Bladder and Urinary Health

Urinary Tract Infections (UTIs): Symptoms, Causes

1. Pregnancy and Urinary Tract Infections
2. Best Ways to Help Prevent UTIs
3. Prolapsed Bladder
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1. Urinary Tract Infections (UTIs): Symptoms, Causes

Your Guide to Urinary Tract Infections (UTIs)

If you're a woman, your chance of getting a urinary tract infection, or UTI, is high; some experts rank your lifetime risk of getting one as high as 1 in 2 -- with many women having repeat infections, sometimes for years on end. Here's how to handle UTIs, whether you're experiencing your first or fifth infection, and how to make it less likely you'll get one in the first place.

What Causes UTIs in Women

UTIs are a key reason we're often told to wipe from front to back after using the bathroom. That's because the urethra -- the tube that transports urine from the bladder to the outside of the body -- is located close to the anus. Bacteria from the large intestine, such as E. coli, are in the perfect position to escape the anus and invade the urethra. From there, they can travel up to the bladder, and if the infection isn't treated, continue on to infect the kidneys. Women may be especially prone to UTIs because they have shorter urethras, which allow bacteria quick access to the bladder. Having sex can introduce bacteria into the urinary tract, too.

To identify a UTI, keep an eye out for the following symptoms:

• A burning feeling when you urinate
• A frequent or intense urge to urinate, even though little comes out when you do
• Pain or pressure in your back or lower abdomen
• Cloudy, dark, bloody, or strange-smelling urine
• Feeling tired or shaky
• Fever or chills (a sign the infection may have reached your kidneys)

Tests and Treatments for UTIs

If you suspect you have a urinary tract infection, head to the doctor. You'll be asked to give a urine sample, which will be tested for the presence of UTI-causing bacteria. The treatment? Antibiotics to kill the intruders. As always, be sure to finish off the prescribed cycle of medicine completely, even after you start to feel better. And drink lots of water to help flush the bacteria from your system. Your doctor may prescribe a medication to soothe the pain, and a heating pad may also be helpful.

Studies on the effectiveness of cranberry juice for preventing or treating UTIs have produced mixed results. The red berry contains a tannin that prevents E. coli bacteria - the most common cause of urinary tract infections- from sticking to the walls of the bladder, where they can cause infection. However, a 2012 review of 24 studies looking into the effectiveness of cranberry juice/extract on UTIs found they did not significantly reduce the incidence of UTIs.

Chronic UTIs

About 1 in 5 women experience a second urinary tract infection, while some are plagued incessantly. In most cases, the culprit is a different type or strain of bacteria. But some types can invade the body's cells and form a community safe both from antibiotics and the immune system. A group of these renegades can travel out of the cells, and then re-invade, ultimately establishing a colony of antibiotic-resistant bacteria primed to attack again and again.

Some women are genetically predisposed to UTIs, while others have abnormalities in the structure of their urinary tract that make them more susceptible to infection. Women with diabetes may be at higher risk, as well, because their compromised immune systems make them less able to fight off infections like UTIs. Other conditions that increase risk include pregnancy, multiple sclerosis, and anything that affects urine flow, such as kidney stones, stroke, and spinal cord injury.

UTI Treatment Options

If you have 3 or more UTIs a year, ask your doctor to recommend a special treatment plan. Some treatment options include:

• Taking a low dose of an antibiotic over a longer period to help prevent repeat infections
• Taking a single dose of an antibiotic after sex, which is a common infection trigger
• Taking antibiotics for 1 or 2 days every time symptoms appear
• Using an at-home urine test kit when symptoms start

The tests, which are available without a prescription, can help you determine whether you need to call your doctor. If you're on antibiotics, you can test to see if they've cured the infection (although you still need to finish your prescription). Contact your doctor if the test is positive, or if your symptoms continue, despite a negative test result.

