bladder infection

Cystitis: short overview

• symptoms: frequent, painful urination of small amounts of urine, cramp-like pain in the bladder, often unpleasant-smelling, cloudy urine, rarely with blood, sometimes fever
• Treatment: especially in pregnant women and recurrent bacterial infections antibiotics, possibly after prior germ determination
• Home remedies: a lot of drinking (> 2l / day), special tarpaulin and kidney tea, hot water bottle (relaxing), warm foot baths, cranberry, nasturtium, toad or horseradish root.
• Who is affected? Especially girls and women (shorter urethra!), Risk increases during pregnancy and after menopause; in boys / men rarely, then often complicated course (causative research important!).
• Causes: mostly bacteria, sometimes fungi, parasites or viruses, rarely drugs or other external factors
• Trigger: Abduction of bacteria from the anal region, frequent sexual intercourse (in women), drainage obstruction in the urethra, common or long-lying bladder catheter, metabolic (diabetes) and immune diseases
• complications: ascending urinary tract infection, kidney (pelvic) inflammation, blood poisoning (urosepsis), epididymitis (in men), scarring in the bladder / shrinking bladder
• Watch out: Pregnancy is likely to increase the risk of miscarriage, pregnancy poisoning and reduced birth weight, so always treat it!

Cystitis – Symptoms

Mild bladder infections can sometimes be only marginally noticeable. The classic signs of a common (uncomplicated) cystitis are pain in urination (alguria), which are usually felt as a burning, and urinary frequency, with only small amounts of urine are given (pollakisuria).

Often these are the only complaints. But there are even more symptoms that indicate a bladder infection and due to various factors (concomitant diseases, type of pathogen) can be more or less pronounced or not at all pronounced. The most common symptoms, but never all together, include:

• Pain when urinating
• difficult urination (dysuria)
• frequent urination
• increased nocturnal urination (nocturia)
• Pain in the bladder area (suprapubic pain)
• Spasmodic, painful contraction of the urinary bladder (Tenesmus)

There are also other signs that may suggest cystitis:

• Occasionally the urine appears cloudy and / or unpleasant.
• In women, increased discharge (fluorine) can occur if an infection also spreads to the vagina.
• Back pain can occur if the inflammation spreads to the kidneys or, in men, to the prostate.
• Sometimes fever also occurs (rarely with simple cystitis).
• Urinary urgency can be so sudden and compelling (imperative urgency) that patients can not make it to the toilet in time (urge incontinence).
• Visible blood in the urine can occur in rare cases. On the other hand, unrecognizable blood admixtures are more common (microhematuria).

Cystitis: treatment

The Blasenentzündungs ​​treatment Above all, the annoying symptoms should subside faster and prevent possible complications. In fact, uncomplicated bladder infections often heal on their own and without the use of medication. But it is better to support and accelerate recovery with the right therapy.

As with almost all bacterial infections antibiotics even with bacteria-induced cystitis the drug of choice. They are usually taken in capsule or tablet form. In severe cases of pyelonephritis (pyelonephritis), the active ingredients sometimes also directly into the veins.

If fungi are the cause of cystitis, antibiotics do not help. Instead, so-called antimycotics are used.

In principle, attempts are made to keep the antibiotic therapy as effective and short as possible in order to reduce the risk of developing so-called resistance to antibiotics. Resistances are insensitivity of bacteria to certain drugs.

Depending on the active ingredient, the duration of application varies. Sometimes a single dose (fosfomycin trometamol) is sufficient. This relieves the side effects, but surviving bacteria could cause a relapse in this case. This is why antibiotics usually become common in cystitisover three to seven days (Nitrofurantoin, Pivmecillinam) taken long.

“Calculated” antibiotic therapy

In uncomplicated, acute cystitis – if there are no additional aggravating factors – the antibiotics are used empirically or calculated. This means that you can rely on drugs that are known to help usually well against the classic pathogens of a common cystitis and thereby cause the least possible side effects.

It does not determine the triggering bacteria more precisely, but assumes that there are typical representatives such as Escherichia coli (E. coli).

So if you notice the typical symptoms of cystitis, it’s best to get to a doctor as soon as possible so that he can initiate the right therapy. Because even if common cystitis is relatively harmless, the risk of complications increases, if just waiting. For example, you can significantly reduce the incidence of recurrent (= recurrent) bladder infections if you take antibiotics on time.

