Bladder infections

Frequent urinary tract infection is one of the most common reasons women come to see me in my clinic.  Why? Because they are awful.  Anyone who has ever had an infection in their urine, called a UTI, knows this.  They can cause severe pain, urinary frequency, a terrible odor in the urine, and be disruptive to even normal daily activities.  Having just one is something a woman is likely to remember for a lifetime.  Unfortunately, many women get them several times a year.

If you have had 2 or more UTIs in the last 6 months, or 3 or more in the last year, then you have recurrent UTIs.  Now, here’s the catch – these need to be ‘proven’ based on urine culture.  Overactive bladder, chronic pelvic pain, vaginal infection, and painful bladder syndrome can all mimic the symptoms of UTI and need to be ruled out before you spend your time and money trying to prevent a bladder infection.  A word of caution – much of the time, when a patient comes to my office, they have never actually had a urine culture.  They think they have, but what was actually done was a screening test called a urinalysis that was suspicious, so they were given antibiotics. If your symptoms get better on antibiotics, then great.  But if not, don’t assume it’s because the medicine didn’t work.  It may just be that you didn’t have a UTI to begin with.

For those women who do  have frequent UTIs, here are some things you can do…

Keep a diary.

Track your symptoms so you can talk to your doctor about how often you have them, what your symptoms are, if anything makes them better or worse, what antibiotics you were given, etc.  Look for patterns – are they always after intercourse? Do you see blood? Have you changed your diet, your birth control, any medications? All of these things are important for planning your next step.

If your infections always occur after intercourse –

the easiest way to manage this is to take one dose of an antibiotic after sex. Most of the time this does the trick.  Good sexual hygiene is also very important. If you use spermicides for birth control, consider a different option. If your partner is not circumcised, make sure they clean themselves well.

If you have gone through menopause –

you probably need estrogen. After menopause, women will develop what’s called atrophy. This is a thinning of the lining of the vagina and bladder, which leads your body’s natural defenses to be impaired.  Simply using a tiny amount of estrogen cream a few times a week can go a long way to resolving your infections.

Probiotics.

Many infections are caused by bacteria that originally come from the gut.  Any imbalance in good vs bad gut bacteria can make you prone to infections.  Any imbalance in the good bugs in the vagina can create a place for the bad bacteria to grow, which later cause urinary tract infections.  Probiotics can help balance this out.  And if you’re willing to put the probiotics in the vagina, it can help even more.

Cranberry.

This is a controversial treatment.  Honestly, the studies are all over the place on this one.  Some say it works great, some say it doesn’t work at all.  In my opinion, it shouldn’t hurt to try cranberry supplements.  But stick with the capsules – the juice has way too much sugar, and even if it’s sugar free, it can really irritate your stomach and bowel.

D-mannose.

This is a supplement you can buy at most stores. Again, the studies here are limited, but it may be able to help prevent bacteria from taking hold in your bladder and causing problems.

pH adjusters.

A neutral pH in your urine may help prevent infections.  There’s very limited data on what the best pH adjusters are, but if nothing else is working for you, this is something to consider.

Corn silk.

This is a ‘natural remedy’ that might be an option.  Like most herbal supplements, information is scarce on whether it works or not.  The theory is that it helps decrease inflammation and soothes the bladder, so it may be best used to get some relief if you have an active infection.  Always talk to your doctor before taking corn silk extract – it can cause your blood sugar to go down, potassium to decrease, and interfere with medicines like coumadin.

Antibiotics.

Some women get so many infections that they really just need to be on a small dose of antibiotics every night for a while.  This should not be the first thing to try, but is something that can be considered if other things don’t help.