How to Prevent UTI Re-infection

You can prevent getting another UTI with the following tips:

• Empty your bladder frequently as soon as you feel the need to go; don't rush, and be sure you've emptied your bladder completely.
• Wipe from front to back.
• Drink lots of water.
• Choose showers over baths.
• Stay away from feminine hygiene sprays, scented douches, and scented bath products -- they'll only increase irritation.
• Cleanse your genital area before sex.
• Urinate after sex to flush away any bacteria that may have entered your urethra.
• If you use a diaphragm, unlubricated condoms, or spermicidal jelly for birth control, consider switching to another method. Diaphragms can increase bacteria growth, while unlubricated condoms and spermicides can cause irritation. All can make UTI symptoms more likely.
• Keep your genital area dry by wearing cotton underwear and loose-fitting clothes. Avoid tight jeans and nylon underwear -- they can trap moisture, creating the perfect environment for bacteria growth

1. Pregnancy and Urinary Tract Infections

What if I Get a UTI When I’m Pregnant?

A urinary tract infection happens in the body's urinary system, which includes your:

• Kidneys
• Ureter (tube that carries urine from the kidneys to the bladder)
• Bladder
• Urethra (a short tube that carries urine from the bladder to outside the body)

Bacteria cause most UTIs. Anyone can get one, and it’s most common in women, especially if they are pregnant.

If you think you might have a UTI, tell your doctor. With proper care, you and your baby should be fine. But you need to make sure it doesn’t affect your kidneys.

Most of these infections are limited to the bladder and urethra. But sometimes they can lead to a kidney infection. If they do, UTIs may lead to preterm labour (giving birth too early) and low birth weight.

Symptoms

If you have a UTI, you may have:

• An urgent need to pee, or urinating more often
• Trouble with peeing
• A burning sensation or cramps in your lower back or lower belly
• A burning feeling when you pee
• Urine that looks cloudy or has an odor

Why Are UTIs More Common During Pregnancy?

Hormones are one reason. In pregnancy, they cause changes in the urinary tract, and that makes women more likely to get infections.

Also, your growing uterus presses on your bladder. That makes it hard for you to let out all the urine in your bladder. Leftover urine is a likely source of infection.

Diagnosis

You’ll take a urine test. Your doctor will test it for bacteria and red and white blood cells. A “urine culture” may also show what kind of bacteria are in the urine.

Treatment

You’ll take antibiotics for 3-7 days or as your doctor recommends. If your infection makes you feel uncomfortable, your doctor will probably start your treatment before you get your urine test results.

Your symptoms should go away in 3 days. Take all of your medication on schedule, anyway. Don’t stop it early, even if your symptoms fade.

Many common antibiotics -- amoxicillin, erythromycin, and penicillin, for example -- are considered safe for pregnant women. Your doctor wouldn’t prescribe others, such as tetracycline, that may lead to liver problems and affect the developing baby's teeth.

How to Avoid UTIs

You can:

• Drink at least eight glasses of water a day.
• Wipe yourself from front to back.
• Empty your bladder shortly before and after sex.
• If you need a lubricant when you have sex, choose a water-based one.
• Don't douche.
• Avoid strong feminine deodorants or soaps that cause irritation.
• Wash your genital area with warm water before sex.
• Wear cotton underwear.
• Take showers instead of baths.
• Don’t wear pants that are too tight.

