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

BLADDER INFECTIONS COMMON AILMENT OF YOUNG WOMEN

Question: I've had quite a bit of trouble with bladder infections. They always seem to start suddenly and make me quite uncomfortable. I drink cranberry juice every day, but they still happen. My doctor doesn't seem very concerned. Do you have any suggestions about what I can do?

Answer: Bladder infections are very common particularly in reproductive-aged women. In fact, bladder infection makes the list of the 10 most common reasons for going to the doctor. About 5 percent of the population aare victims of bladder infection, called "cystitis" in doctor language, with a 50:1 ratio of females to males. This is overwhelmingly lopsided, especially when you consider that for the first year of life and again after age 55, men and women have about the same number of bladder infections. Perhaps your doctor doesn't seem very concerned because cystitis is such a common ailment.

You said that you have "quite a bit of trouble" from bladder infection, but "quite a bit" is hard to measure. Many women in the reproductive years have one or two episodes per year without any underlying abnormality causing the infection. That isn't very often if you or a loved one aren't the one experiencing the burning with urination, frequent urination and urgent need to urinate that are the classic symptoms of this condition. If, on the other hand, you are the one with cystitis, twice a year may seem like "quite a bit of trouble."

There are several health problems that can increase the risk of cystitis. Diabetes and immunosuppression from cancer drugs, cortisone or AIDS can significantly increase the risk of cystitis in a person of any age or sex. In these individuals, the body's defense system is not as efficient at killing off the few bacteria that get into the bladder, so these germs can reproduce in large enough numbers to cause an infection.

Pregnancy is a common condition that increases the risk in reproductive-age women, but the greatest risk is sexual intercourse. During intercourse the E. coli bacteria that are present on the skin can be forced up the woman's urethra the tube that connects vagina with the bladder. Once in the bladder, the germs multiply and the infection is established.

The E. coli bacteria cause more than 90 percent of cystitis cases typically bringing on symptoms quite rapidly, just as you have experienced. Because we physicians see this cluster of symptoms so often and they are so characteristic of a bladder infection, most of us do only a simple urinalysis before starting a reproductive-age woman on an antibiotic. Fortunately, the E. coli bacteria are easily killed by a variety of antibiotics. Today, following the advice of recent research, most doctors prescribe only three days of antibiotic instead of the seven- or ten-day treatment that was considered best just a few years ago.

You mentioned that you drink cranberry juice to help prevent bladder infection. Many of us have recommended this for years, and now there is additional scientific data that shows it does certainly reduce one's risk of bladder infection. As you have noted though, it doesn't guarantee that you will avoid them completely.

The best preventive measure you can add is soap and water. Be sure to bathe before intercourse. This reduces the number of bacteria present on the skin, which consequently reduces the risk of getting them into the bladder. It is also important to only wipe from the front to the back after going to the bathroom. This will reduce the risk of bringing more E. coli bacteria from around the rectum forward to the vagina and urethra.

In spite of their best efforts, some women still have bladder infections more than twice a year. This should prompt your doctor to make sure you don't have an underlying disease or abnormality in the structure of the bladder or urethra. Often, however, these tests are quite normal. Some women are just unlucky. Perhaps that is why you have "quite a bit of trouble."

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.