 10 hours following cranberry juice ingestion. [JAMA 2002;287(23): pp.3082-3083]
Corn Silk (Zea Mays)
Corn silk can be used especially when mucous is present or with bladder and urethral irritation.
Increased Water Consumption
The mainstay of prevention is to keep the urine dilute by drinking fluids and urinating often. Added water consumption during an infection will help flush out the problem bacteria. Repeated infections may require that routine water consumption be increased to prevent their recurrence.
Caffeine/Coffee Avoidance
Coffee, soda and other caffeinated beverages may irritate the bladder lining and are not recommended.
Antibiotics
See the E Coli Syndrome under this topic and Conventional Drugs.
Conventional Drugs / Information
While natural means may prevent as well as treat cystitis, there are times when the judicious use of antibiotics is the best treatment choice. Natural means alone will often prevent recurrence and in some cases resolve bladder infections that have resisted antibiotic treatment.
Personal Hygiene Changes
For women, poor personal hygiene following urination or defecation can expose the vagina and urethra to bacteria from the surrounding area. To prevent bladder infections, practice good personal hygiene by always “wiping front to back” to keep bacteria from entering and colonizing the vagina and urethra. Wash the skin around the vagina, perineum and rectum daily. Shower or bathe but avoid bubble baths, bath oils and scented soaps, which can act as irritants. During menstruation, change sanitary pads every 2-3 hours and tampons every 4-5 hours. Sanitary pads and tampons containing deodorants or perfumes can irritate the skin, allowing bacteria to enter.
Estrogen Replacement
Further evidence that estriol is effective in counteracting the symptoms of the menopause comes from studies with estriol intravaginal creams. One such study, conducted by scientists from the Technion Faculty of Medicine in Haifa, Israel, looked at urinary tract infections, a common affliction in post-menopausal women who suffer from an atrophying vagina characterized by elevated pH and a disrupted flora caused by lack of estrogen.
In this study, 93 postmenopausal women with a history of recurrent urinary tract infections were enrolled in a randomized, double-blind trial of a topically applied intravaginal 0.5 estriol cream. One group received 0.5 mg. of estriol every night for two weeks, followed by twice-weekly applications of the cream for eight months, and the other group received a placebo cream in the same manner.
The results of the study showed a dramatic reduction in urinary tract infections in the women receiving the estriol cream compared to those receiving the placebo cream. The incidence of infection was almost 12 times greater in the placebo group (5.9 per patient year) compared to the estriol group (0.5 per patient year). According to the Israeli scientists, “The intravaginal administration of estriol prevents recurrent urinary tract infections in postmenopausal women, probably by modifying the vaginal flora.”
Test Urinalysis
Urine culture and susceptibility testing add little to the eventual choice of an antibiotic as treatment because of the limited number of possible pathogens. Many patients, therefore, may receive an abbreviated laboratory work-up using dipstick tests to screen for the presence of bacteria and white blood cells.
If treatment does not improve symptoms, further testing should be done. Cultures need to be performed when the diagnosis is unclear or when there are other risk factors such as a history of recurrent infections. Cultures should also be performed when symptoms such as fever, lower back pain or signs associated with vaginitis are present.
During urinalysis, urine pH is determined. If elevated, lowering it will assist in resolving the infection.
Ozone / Oxidative Therapy
Although antibiotics as well as herbal and orthomolecular therapies are generally effective for acute cystitis, injecting ozone into the bladder offers yet another approach. It is in the treatment of chronic cystitis that ozone therapy really shines.
Hydrotherapy
Sitz baths may be used for chronic cystitis, but should not be used in acute cases.
Vitamin C (Ascorbic Acid)
The urine pH is often elevated in times of bacterial infection but can be lowered by some medications or unbuffered vitamin C. This produces a less favorable growth environment for some bacteria.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Strongly counter-indicative |
| May do some good |
| Likely to help |
| Highly recommended |
| Reasonably likely to cause problems |
Glossary
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Cystitis
Inflammation of the urinary bladder.
Bacteria
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Herpes Simplex
An infection, often recurrent, caused by herpes virus type 1 and 2. It causes cold sores around the lips and mouth, and also causes painful blisters on the genitals and in the pubic area, thighs, and buttocks.
Chlamydia
A sexually-transmitted disease that is often without symptoms. Some females experience a white vaginal discharge that resembles cottage cheese, a burning sensation when urinating, itching, and painful intercourse. A clear watery urethral discharge in the male probably is a chlamydia infection.
Gonorrhea
A sexually-transmitted disease that is often without symptoms. If there are symptoms in the female, they include frequent and painful urination, cloudy vaginal discharge, vaginal itching, inflammation of the pelvic area, and abnormal uterine bleeding. If the male has a purulent (pus-like) urethral discharge, he should assume he has gonorrhea until proven otherwise.
Prostate
The prostate gland in men that surrounds the neck of the bladder and the urethra and produces a secretion that liquefies coagulated semen.
Chronic
Usually Chronic illness: Illness extending over a long period of time.
White Blood Cell
(WBC): A blood cell that does not contain hemoglobin: a blood corpuscle responsible for maintaining the body's immune surveillance system against invasion by foreign substances such as viruses or bacteria. White cells become specifically programmed against foreign invaders and work to inactivate and rid the body of a foreign substance. Also known as a leukocyte.
Protein
Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.
pH
A measure of an environment's acidity or alkalinity. The more acidic the solution, the lower the pH. For example, a pH of 1 is very acidic; a pH of 7 is neutral; a pH of 14 is very alkaline.
Mucosa
Mucous tissue layer lining tubular structures (nasal passages, ear canal, etc.).
Nausea
Symptoms resulting from an inclination to vomit.
Antimicrobial
Tending to destroy microbes, hinder their multiplication or growth.
Vitamin A
A fat-soluble vitamin essential to one's health. Plays an important part in the growth and repair of body tissue, protects epithelial tissue, helps maintain the skin and is necessary for night vision. It is also necessary for normal growth and formation of bones and teeth. For Vitamin A only, 1mg translates to 833 IU.