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2. Best Ways to Help Prevent UTIs
3. Best Ways to Help Prevent UTIs
4. If you’ve ever had a urinary tract infection, you know how painful and frustrating they can be, especially if they keep coming back. While antibiotics generally clear up a UTI within a few days, there are also some simple measures you can take to help prevent getting one in the first place.
   To say goodbye to burning, frequent urination, and other unpleasant symptoms, start with these changes today. The key is to keep bacteria out of your system.
   1. Drink plenty of water, and relieve yourself often. The simplest way to prevent a UTI is to flush bacteria out of the bladder and urinary tract before it can set in. If you’re well-hydrated, it will be tough to go too long without urinating.
   2. Wipe from front to back. Bacteria tend to hang around the anus. If you wipe from front to back, especially after a bowel movement, they're less likely to make it to the urethra.
   3. Wash up before sex and urinate after it. Use soap and water before sex. This keeps bacteria away from the urethra. And urinating afterwards pushes any bacteria that entered the urinary tract back out.
   4. Steer clear of irritating feminine products. Skip douches, deodorant sprays, scented powders, and other potentially irritating feminine products.
   5. Rethink your birth control. A diaphragm, spermicide, or spermicide-lubricated condom can make you more likely to get a UTI because they all can contribute to bacterial growth. If you often get UTIs and use one of these birth control methods, switch to a water-based lubricant for vaginal dryness, and consider trying another birth control method to see if it helps.
   Some doctors also advise women who get a lot of UTIs to wear cotton underwear, take showers instead of baths, and avoid tight clothes that can trap bacteria near the urethra. While these are simple enough to do, none of them is supported by scientific data.

Ideas to Talk to Your Doctor About

If you get a lot of UTIs, your doctor may consider:

• A daily low dose of antibiotics, taken for 6 months or longer
• Having you test yourself for a UTI at home when you have symptoms
• Taking a single dose of antibiotics after having sex

If you’ve gone through menopause, you could ask about estrogen vaginal cream. After menopause, women have less estrogen in their bodies, which can cause vaginal dryness and make the urinary tract more vulnerable to infection. The treatment can help balance the area’s pH factor and allow “good” bacteria to flourish again.

What About Cranberry Juice?

There’s no harm in trying it. But it’s not a proven fix. 

Over the years, a lot of studies have focused on a substance found in cranberries that are thought to prevent bacteria from sticking to the lining of the urinary tract. But none of these studies has shown how much of this substance it would take to help prevent UTIs. 

If you still want to give it a try, drinking cranberry juice or taking cranberry pills is probably fine to do. But there are some exceptions, like if you take a blood-thinning medication, a medication that affects the liver, or aspirin. It’s always wise to talk to your doctor first before you try any supplements.

1. Prolapsed Bladder

Prolapsed Bladder

The bladder is a hollow organ in the pelvis that stores urine. The pressure created when the bladder fills with urine is what causes the urge to urinate. During urination, the urine travels from the bladder and out the body through the urethra.

In women, the front wall of the vagina supports the bladder. This wall can weaken or loosen with age. Significant bodily stress such as childbirth can also damage this part of the vaginal wall. If it deteriorates enough, the bladder can prolapse, meaning it is no longer supported and descends into the vagina. This may trigger problems such as urinary difficulties, discomfort, and stress incontinence (urine leakage caused by sneezing, coughing, and exertion, for example).

Prolapsed bladders (also called cystoceles or fallen bladders) are separated into four grades based on how far the bladder droops into the vagina.

• Grade 1 (mild): Only a small portion of the bladder droops into the vagina.
• Grade 2 (moderate): The bladder droops enough to be able to reach the opening of the vagina.
• Grade 3 (severe): The bladder protrudes from the body through the vaginal opening.
• Grade 4 (complete): The entire bladder protrudes completely outside the vagina; usually associated with other forms of pelvic organ prolapse (uterine prolapse, rectocele, enterocele).

Prolapsed bladders are commonly associated with menopause. Prior to menopause, women’s bodies create the hormone estrogen, which helps keep the muscles in and around the vagina strong. Women’s bodies stop creating as much estrogen after menopause, and those muscles tend to weaken as a result.

Causes of a Prolapsed Bladder

The following factors are commonly associated with causing a prolapsed bladder:

• Childbirth: This is the most common cause of a prolapsed bladder. The delivery process is stressful in the vaginal tissues and muscles, which support a woman’s bladder.
• Menopause: Estrogen, a hormone that helps maintain the strength and health of muscles in the vagina, is not produced after menopause.
• Straining: Lifting heavy objects, straining during bowel movements, having a long-term condition that involves coughing, or having long-term constipation may damage the muscles of the pelvic floor.

