Portuguese version: INFECÇÃO URINÁRIA (CISTITE)
Spanish version: INFECCIÓN URINARIA – CISTITIS
Let’s talk about urinary infection, a very common disease, especially in females. 60% of adult women will have at least one episode of urinary tract infection (UTI) during their lives.
There are 2 types of UTI:
Cystitis => bladder infection.
Pyelonephritis => infection of the kidneys (read: URINARY TRACT INFECTION – PYELONEPHRITIS )
Indeed, there is a third type, which is urethritis, usually caused by sexually transmitted diseases. But that is subject to another topic.
This time I’m going to write about cystitis, which is the infection of the bladder.
While cystitis is a relative simple problem, a pyelonephritis may lead to sepsis and death by widespread infection. In general, pyelonephritis occurs when the bacteria in the bladder reaches the kidney through the ureters.
Look at both pictures of male and female urinary tract, to better understand its anatomy.
While urinary tract infection is rare in men, except in young children and in elderly, women spend the entire life under the risk of infection.
To find out why it happens, it’s necessary to understand a little bit of our anatomy and the pathophysiology of this infection.
The first important information is that over 80% of UTI are caused by a bacteria that usually lives in our intestine, called Escherichia coli (E.coli). In the colons, most subtypes of E.coli causes no harm. The infection occurs when, for some reason, these bacteria are able to colonize the area around the vagina, going into the urethra and reaching the bladder.
E.coli is the most common agent, but many other bacteria of the intestinal tract can also cause cystitis.
Take a look at the pictures below. They show the anatomy of man and woman.
Notice that the urethra in women is smaller and its entry much closer to the anus than is in men. Man’s urethra is longer, which requires that the E.coli travels a longer distance in order to reach the bladder.
For obvious reasons, anal sex is a risk factor for UTI in men, as you bring intestine bacterias right to the entry of urethra.
Now you might be thinking:
- Well, if a UTI is caused when a bacteria normally found in faeces, colonizes the area around the vagina, all I have to do is wash my vagina very well in order to kill these intruders and prevent bladder infection.
Unfortunately, that is not what happens.
The fact is that, women’s vagina has its own bacterial flora. For a bacteria from the anus colonize the region, it must compete with those already living on site. When you wash your vagina many times a day or when you use special disinfectant products, you kill the natural flora of the vagina, facilitating the process of colonization of foreign bacteria that are coming from the anus
So, what should be done to prevent urinary infections ?
- Keep the genital area clean, but don’t over clean it. You should pay special attention when cleaning up after the evacuation. Whipping must always be done from front to back, in the opposite direction to the vagina.
- Take showers rather than bathtubs.
- NEVER perform direct vaginal shower. This will push the bacteria into the bladder.
- Avoid using deodorant sprays or feminine products in the genital area.
- Always urinate after sexual intercourse. The intercourse promotes entry of bacteria into the urethra.
- Drink enough liquid to urinate frequently and expel the bacteria from the bladder and urethra.
- Do not use condoms which contain spermicides.
- Indiscriminate use of antibiotics can also alter the natural flora of the vagina and facilitate infections.
- Women at menopause should use estrogen based vaginal creams to reduce dryness and local traumas.
For those who like natural products, Cranberry demonstrably reduces the risk of infection. You can have cranberry juice or take the pills now for sale in drugstores.
And how can I know if my symptoms are derived from a cystitis ?
The irritation of the bladder causes typical symptoms. The most common is a burning sensation when urinating, called dysuria. Others symptoms include, darkened, cloudy, strong-smelling or bloody urine, urge to void, even with the bladder is empty, discomfort in the pelvic area and low-grade fever.
Some people associate a strong-smelling urine with urinary tract infection. This is not necessarily true. The main reason for a bad-smelling urine is lack of water in it. The more concentrated the urine is, the stronger will be the odor. If your urine is dark yellow and has a very strong smell, you should drink more liquids to dilute it. This usually resolves the problem and help prevent the formation of kidney stones.
When the symptoms are typical, some doctors prefer treatment without the request of any examination. Others, if readily available, ask for a rapid analysis of urine to confirm the presence of pus. But it’s not wrong at all to treat without asking any exam.
Regardless of conduct, cystitis should always be treated with antibiotics to prevent recurrences and progression to pyelonephritis. In general, only a 3 days course are sufficient.
The biggest concern is to avoid the bacteria from reaching the kidneys and causing a pyelonephritis. The clinical picture is of high fever, back pain, chills, nausea and vomiting. In this case treatment should be at least for 7 days and blood and urine tests are needed. In severe cases, treatment should be given intravenously.
Despite all the precautions listed above, some women have recurrent urinary infections. Those are generally people with genetic predisposition. Some may benefit by taking 1 tablet of an appropriate antibiotic after sexual intercourse. In severe cases, with several UTI a year, you may need longer courses (up to 1 year) of antibiotics.
Another option is the Uro-Vaxom, a kind of vaccine with 16 different strains of E.coli. It seems that the use of this product for 3 months reduces the occurrence of cystitis. Note that this drug only works for those who have recurrent infections of the E.coli. That’s for sure not the solutions of all infection, but it can really help in some cases.
