Bladder Infections

Bladder infections are among the most common reasons for which people seek medical attention. Indeed, urinary tract infections (UTIs) are the commonest bacterial infections in adult women. Bladder infections may reflect underlying abnormalities in the urinary system and can lead to serious medical complications if ignored.

Bladder infections are usually caused by bacteria that are normally found in the urethra (or urinary passage). Normally, these bacteria do not cause problems as they are routinely flushed from the urinary tract by passing the urine. In certain circumstances, these bacteria are able to gain access to the bladder, and if they multiply in sufficient quantities, may cause an infection of the bladder. Certain risk factors predispose to bladder infections:
• Women have a greater risk of developing UTIs because of the shorter urethra. The bacteria therefore have a much shorter distance to travel to get to the bladder
• Sexual intercourse increases the risk of a bladder infection by increasing the risk of introducing bacteria into the urethra
• Use of a spermicide during sexual intercourse
• Pregnancy
• Medical conditions associated with a suppressed immune system, such as diabetes
• Urinary retention, which results in the inability of the bladder to empty correctly. This includes patients with bladder problems from spinal cord injuries as well as urinary obstruction from prostate enlargement.
• Urinary catheters, especially if these are left in place for more than a week
• Urinary tract abnormalities
• Bladder stones
Two of the most common bacteria that cause UTI are E. coli and S. saprophyticus.
The most common symptoms of bladder infections are:
• Burning with urination
• Passing urine more frequently
• Blood in the urine
• Fever and chills
• Lower abdominal pain
Left untreated, urinary tract infects can ascend to the kidneys. A more serious infection called pyelonephritis may then result. Pyelonephritis is a potentially life threatening infection that often requires hospitalization and intravenous antibiotic therapy. A simple office urinalysis often confirms the diagnosis but gives no information about the bacteria which actually caused the infection. For that, the urine is sent for culture. With the culture, the actual cause of the bacteria is determined, as well as the types of antibiotics that are likely to be effective in treating the infection.
Bladder infections are treated with antibiotics. The antibiotic selected will depend on the most likely bacteria as well as the resistance pattern of the bacteria in a given locale. For simple infections, treatment duration can be as little as 3 days, whereas more complicated cases may be treated for a longer duration. A medication to reduce urinary discomfort is sometimes prescribed. This medicine often causes a temporary discoloration of the urine. For recurrent bladder infections, a prophylactic antibiotic is sometimes prescribed in an effort to reduce the frequency of infections. A Cochrane Review (2009) looked at 10 studies in which cranberry juice was used to prevent recurrent bladder infections. The reviewers concluded that cranberry juice was effective in reducing recurrent UTIs in women. It was not clear from the analysis what “dose” of cranberry juice was optimal in preventing the infections and it did not seem to be as effective in men. Catheter associated UTIs are often preventable and are a significant public health concern in hospitals and nursing homes. The rate of these infections can be reduced by avoiding unnecessary catheterizations, proper insertion technique and removing catheters as early as possible.
Bladder infections are a fairly common problem faced by primary care doctors and are usually easy to treat in the early stages. Prompt treatment, preventative efforts and evaluation for underlying causes in cases of recurrent infections are important in preventing complications.

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