The disease goes by different names — bladder infection, cystitis, urinary tract infection or UTI — but the symptoms are always the same and they're always agonizing. Suddenly you feel an urgent need to urinate. When you try to do so, however, you can produce very little, and a dreadful burning sensation rewards your efforts. The urge returns every few minutes, too — sometimes accompanied by lower abdominal pain, a low-grade fever, chills or blood in the urine.
Although it's certainly not fatal, cystitis is a very uncomfortable condition and it strikes an amazingly large segment of the population. In fact, many authorities agree that it's women's most common bacterial infection and their second most common illness overall, occurring more frequently than any disease except colds!
The bacteria usually responsible for UTI are Escherichia coli (commonly known as E. coli ) — organisms necessary to proper digestion — which lives in the intestines and bowel. In order to cause UTI, though, the bacteria must find their way into the urethra and then up to the bladder where they feed on urine, multiply and cause infection. As you'd imagine, then, bladder aliments are of primary concern to women, because of some basic anatomical differences between the sexes: Women's urethral and anal openings are closer together than are men's, and their urethras are also considerably shorter.
How to Prevent a Urinary Tract Infection
Because most UTI are caused by E. coli micro-organisms that have crept from the anal area into the vagina and urethra, proper hygiene is the best way to prevent flare-ups. Here are four basic rules a woman should follow if she wishes to avoid a painful bout of cystitis.
 After eliminating, be careful to wipe from front to back (away from the urethra), to prevent the passage of bacteria into the bladder.
 Keep the vaginal and anal areas clean, preferably with a mild, non-perfumed soap.
 Drink plenty of fluids to dilute the urine (so it will provide less nourishment for E. coli) and keep the system flushed. We recommend eight tall glasses of water a day.
 Urinate frequently, at least once every two or three hours. This will expel bacteria and eliminate the urine they feed on.
Contributing Factors to Bladder Infections
As any woman who has suffered UTI will confirm, cystitis is more than just a minor infection: It can become an unwelcome part of one's life. If you get recurrent UTI — as 10 to 15 percent of all women do — you should probably take steps to determine what factors might be contributing to the situation. Possible causes include (but aren't limited to) the following:
- Stress. Job or family problems, school pressures, decreased resistance due to another illness and premenstrual tension have all been known to contribute to the onset of cystitis. A personal stress management program (many people use meditation, yoga, or regular exercise) may help.
- Lovemaking. UTIs have long been associated with sex. (In fact, it's still occasionally referred to by the now rather archaic term "honeymoon cystitis.") If you suspect this is the cause of frequent flare-ups, discuss the problem with your partner. You may want to change styles of lovemaking or methods of birth control. (Urinating both before and after intercourse is also a good idea.)
- Underwear. Choose cotton undergarments, because that natural fabric is less irritating than are synthetic fibers. Cotton also allows the vaginal/anal area to "breathe" and doesn't tend to trap bacteria-attracting heat and moisture.
- Menstrual products. Blood is an excellent culture medium for bacteria, so avoid its buildup by changing tampons or sanitary napkins frequently. Also, beware of deodorant tampons (which can cause allergic reactions) and super-absorbent types (which expand in the vagina and can irritate the neighboring urethra).
- Estrogen. As the level of estrogen in a woman's blood rises, so does her susceptibility to cystitis because this hormone makes the urinary tract more hospitable to bacteria. Therefore, pregnant women (whose bodies release estrogen naturally) and those who use oral contraceptives (the pills raise estrogen levels artificially) are especially susceptible to UTI. If you take birth control pills and have recurrent bladder infections, you might consider switching to lower-estrogen pills or — as mentioned before — even choosing an entirely different contraceptive method.
- Perfumed Products. Scented toilet paper and soap, feminine deodorant sprays and even bubble baths can contribute to cystitis. In fact, the FDA recently ordered bubble-bath manufacturers to print a cautionary label on their products warning of possible "irritation to the skin and urinary tract."
- Laundry products. Bleaches, detergents and fabric softeners can leave residues that may cause irritation and/or allergic reactions.
- Food and drink. Alcohol, spicy foods, coffee, tea, and other foods that contain caffeine — even chocolate! — can act as irritants to the urinary tract.
