FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

PAIN AND URGENCY MAY MEAN BLADDER INFECTION

Question: I've had problems with blood in my urine, but no pain with urination. My doctor said I have cystitis. What I don't understand is whether I have infection in my bladder or if it is simply inflammation?

Answer: Blood in the urine is often the results of infection involving the lining of the urinary bladder. Bladder infections are quite common in women of all ages and relatively common in male children and men over 65. And from other information in your letter, I know you are in the group with the highest risk for bladder infection women in their reproductive years.

Women have 50 times the likelihood of bladder infections during their reproductive years compared to men of the same age. There are several reasons for this. The most important of these is that the bacteria that normally live in the vagina and in the rectum in huge numbers can spread onto the skin around and just inside the urethra, the tube that drains urine from the bladder. These bacteria can then multiply and spread up the urethra, and this spreading can be enhanced during intercourse. Once inside the bladder, the bacteria grow and damage the lining of the bladder, and, thereby, cause blood in the urine. This is often, but not always, accompanied by the physical symptoms of frequent urination, pain with urination, and a sense of urgency. (Urgency is a doctor term that describes the sensation of "I gotta go NOW and I mean NOW!")

The distance from the bladder to the outside (the length of the urethra) in women is the second reason they frequently suffer from bladder infections. The body is not defenseless against invading bacteria. The mucosa, the skin-like lining of the urethra, produces antibodies that fight off infection. Therefore, since a woman's urethra is shorter than a man's, she has less opportunity to fight off bacteria before they reach the bladder and cause an infection there.

Blood in the urine can come from damage to any parts of the urinary tract from the kidneys all the way to the outside opening of the urethra. Damage to each part, whether from infection or other problems, has its unique group of symptoms that can usually be identified by a careful history and physical examination, and an examination of the urine. I'm sure this is what your doctor has done to determine your problem is with your bladder.

Your specific question is it infection or is it inflammation can't be answered without the findings of a careful examination. Actually though, infection is only a specific cause of inflammation. Talk with your doctor. He or she can tell you the cause of your symptoms.

Question: Will drinking cranberry juice keep me from having bladder infections?

Answer: Cranberry juice isn't a miracle drug. It will not prevent infections. However, the benefits of drinking cranberry juice isn't totally an advertising myth. The liquids we consume are ultimately eliminated from the body as sweat, as moisture in bowel movements, or as urine. Some things, such as cranberry juice, tend to make the urine more acidic, and it is the acidity that helps the body's bladder fight off invading bacteria. Actually, drinking large quantities of cranberry juice at the first signs of a bladder infection is often effective because the urine is more acidic and also because the larger volume of urine tends to "wash away" many of the problem causing bacteria. Drink cranberry juice if you like it. Otherwise, take vitamin C to make your urine acid and drink lots of water. It works just as well and it costs less.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.