Symptoms of a Prolapsed Bladder

The first symptom that women with a prolapsed bladder usually notice is the presence of tissue in the vagina that many women describe as something that feels like a ball.

Other symptoms of a prolapsed bladder include the following:

• Discomfort or pain in the pelvis
• Tissue protruding from the vagina (The tissue may be tender and may bleed.)
• Difficulty urinating
• A feeling that the bladder is not empty immediately after urinating (incomplete voiding)
• Stress incontinence (urine leakage during sneezing, coughing, or exertion)
• More frequent bladder infections
• Painful intercourse (dyspareunia)
• Low back pain

Some women may not experience or notice symptoms of a mild (grade 1) prolapsed bladder.

When to Seek Medical Care for a Prolapsed Bladder

Any woman who notices symptoms of a prolapsed bladder should see her doctor. A prolapsed bladder is commonly associated with prolapses of other organs within a woman’s pelvis. Thus, timely medical care is recommended to evaluate for and to prevent problematic symptoms and complications caused by weakening tissue and muscle in the vagina. Prolapsed organs cannot heal themselves, and most worsen over time. Several treatments are available to correct a prolapsed bladder.

Exams and Tests for a Prolapsed Bladder

An exam of the female genitalia and pelvis, known as a pelvic exam, is required in order to diagnose a prolapsed bladder. A bladder that has entered the vagina confirms the diagnosis.

For less obvious cases, the doctor may use a voiding cystourethrogram to help with the diagnosis. A voiding cystourethrogram is a series of X-rays that are taken during urination. These help the doctor determine the shape of the bladder and the cause of urinary difficulty. The doctor may also test or take X-rays of different parts of the abdomen to rule out other possible causes of discomfort or urinary difficulty.

After diagnosis, the doctor may test the nerves, muscles, and the intensity of the urine stream to help decide what type of treatment is appropriate.

A test called urodynamics or video urodynamics may be performed at the doctor's discretion. These tests are sometimes referred to as "EKGs of the bladder". Urodynamics measures pressure and volume relationships in the bladder and may be crucial in the decision making of the urologist.

Cystoscopy (looking into the bladder with a scope) may also be performed to identify treatment options. This test is an outpatient office procedure that is sometimes performed on a television screen so the person can see what the urologist sees. Cystoscopy has little risk and is tolerable for the vast majority of people.

Prolapsed Bladder Treatment

A mild (grade 1) prolapsed bladder that produces no pain or discomfort usually requires no medical or surgical treatment. The doctor may recommend that a woman with a grade 1 prolapsed bladder should avoid heavy lifting or be straining, although there is little evidence to support this recommendation.

For cases that are more serious, the doctor takes into account various factors, such as the woman’s age, general health, treatment preference, and the severity of the prolapsed bladder to determine which treatment is appropriate.

Nonsurgical treatments for a prolapsed bladder include the following:

• Pessary: A pessary is a device that is placed in the vagina to hold the bladder in place. Pessaries must be removed and cleaned at regular intervals to prevent infection. Some pessaries are designed to allow the woman to do this herself. A doctor must remove and clean other types. Estrogen cream is commonly used along with a pessary to help prevent infection and vaginal wall erosion. Some women find that pessaries are uncomfortable or that they easily fall out.
• Estrogen replacement therapy: Many women with prolapsed bladders may benefit from this therapy. Estrogen helps strengthen and maintain muscles in the vagina.

Prolapsed Bladder Care at Home

For mild-to-moderate cases of prolapsed bladder, the doctor may recommend activity modification such as avoiding heavy lifting or straining. The doctor may also recommend Kegel exercises. These are exercises used to tighten the muscles of the pelvic floor. Kegel exercises might be used to treat mild-to-moderate prolapses or to supplement other treatments for prolapses that are more serious.