First Aid For Bladder Infections
The onset of a bladder infection is fairly easy to recognize, as it'll be heralded by the symptoms mentioned at the beginning of this article. If you feel UTI coming on, there are several things you can do that might nip it in the bud — or at least reduce your discomfort until you can get to a doctor.
Drink lots of water immediately, and keep on drinking it. Some women get relief by drinking cranberry juice, because the acidic beverage makes urine less hospitable to infection-causing E. coli. Others, however, find that the juice increases the burning sensation accompanying urination and prefer to stick to water.
Urinate as frequently as possible.
Try a tea of German (not Roman) chamomile, bearberry and flaxseed. These herbs — which have been used for centuries to treat UTI — ease the pain by relaxing the urinary tract. (Bearberry dyes urine green, so don't be alarmed.)
Take Pyridium. This prescription drug is a urinary analgesic (pain killer) that will dye your urine bright orange and take the edge off that searing pain. However, it shouldn't be used by pregnant women or anyone with kidney problems. If you can't get to a doctor for a prescription, you might want to try one of the (almost equally effective) over-the-counter urinary analgesics. They're most often sold under the names Baridium or Azo-Standard.
A heating pad on the lower abdomen or a hot bath often helps, too.
Professional Care For a UTI
Of course, sometimes first aid won't work, and a visit to the doctor's office or emergency room is necessary. Professional treatment of a bladder infection involves three steps: determining that there are bacteria in the urine, testing their sensitivity (that is, discovering what will kill them) and then attacking with an appropriate medication. The typical prescription for UTI is a sulfa drug, either Gantrisin or Azo-Gantrisin. Stubborn infections are sometimes treated with Macrodantin, a more expensive medicine.
Some women are allergic to sulfa drugs and black females may develop serious anemic reactions to such medications, so be sure to discuss those possibilities with your doctor — he or she may want to prescribe ampicillin instead. Any of the drugs used to treat cystitis will relieve the pain quickly, but it's important to take the entire course of medication you receive, in order to completely destroy the bacterial strain. Remember, too, that antibiotics will kill not only the invaders in your bladder, but also other beneficial micro-organisms in your intestines. For that reason, it's a good idea to eat lots of yogurt (which replenishes the supply) while taking sulfa medication.
Unfortunately, many women receive unsympathetic — or even hostile — reactions when asking their physicians for advice on how to treat urinary complaints, because some medical "experts" assume incorrectly that all UTI is sex-related while others consider the patient's problem psychogenic. This is complicated by the fact that, in many cases, bacterial counts in the woman's urine specimen aren't high enough to be considered — by some standards — symptomatic of a bladder infection.
Then again, recent studies have indicated that recurrent UTI is often caused not by E. coli, but by Chlamydia, a micro-organism that doesn't even grow in urine cultures (and therefore can't be detected by standard UTI tests). Physicians who are unaware of the Chlamydia-cystitis link — and surprisingly, quite a few are — may believe the negative test instead of the woman and give her tranquilizers for her "imagined" symptoms. Therefore, if you know you have a bladder infection, don't accept a prescription for Valium. Instead, inquire whether your urine specimen contained white blood cells (which, of course, would indicate an infection) and suggest that Chlamydia might be the cause. The proper medication for such cases would be tetracycline or erythromycin.
An Anatomical Problem
If you experience recurring UTI despite your best preventive efforts, you may have an anatomical problem in your urinary tract. This could be either an unusual stricture (or narrowing) of the urethra, or — more commonly — a condition called "vesico-ureteral reflux," in which the valves between the bladder and ureters don't close completely after the bladder contracts to release urine. As a result, bacteria-contaminated urine returns to the ureters, and drops back either into the bladder to cause another UTI or — worse yet — into the kidneys to cause a kidney infection. [EDITOR'S NOTE: Regular cystitis symptoms — when accompanied by high fever — usually indicate kidney injection. If you develop this potentially serious condition, see a doctor right away.] Physicians use a special x-ray — called an intravenous pyelogram, or IVP — to investigate structural problems in the urinary tract. If such irregularities are discovered, they can often be corrected surgically.