Bladder
Infection (Cystitis)Introduction: This 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 more frequent and painful urination
of small amounts.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). Diagnostic tests: 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. Treatment: 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). |