If the therapy strikes, the symptoms should improve noticeably already after one day.

Preventive use of antibiotics

In women who repeatedly suffer from bladder infections, antibiotics in low dosage may even be preventive (prophylactic). Previously, however, a several-month trial with immune-stimulating drugs should be carried out.

Determination of bacterial species and antibiotic activity

Sometimes, cystitis can be more severe or chronic. Or there are special circumstances such as pregnancy or certain comorbidities. In such cases, it makes sense to culture the bacteria in a culture via a patient’s urine sample for further investigation.

In this way, you can accurately determine them and also test which antibiotics they respond particularly well. These are then used specifically in the treatment of cystitis. Testing for resistance is also called antibiogram.

If antibiotic therapy has no effect, there may be a variety of reasons. Sometimes it is due to patient application errors, or unidentified risk factors prevent success. Of course, possible resistances of the pathogens against the antibiotics used must also be mentioned.

If all these factors have been considered and continue to improve, then it will switch to another antibiotic.

Cystitis: Treatment for pregnancy

Since bladder infection during pregnancy can lead to serious complications, it is important to start treatment as soon as possible. Women who notice typical symptoms of cystitis should therefore See a doctor immediately.

Also the cystitis treatment in pregnancy is based on antibiotics. However, one resorts to preparations that have a good compatibility during this particular phase of life. These are mainly drugs from the groups of penicillins and cephalosporins and fosfomycin trometamol.

An antibiotic therapy is usually initiated in pregnant women, even if the doctor in the urine of the woman detects increased bacterial counts (bacteriuria) – even if there are no symptoms of cystitis.

Cystitis: home remedies

Home remedies for cystitis are many. Some of these can actually help the healing process. Bladder and kidney tea or their herbal active ingredients belong for example to this. They have antispasmodic, anti-inflammatory and diuretic properties. But three to four cups a day are enough.

Also certain ingredients (anthocyanidins and proanthocyanidins) of Cranberry juice should be helpful in preventing bacteria from adhering to the mucosal lining of the urinary tract, causing cystitis or recurrence. However, the study situation is not clear here.

For mild, uncomplicated bladder infections, essential and mustard oils like those found in Nasturtium, hominy or horseradish root provide relief as a phytomedical adjunctive therapy. They have an antibiotic effect and are generally well tolerated.

Generally you should have a bladder infection drink a lot (at least 2 liters per day) – even if the urination hurts. Because with the urine the pathogens are flushed out. Heat, for example in the form of a hot water bottle or a foot bath, relaxes the bladder muscles, which often cramp in inflammation and can relieve the symptoms.

Coffee, citrus juices, alcohol and sugary drinks should be taboo if you have a bladder infection. They irritate the urinary tract or promote the growth of bacteria in the case of soda and Co.

What home remedies also help and which you should avoid better, you can find out here: cystitis – home remedies.

Homeopathy – treat bladder infection without antibiotics?

There are many homeopathic remedies to help with different forms of cystitis. However Globuli & Co. do not replace antibiotics. The doctor’s visit is therefore advisable in any case, especially in high-risk patients such as pregnant women and diabetics. Homeopathic remedies can then be used in addition to conventional cystitis treatment. However, the concept of homeopathy and its specific effectiveness are controversial in science and not clearly proven by studies.

Further information can be found here: Homeopathy for cystitis

What happens with cystitis?

When it comes to cystitis, the urothelium – the mucous membrane in the bladder – is impaired. On the one hand this can lead to pain, on the other hand it often has an influence on the frequency of urination: The affected bladder wall reacts more sensitively to strain stimuli and gives the command for emptying faster. This results in frequent urination (Pollakisurie) in a bladder infection.

Blood in the urine can also occur as a result of the irritated bladder mucosa, but is one of the rarer signs of disease. More about this can be found under “Symptoms”.

Since it is usually not only the bladder that is affected by inflammation alone, but also the urethra, doctors often speak generally of a urinary tract infection (UTI). In unfavorable cases, the infection even attacks the ureters and kidneys. Kidney pelvic inflammation (pyelonephritis) in particular can be a serious complication.

