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Chronic Bladder Infections

Chronic Bladder Infections

Though the incidence of chronic bladder infections is high in women, men could also get affected by infections of the urinary tract. The following write-up provides information on the causes, symptoms, and treatment of bladder infections.
Kundan Pandey
Last Updated: Apr 7, 2018
The urinary tract consists of the kidneys, bladder, ureters, and the urethra. While kidneys are bean-shaped organs that filter waste from the blood and produce urine, ureters are tubes that carry urine from the kidneys to the bladder. The bladder is a hollow organ that stores urine. Urine is excreted through the urethra, when the bladder muscles contract and the sphincter muscles relax. A urinary tract infection (UTI) occurs when bacteria enter and multiply in any part of the urinary tract. Bacteria can enter the bladder as they move from the urethra to the bladder. At times, bacteria can even move from the bladder to the kidneys through the ureters. Bacterial overgrowth could lead to the inflammation of the urethra (urethritis), bladder (cystitis), or the kidneys (pyelonephritis).
The incidence of UTI is higher in women, and women are also more likely to get affected by recurrent infections. Chronic bladder infections are said to occur when the affected individual suffers from cystitis twice in six months or thrice a year. Usually the acidic environment of the vagina curbs the growth of bacteria, but bacterial overgrowth could affect women with a compromised immune system. Women may be vulnerable to recurring bouts of bladder infections under certain circumstances. For instance, women who have a higher number of bacterial receptors on the cells that make up the epithelium of the urinary tract, are likely to get affected by chronic bladder infections.
Contributing Factors
More often than not, cystitis is caused by the overgrowth of a bacterium named Escherichia coli in the urinary tract. However, the overgrowth of pathogens such as Enterococcus faecalis, Klebsiella pneumoniae, Staphylococcus saprophyticus, and Proteus spp. could also cause bladder infections. The presence of more than 100,000 colony-forming units (CFU) of one of the types of bacteria per milliliter of urine in a clean-catch midstream urine specimen is indicative of significant bacteriuria (presence of bacteria in urine). Usually a count of more than 100,000 CFU/mL is observed in case of a symptomatic infection. When the urine is collected via bladder catheterization, 100 CFU of a single species of bacteria per milliliter of urine is indicative of bacteriuria. Inflammation of the bladder could occur due to anatomical abnormalities or other factors that cause bacteria to move towards the bladder. Urinary tract infections are categorized into complicated (presence of underlying predisposing factors) and uncomplicated (absence of underlying predisposing factors) UTI. Here are some of the common causes of recurrent bladder infections.
Catheterization
Cystitis could be hospital-acquired. Urinary catheterization, which refers to the placement of a thin, flexible tube (catheter) in the urethra or the bladder for drainage of urine, could also put a person at a risk of developing cystitis. This procedure may be required before certain diagnostic tests. The use of an indwelling catheter may be recommended for people who are bedridden, or affected by neurogenic bladder or urinary incontinence. An infection could occur if the catheter or the area where the catheter exits the body is not cleaned.
Bladder Stones
Bladder stones are small masses that form due to the crystallization of minerals in urine. The urine could become concentrated due to improper emptying of the bladder. At times, nerve damage could adversely affect bladder control, thereby leading to incomplete emptying of the bladder. The presence of diverticula, which are pouches on the walls of the bladder, could also be associated with the formation of bladder stones. Diverticula form when a part of the lining of the bladder bulges from a weak spot in the bladder wall. If these pouches become bigger, the affected individual may face difficulty in passing urine. In case of men, an enlarged prostate may compress the urethra, thereby preventing the passage of urine.
Diabetes
Women who are affected by diabetes are also susceptible to bladder infections. The elevated levels of glucose in urine could cause overgrowth of Candida albicans. The immune system may also get weakened due to diabetes, which is why diabetics may be susceptible to cystitis.
Increased Sexual Activity
Honeymoon cystitis is a colloquial term used for recurring bladder infections in women due to increased sexual activity right after marriage. This is a type of uncomplicated cystitis. Women are more susceptible to bladder infections as they have a short urethra. Since the urethral opening is quite close to the vagina and anus, bacteria from these areas can easily move from urethra to the bladder. Traumatic cystitis is another form of cystitis. Trauma to the bladder due to abnormally forceful sexual intercourse can cause coliform bacteria to move from the bowel to the urethra, from where the bacteria can ascend towards the bladder. The use of spermicide or diaphragm can also put women at an increased risk of developing recurrent bladder infections. Prolonged use of antibiotics or spermicide adversely affects the microbial flora of the vagina, thereby increasing the risk of overgrowth of bacteria. Low estrogen levels during menopause can also alter the balance of microbial flora in the vagina.
