Bladder infections
General
When bacteria (or rarely other pathogens) multiply in the genitourinary tract, this can lead to various types of urinary tract infection. In around 80–90% of cases, inflammation is caused by microorganisms which enter the urinary tract naturally, i.e. via the urethra, and move upwards. These are known as ascending urinary tract infections. They are usually caused by intestinal bacteria which have been carried across from the anal or perineal area. The most common cause of infection is the E. coli bacterium.
Women are particularly prone to acute cystitis. The shorter urethra in women makes it easier for microorganisms to make their way into the genitourinary tract. Microorganisms ascending the urinary tract during sexual intercourse and the type of contraceptive used may also have an effect. In addition, changes in hormone levels during and after the menopause in the form of lower local oestrogen levels can also impact defence mechanisms. Similarly, hormone-induced urinary tract dilation during pregnancy can also lead to an increase in urinary tract infections.
Acute bladder infection (cystitis)
The most common urological disorder in young women is uncomplicated cystitis (with no fever), to which a shorter urethra makes women particularly prone, and which is often associated with sexual intercourse or not drinking enough fluid. Symptoms include a burning sensation during urination, a constant urge to urinate, pain in the area of the bladder and sometimes blood in the urine. In young women, up to three episodes of cystitis per year is acceptable and does not require further urological investigation. In such cases, a short course of antibiotics following susceptibility testing is an appropriate treatment. Acute cystitis can also often be treated using plant-based remedies (‘phytotherapeutics’) and by drinking large amounts of fluids.
For patients with more frequent cystitis or cystitis which is resistant to treatment, further tests are required to determine the cause. Ultrasound examinations, advanced imaging of the urinary system (x-ray/CT scan with a contrast agent), cystoscopy and, where necessary, bladder biopsies (where small samples of tissue are removed for analysis) may be recommended. If no cause requiring surgery can be identified, low-dose antibiotic therapy over several weeks or the administration of a vaccine against urinary tract infections (active immunisation using StroVac® / UroVaxom®) often prevents future recurrence. Lifestyle modifications, such as drinking more fluids, avoiding excessive genital hygiene, etc. can also often be sufficient to prevent further urinary tract infections.
In women, a one-off bout of cystitis does not require further investigation. In men, however, it generally makes sense to undertake more detailed investigations. In men, there is usually a cause requiring treatment, such as a urethral stricture, an enlarged prostate or a neurogenic bladder control problem. In addition, the possibility of a bladder tumour should be excluded.