Special forms of cystitis

In addition to the classic cystitis there are some other, significantly rarer forms such as the hemorrhagic cystitis, in which it comes to larger blood enemas in the urine. The triggers are often viruses.

The interstitial cystitis is chronic and has no bacterial or viral cause. In the emphysematous cystitis it comes to gas formation in the bladder, affected are often diabetics.

Complicated or uncomplicated cystitis?

Depending on how the accompanying circumstances of cystitis are, a distinction in medicine between a “complicated” and an “uncomplicated” variant. After this classification, a cystitis is uncomplicated, as long as there are no functional limitations or malformations in the urinary tract and no relevant kidney dysfunction or other debilitating comorbidities.

However, if one of these factors is fulfilled, it can promote the development of cystitis and cause complications, so it is “complicated”.

Who is affected by cystitis?

Cystitis in women

Women are more likely to have cystitis than men. This has mainly anatomical reasons. Because the female urethra is only about two and a half to four inches long, the male, however, about twenty centimeters.

In women, inflammatory agents such as bacteria have to travel a much shorter path to the bladder. In addition, the opening of the urethra in women is closer to the anal region, where there are more bacteria, which are among the common causes of cystitis.

After the menopause, the risk of cystitis increases again slightly, as the decline in the estrogen level makes the mucous membrane in the urethra thinner. This also makes it easier for germs to get to the bubble.

Cystitis in men

Cystitis in men is much rarer, but when it does, often more persistent than in women. In addition, bladder infections with age are also more common in men, because they often suffer from an enlarged prostate. For more information, see “Causes and risk factors”.

Cystitis in children

Even in children of both sexes, it can often lead to cystitis, alone, because the immune system is not as well trained as in adults. In young boys, however, should be thought of possible malformations in the genitourinary tract, if a cystitis is particularly common.

Cystitis: causes and risk factors

By far the most common cause of cystitis bacteria, In most cases, the pathogens come from the intestine, penetrate the urethra and “climb” up to the bladder. One then speaks of an ascending, ie ascending infection.

Inflammation can also start in the kidneys. The germs then descend from there via the ureter to the bladder (descending infection). However, this is very rare.

By far the most common cases, the causative bacteria are representatives of the species Escherichia coli (short: E. coli), which are completely normal in the intestine. However, if they get into the urinary tract, they can cause inflammation there.

In addition to E. coli, other bacterial species (for example Proteus, staphylococci) and, in more rare cases, also fungi (including Candida albicans), parasites and viruses (eg adenoviruses, polyoma) are considered as the cause of cystitis.

If a bladder infection occurs after a tropical journey, schistosomiasis (schistosomiasis) can be the trigger. The disease-causing sucker prefers the urinary tract. Be sure to go to the doctor.

Otherwise, cystitis may also occur as a side effect of certain drugs, such as the cyclophosphamide used in cancer. Likewise, an irradiation in the pelvic area can cause a bladder infection (radiation cystitis).

What causes cystitis?

Certain risk factors or circumstances increase the likelihood of cystitis. This includes:

• Frequent sexual intercourse (Honeymoon cystitis). Due to the mechanical friction, the intestinal irritants from the anal region are easier to reach into the urethra.
• The use of some contraceptive methods, for example diaphragm or spermicides.
• Longer-lying bladder catheter.
• Bladder dysfunction: If the urine builds up, bacteria find in it an optimal breeding ground to multiply. The result can be recurrent urinary tract infections.
• Diabetes mellitus, as sufferers are generally more prone to infection and the increased sugar in urine also serves as a nutrient for bacteria.
• A weakened immune system, eg. As by hypothermia or psychological influences such as stress.
• A disorder of urinary outflow. This occurs, for example, as a result of a narrowing of the urethra, or if the valve mechanism between the ureter and bladder does not function properly and urine flows back from the bladder into the ureter (reflux). Even an enlarged prostate can cause a urinary retention in men.
• Mechanical procedures such as bladder reflexes and irrigation.
• Pregnancy and postpartum: The altered hormonal position during pregnancy and in the first weeks after birth, the urinary tract are widened, germs are easier to penetrate and ascend.
• Wrong “wiping technique” after the bowel movement. When wiping from back to front, intestinal bacteria are transported towards the urethral entrance.