In case of children, bladder infections could occur due to constipation or voiding dysfunction. Voiding dysfunction refers to a lack of coordination between the bladder muscle and the urethra. Bladder infections could also be caused by urinary stasis, which refers to slowing or stoppage of the flow of urine. Infrequent voiding due to incomplete toilet training could also be a contributing factor.
Symptoms and Diagnosis
Cystitis could cause a host of distressing symptoms. Some of the symptoms that may be experienced by an affected individual include:
Dysuria (painful or difficult urination)
Burning sensation while urinating
Urinary urgency (sudden urge to urinate)
Need to urinate at night
Polyuria (frequent urination)
Pain above the pubic bone
Small volume voiding (passing small amounts of urine)
Pyuria (increased number of white blood cells in the urine)
Hematuria (traces of blood in urine)
Malaise
Besides the aforementioned symptoms, the color and odor of the urine may also change. Urine may appear to be dark or cloudy. It may be foul-smelling. Children who are affected by cystitis are likely to experience symptoms such as reduced appetite, irritability, vomiting, weakness, or pain while urinating. These symptoms could also be exhibited by a person affected by interstitial cystitis. Also known as bladder pain syndrome, interstitial cystitis is not believed to be caused by a bacterial infection.
Besides studying the symptoms and examining the patient's medical history, doctors may conduct certain diagnostic tests and imaging procedures for identifying the underlying cause. Urinalysis is an integral part of the diagnosis of bladder infections. A urine culture test is often ordered in order to detect the presence of pathogens and identify the causal organism. If cystitis recurs, it becomes essential to find out if the infections are caused by the same organism or different organisms. Cystoscopy is another procedure that involves the insertion of a cystoscope through the urethra in order to examine the bladder. A small sample of tissue may also be taken for biopsy. Doctors may also conduct an ultrasound in order to ascertain if there is an abnormal growth in the bladder.
Treatment and Prevention
The treatment of cystitis that is caused by bacterial overgrowth usually involves the use of antibiotics. Drugs that are effective in the treatment of chronic bladder infections include nitrofurantoin, fluoroquinolone, trimethoprim-sulfamethoxazole, cephalosporins, and amoxicillin. Antispasmodics or urinary analgesics may also be prescribed. In case of menopausal women, estrogen replacement therapy may reduce the incidence of cystitis. If multiple infections are caused by the same organism, then longer courses of antibiotics would be required. Further testing would be required to see if an underlying medical condition is behind these infections.
Antibiotic therapy doesn't prove to be an effective treatment option for interstitial cystitis, and a combination of treatment options such as nerve stimulation, use of oral drugs, or instillation of drugs into the bladder through a catheter may be suggested. In severe cases, surgery may be recommended.
Besides following the treatment options, affected individuals can also follow certain effective home remedies to prevent the recurrence of bladder infections. These include:
► Drinking 6-8 glasses of water daily will certainly prove beneficial as water helps in flushing out the bacteria from the body during urination.
► Excessive consumption of caffeinated drinks can lead to dehydration. Those who are prone to developing urinary tract infections must cut down on the intake of tea and coffee.
► Following a diet that is rich in Vitamin C is believed to be effective in controlling bacterial growth in the urinary tract. Cranberry juice, apple juice, and oranges are good sources of vitamin C. In fact, cranberry juice is believed to be very effective when it comes to preventing urinary tract infections.
► Incomplete emptying of bladder puts a person at a risk of developing an infection. So, empty your bladder as soon as you feel an urge to urinate.
► Women are susceptible to bacterial cystitis, which is why they must follow certain preventive measures to avoid bacterial overgrowth. They must keep the vaginal area clean. However, women must refrain from using feminine products that may contain harmful chemicals.
► You can prevent bacteria from the anus to move towards the vagina and urethra by wiping from front to back after a bowel movement.
► It would be best to empty your bladder after intercourse.
► Bacteria thrive in a warm and moist environment. Women must therefore wear loose-fitting clothes and cotton undergarments.
While women are more likely to get affected by urinary tract infections, men who have an enlarged prostate could also develop cystitis. The presence of kidney stones may also put them at a risk of developing bladder infections. The use of urinary catheters could also make them susceptible. Recurrent infections of the urinary tract not only cause distressing symptoms, they can also be indicative of other medical conditions. If a person experiences any of the aforementioned symptoms, he/she must immediately seek medical help for a proper diagnosis and treatment.
Disclaimer: The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.