Medications for Prolapsed Bladder

Estrogen replacement therapy may be used for a prolapsed bladder to help the body strengthen the tissues in and around the vagina. Estrogen replacement therapy can't be used by everyone (such as in a people with certain types of cancer). Women’s bodies stop creating as much estrogen naturally after menopause, and the muscles of the vagina may weaken as a result. In mild cases of prolapsed bladder, estrogen may be prescribed in an attempt to reverse bladder prolapse symptoms, such as vaginal weakening and incontinence. For more severe degrees of prolapse, estrogen replacement therapy may be used along with other types of treatment.

Estrogen can be administered orally as a pill or topically as a patch or cream. The cream has very little systemic absorption and has a potent effect locally where it is applied. Topical administration has less risk than the oral preparations. The application of estrogens to the anterior vagina and urethral area may be very helpful in alleviating urinary symptoms, such as urgency and frequency, even in the face of prolapsed bladder.

Prolapsed Bladder Surgery

Severe prolapsed bladders that cannot be managed with a pessary usually require surgery to correct them. Prolapsed bladder surgery is usually performed through the vagina, and the goal is to secure the bladder in its correct position. The bladder is repaired with an incision in the vaginal wall. The prolapsed area is closed and the wall is strengthened.

Depending on the procedure, surgery can be performed while the woman is under general, regional, or local anaesthesia. For smaller surgeries, many women go home the same day of surgery.

Various materials have been used to strengthen pelvic weakness associated with a prolapsed bladder.

The risks of placing mesh through the vagina to repair pelvic organ prolapse may outweigh its benefits, according to the FDA. However, the use of mesh may be appropriate in some situations. A surgeon should explain in detail the risks, benefits, and potential complications of these materials and he or she should explain about the procedure itself before proceeding with the surgery.

After surgery, most women can expect to return to a normal level of activity after six weeks. However, surgeons may recommend reducing or eliminating activities that cause straining for up to six months.

Other Therapy for Prolapsed Bladder

Physical therapy such as electrical stimulation and biofeedback may be used for a prolapsed bladder to help strengthen the muscles in the pelvis.

• Electrical stimulation: A doctor can apply a probe to targeted muscles within the vagina or on the pelvic floor. The probe is attached to a device that measures and delivers small electrical currents that contract the muscles. These contractions help strengthen the muscles. A less intrusive type of electrical stimulation is available that magnetically stimulates the pudendal nerve from outside the body. This activates the muscles of the pelvic floor and may help treat incontinence.
• Biofeedback: A sensor is used to monitor muscle activity in the vagina and on the pelvic floor. The doctor can recommend exercises that can strengthen these muscles. These exercises may help strengthen the muscles to reverse or relieve some symptoms related to a prolapsed bladder. The sensor can monitor the muscular contractions during the exercises, and the doctor may be able to determine if the targeted muscles would benefit from the exercises.

Follow-up for Prolapsed Bladder

A woman undergoing treatment should schedule follow-up visits with her doctor to evaluate progress. Pessaries need to be removed and cleaned at regular intervals to prevent complications.

Prolapsed Bladder Prevention

To prevent a prolapsed bladder, a high-fibre diet and a daily intake of plenty of fluids can reduce a person’s risk of developing constipation. Straining during bowel movements should be avoided, if possible. Women with long-term constipation should seek medical attention in order to lessen the chance of developing a prolapsed bladder.

Heavy lifting is associated with prolapsed bladder and should be avoided, if possible.

Obesity is a risk factor for developing a prolapsed bladder. Weight control may help prevent this condition from developing.

Outlook for a Prolapsed Bladder

A prolapsed bladder is rarely a life-threatening condition. Most cases that are mild can be treated without surgery, and most severe prolapsed bladders can be completely corrected with surgery.

Multimedia

Media file 1: Line drawing indicating the relationship between the kidney, ureters, and bladder.