The biggest risk factor is the female gender due to the anatomical features mentioned. Accordingly, bladder infections are most common in young, sexually active women.

Possible complications of cystitis

A simple cystitis heals either spontaneously or under the right antibiotic therapy after just a few days. In unfavorable cases, however, complications may arise.

Recurrent cystitis (recurrent cystitis): In people who are particularly likely to suffer from bladder infections, doctors also speak of chronic or recurrent cystitis. By definition, there must be at least two bladder infections per semester or three per year. Again, symptoms of bladder irritation such as burning on urination occur (as in a simple cystitis).

In contrast to normal cystitis, untypical pathogens are often the trigger in the recurring form, which is why a urine culture is useful for determining germs (see “Diagnosis”). Timely treatment of simple bladder infections with antibiotics can reduce the risk of recurrent cystitis.

Pyelonephritis: Pyelonephritis is a more dangerous complication of cystitis. It arises when the pathogens from the bladder via the ureter on to the renal pelvis rise. The renal pelvis act as a sort of collecting funnel and describe the place where the ureters exit from the kidneys. Here the primary urine filtered off by the kidneys is collected. In pyelonephritis, part of the kidney tissue is also inflamed.

In addition to a general, severe malady also occur in pyelonephritis typical of an infection of the upper urogenital tract symptoms. Cystitis-specific disease signs are often added. The kidney function is not affected.

blood poisoning: Particularly feared as part of a kidney pelvic infection is the life-threatening urosepsis, so blood poisoning by the causative agent. This happens when the germs in large numbers from the kidney tissue into the bloodstream. This can easily happen because the kidneys are very well supplied with blood. Timely antibiotic therapy is therefore particularly important.

EpididymitisIn the same way as the pathogens in some cases ascend the ureter to the renal pelvis, in men, they can reach the epididymis via the vas deferens, which sit directly on the testicles. The result is then an inflammation of the same (epididymitis), which is associated with a swelling and sometimes severe pain. As the spermatozoa mature in the epididymis, infertility can even occur in the extreme case.

contracted bladder: This is a reduced bladder with a rigid bladder wall. It holds less volume, those affected often feel a strong urinary urgency, but can hardly deliver urine. In many cases, unhealed or chronic cystitis causes a shrinking blister because it permanently damages the organ and causes the tissue to scar.

pregnancy complications: Women suffer more often from bladder infections during pregnancy due to certain hormonal changes. Experts believe that prematurity, reduced birth weight, and some form of high blood pressure during pregnancy (pre-eclampsia) may be the result of cystitis.

However, this does not mean that any cystitis during pregnancy must cause such complications. On the contrary, only in rare cases and in particularly unfavorable courses this occurs.

Pregnant women with suspected cystitis (symptoms such as pain when urinating, frequent urinary urgency, etc.) but should always see a doctor quickly. Only then can appropriate antibiotic therapy be started in time, minimizing the risk of complications.

Hemorrhagic cystitis: This is not exactly a complication, but a special form of cystitis. In contrast to normal cystitis, it has atypical pathogens rather than triggers, namely mostly viruses or Enterobacter. However, as with normal cystitis, symptoms such as painful urination occur.

In addition, a special feature of hemorrhagic cystitis is a greater amount of blood in the urine of the patients. Blood in the urine always looks dramatic, but in this case does not mean that the hemorrhagic cystitis is particularly dangerous.

Is a bladder infection contagious?

Although with appropriate hygiene the risk is low, cystitis can be quite contagious. Since it is primarily caused by E. coli bacteria, public toilets, where they like to frolic, a potential source of infection. Also on the shopping cart pole, handles in public transport or door handles and taps in the office bacteria can reach the hands and from there at some point by touching in the genital area. Regular hand washing can prevent such transmission.

A direct infection is also possible through

• E. coli bacteria in human stool. The risk that they get from the anus into the urethra but is less, if you wipe after bowel movements from front to back.
• Sexual intercourse. Here, condoms can prevent the bacteria from entering the urethra via the penis.

Cystitis: examinations and diagnosis

First, the doctor raises the patient’s medical history, especially the symptoms and possible risk factors must be queried. It also plays an important role for subsequent examinations and treatment, to which group the patient belongs.

In a young, otherwise healthy woman cystitis has a different status than for example in a young man, a pregnant woman or a diabetic.

