Urology/UTI,s

Advertisement


Question
Hello,I am 42 year old Caucasian female. I've suffered from uncomplicated UTI's (cystitis) since my teenage year. The bacteria found was E.Coli in all cases. Two years ago, although i took Norocin tablets, the pain during urination didn't wear off. I had two subsequent urine cultures which showed that the bacteria hadn't disappeared. I took a cocktail of antibiotics for 3 months which eventually killed the bacteria and although urine cultures are negative, i still felt pain and discomfort. A year ago i underwent cystoscopy and the doctor found a bacteria biofilm in my bladder (trigonitis)as well as a problem with my bladder capacity. I had 10 injections of drugs in my bladder, to no avail and then he prescribed Oxybutynin Hydrochloride. I was told to take care of my diet too so as not to inflame my bladder but no result so far.

Answer
Elisabeth, so sorry to hear of your problems.  Although you are not having UTIs at present, let me give you some information regarding this as the general principles of bladder care apply to all women.  Urinary tract infections (UTIs) in women are very common compared to men.  This is due to the relatively short length of the female urethra.  This results in the bladder being nearer the external environment.  The most likely sources of bacteria are from the rectum, colonization in the vagina, or introduction via sexual activity.  Frequent bathing, as opposed to showering, also allows bath water to reflux into the bladder.  This may also be an entry path for bacteria.  In addition, refluxed soap residues often will irritate the lining of the bladder and urethra (mucosa) causing symptoms.  Females can lessen the likelihood of infection by not ignoring the desire to void, by emptying the bladder just prior to and soon after intercourse, by taking showers rather than baths and by always wiping from the urethra toward the rectum – NEVER the reverse!  The use of a diaphragm and spermicidal jellies also increase the risk of UTIs.  The typical symptoms of a UTI are frequency, burning, and urgency.  With more severe inflammation, blood may appear in the urine.  If bleeding occurs, you should seek consultation with a urologist once you are better to ensure that there are no other causes for the bleeding.  If the infection spreads from the bladder into the kidneys, the patient is much more ill and typically exhibits flank (kidney) pain, fever and chills.    If untreated, kidney infections may spread into the blood stream causing a life threatening disorder called septicemia.  This requires hospitalization, intravenous antibiotics and intensive care.

Most UTIs involve the lower urinary tract (urethra and/or bladder).  A tentative diagnosis is made by doing a urinalysis which typically demonstrates white blood cells (“pus cells”) and bacteria.  A positive dip stick test of the urine for nitrates or leukocyte esterase strongly suggests a UTI but culturing the urine for bacteria provides a definitive diagnosis.    Sensitivity studies are then done on the culture to determine which antibiotics will destroy the germ.  Most routine UTIs require 3-7 days of antibacterial therapy.  If the infections are frequent, long-term low dose daily or post-coital prophylactic antibacterial therapy may be needed.  In younger women, there is some evidence that cranberry products may prevent the recurrence of UTIs.  However, the dose is not standardized and they have not been successful in treating UTIs.   In the post-menopausal female, topical vaginal estrogen therapy may be of benefit.  Patients with recurrent UTIs often need to consult with a urologist to have their urinary system evaluated to try and find the reason for the frequent problems.  This usually involves imaging studies of the upper urinary tract, cystoscopic examination of the bladder and a measurement of residual urine (that urine still left in the bladder after urinating).    

As far as your present discomfort is concerned, I suspect your urologist thinks you have interstitial cystitis.  The diagnosis of this disorder is generally a clinical one made by ruling out other causes for urinary frequency and bladder pain.  Full evaluation by a urologist is necessary to make the diagnosis.  A biopsy may be helpful but is not truly diagnostic.  Medications used to treat IC are of 3 types: oral (systemic), topical (instilled into the bladder), and pain medicines.  Atarax is an oral systemic drug in the antihistamine family.  Since IC seems to be associated with an increased number of cells in the bladder wall that produce histamine (mast cells), atarax works by neutralizing the histamine released (that theoretically is irritating the bladder).  The usual dose of atarax for IC is 25 mgm 2-3 times daily.  It may take up to 4 weeks for maximum benefit to occur.  Therefore, as you noticed no significant improvement after your 4 weeks trial, it probably won't provide much benefit if tried again.  In general, the favorable response rate to atarax, however, as with all treatments for IC, is quite variable. The other oral agent used in IC is Elmiron.  It seems to work by coating the bladder wall so it is less inflamed by irritants.  

The classic medication that can be instilled into the bladder to treat IC is DMSO (dimethylsulfoxide).  It is placed into the bladder via a catheter and requires a series of instillations.  Success rates are in the 60-80% range but relapses within 6 months area common.   

There are a number of oral medications in the drug class called anti-spasmotics, that are often used orally to relieve urinary frequency (such as oxybutynin).  They do not specifically affect the underlying disorder of IC but can provide significant symptomatic relief.

There is an extensive help network on the internet for those with IC.  I believe some of the links below will be very informative.  Good luck.

http://www.ichelp.org/Page.aspx?pid=329
http://www.ic-network.com/
http://kidney.niddk.nih.gov/kudiseases/pubs/interstitialcystitis/  

Urology

All Answers


Answers by Expert:


Ask Experts

Volunteer


Arthur Goldstein, M.D.

Expertise

Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.

Experience

I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in endourology.

Organizations
American Medical Association, American Urological Association, American College of Surgeons

Education/Credentials
College degree - BS Medical degree - MD Master of Science - MS

©2016 About.com. All rights reserved.