The history of the disease often also indicates whether there is complicated or uncomplicated cystitis.

If complicated cystitis can be ruled out, young women will be left out of the study if they are otherwise healthy. The most typical symptoms are already sufficient here to make the diagnosis. It is then initiated a standardized therapy. Special features are not expected.

urinalysis

In other cases, such as with pregnant women or young men, further investigations are included in the medical history. Particular importance is attached to the suspicion of cystitis urine diagnostics. The urine of the patients is examined for bacteria and blood admixtures, using different methods:

• The urine test strip (Stix): With the help of this simple procedure can be roughly determined the number of bacteria in the urine and any admixture of blood can be determined.
• The microscopic urinalysis, which allows a more accurate estimation of the bacterial count and identification of cells.
• The urine culture: In this case, the pathogens present in the urine are cultivated on a special nutrient medium so that they can be precisely identified.

The urine strip is not sufficient as the sole diagnostic instrument. But he can help if the first question to be clarified, if any bacteria in the urine are present in greater numbers. The sole examination with test strips, without existing symptoms of cystitis, but does not make sense, since without any symptoms even with increased bacterial count (asymptomatic bacteriuria) initially no further steps must be initiated.

Pregnant women are an exception: asymptomatic bacteriuria causes kidney inflammation (pyelonephritis) in about 30 percent of pregnant women and must therefore always be treated.

If the patient is asked for a urine sample for examination, he should definitely use the so-called “midline urine”. This means that the urine should be intercepted from the already running stream of urine, and the first or last milliliters are discarded.

The reason is that the urine should be contaminated as little as possible with the normally occurring bacteria on the mucous membrane, which could otherwise falsify the result. Therefore, the genitals must first be thoroughly cleaned with water. Women should also spread the labia while urinating.

If there is a suspicion of nephritis or other complication factors, the ultrasound (ultrasound) is available as a further examination, with which residual urine determination can be carried out. This also allows conclusions about a bladder emptying disorder such as a urine flow measurement (uroflowmetry) or a micturition cystogram.

In the latter case, a contrast agent is injected through the urethra into the bladder and the emptying is documented by X-ray. A cystoscopy may also make sense.

Cystitis: How to Prevent

Some people are more likely to get cystitis than others. That depends on various factors. However, you are not completely exposed to the infection; certain measures should help to keep the urinary tract healthy:

• drink a lot (min 1-1.5 liters per day): Best water and unsweetened herbal or fruit tea. Cranberry juice is said to have a positive effect against recurrent cystitis when consumed regularly. However, this is not scientifically clear.
• often go to the bathroom: If you have to, do not wait. If the urethra is flushed more often, it is harder for bacteria to ascend there. Even after sexual intercourse (within 10 to 15 minutes), women should try to leach water to flush out the bacteria that could be pushed into the urethra by the act.
• antibiotics: In special cases, a preventive administration of antibiotics may be useful. Long-term antibiotic use may be considered for recurrent or chronic cystitis.
• wipe properly: Who wipes after the toilet from front to back, does not rub the bacteria from the anus into the urethra.
• keep warmEspecially the feet and abdomen. Chilling weakens the immune system, bacteria have an easy time.
• fresh, comfortable underwear: Avoid tight panties as they may irritate the pubic area and transport germs to the vagina. Better: well-fitting cotton underpants.
• intimate hygiene: regularly, but not overly. It is best to wash the genital area only with warm water. Soaps, intimate sprays or disinfectants can irritate the sensitive mucous membrane.
• Prevent bubble-friendly: Condoms protect against pathogens while vaginal suppositories and diaphragms tend to favor infection.

Cystitis: disease course and prognosis

The vast majority of cystitis runs harmless and heals under antibiotic therapy after a few days again. In some women, there are recurrent cystitis at regular intervals, especially in old age increases the risk.

Only rarely and usually due to special concomitant circumstances result in more serious complications. Special attention should be given to kidney involvement as a result of cystitis, as this can lead to blood poisoning in unfavorable cases (urosepsis).

Additional information

guidelines:

• S3 Guideline “Epidemiology, diagnosis, therapy, prevention and management of uncomplicated, bacterial, community-acquired urinary tract infections in adult patients” of the Association of the Scientific Medical Association (as of 2017)