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Occurring in otherwise healthy individuals with no neurological or structural abnormalities, acute, symptomatic, uncomplicated urinary tract infection (UTI) may be the most common infection after the common cold and flu.
Natural Defense Mechanisms. The greatest defense mechanism against bacterial inflammation and adherence to the bladder or urethral lining is urine: invading bacteria stimulate urination. Voiding washes out bacteria from the bladder and urethra and dilutes bacterial concentrations, preventing adherence. The surface cells of the bladder are coated with a special urinary mucus. This thin negatively-charged surface layer attracts water molecules and forms a barrier between the bladder and urine, preventing bacterial adherence. White blood cells will also move into the bladder and urine to kill the invading bacteria. The kidneys produce a protein which contains mannose residues that block the attachment points of some types of E. coli. This prevents their attachment to the bladder and encourages their excretion.
Incidence; Causes & Development; Risk Factors
Acute bacterial cystitis affects 8-10 million Americans each year. An acute UTI will be experienced by 25 to 40% of females in their lives, and up to 6% of women will have one or more UTIs in a given year.
Cystitis is a common occurrence in women, but it is less common and a potentially more serious condition for men.
E. coli is responsible for more than 80% of all acute female bladder infections. However, S. saprophyticus is more often isolated from women using spermicide-coated condoms (74%) and diaphragms than is E. coli. Other bacteria such as Proteus, Klebsiella or Enterobacter are occasionally isolated from uncomplicated UTIs. Vaginitis and urethritis caused by sexually transmitted pathogens such as herpes simplex, chlamydia or gonorrhea may mimic cystitis.
For men the cause can be an underlying bladder or prostate infection, an obstruction or tumor, or an enlarged prostate.
The largest risk factor for acquiring and developing an acute UTI is being female. This is because the short female urethra provides greater access to the bladder, and the nearby vagina provides a favorable environment for bacterial colonization and growth.
The risk of acquiring an acute infection is more than 3-fold among women with a previous infection compared to women with no history of UTI.
Sex and Cystitis
Once referred to as "honeymoon-cystitis", many women acquire their first infection after their first sexual experience. A study has shown that, compared to women who have not been sexually active during the previous week, the relative risk of a UTI among unmarried women increases 2.6 times for women who have engaged in sexual intercourse 3 times per week, and 9.0 times for women who have had intercourse seven times during the previous week. New sex partners and intercourse methods introduce bacteria into the vagina and urethral area. If bacteria are not removed by voiding or cleaning, they will colonize in this area, posing a risk of infection.
Barrier methods of birth control can also increase the risk of acquiring a UTI. Condoms increase the risk of vaginal tears, allowing bacteria to invade and adhere. Contraceptive sponges, foams, creams, gels and condoms use nonoxynol-9 (N-9) as a spermicide. Lactobacilli, the normal flora of the vagina, provide protection from external bacteria overgrowth, but are eradicated by N-9. The removal of lactobacilli by N-9 or other antibiotics alters the vaginal pH and natural flora, allowing Escherichia coli (E. coli) and Staphylococcus saprophyticus to proliferate, colonize and adhere to the vaginal mucosa. The odds that a woman exposed to condoms coated with N-9 would get a UTI were found to be 3 times higher than for sexually active women who did not use coated condoms. Diaphragms that are worn for more than 24 hours or improperly fitted can harbor bacteria or irritate tissue. A cervical cap, however, may not be associated with an increased UTI risk; less spermicide is used inside the enclosed cap, causing less alteration of the vaginal flora. Using extra lubricant during sex to decrease friction and irritation can help prevent the development of an infection.
Signs & Symptoms
Signs and symptoms of a complicated infection include nausea, vomiting, flank pain, fever and chills. Treatment may require hospitalization and longer, more expensive antibiotic treatment.
Diagnosis & Tests
As a man, if you experience the symptoms of cystitis, you should see your doctor immediately. An analysis and culture/sensitivity of your urine will be performed which should identify the kind of bacteria causing the infection and the antibiotic most likely to help.
The leukocyte esterase (LE) dipstick test is used to screen for pyuria (presence of pus in the urine when voided). LE, an enzyme found in neutrophil granules, reacts with an impregnated reagent pad to produce a blue color within 2-5 minutes. A positive test indicates the presence of white blood cells (WBC). When compared to standard methods of defining UTIs (isolating >=105 CFU/mL of pathogenic bacteria)11 or significant pyuria (>=10 WBC/mm3 urine) the sensitivity is 75%-96% and the specificity is 94%-98%.15 Pyuria indicates inflammation and not necessarily an infection. This is an efficient, cost-effective method for determining the presence of pyuria when routine microscopy is unavailable, impractical or for an outpatient evaluation.15 Vitamin C and phenazopyridine10 may cause false-negative or unreadable results.
The nitrate test is also widely available, for use at home or in the office. The nitrate test is qualitative in that it is used as a surrogate to detect Gram-negative bacteria, since only Gram-negative bacteria are able to produce nitrate. An aromatic amine-impregnated pad produces an azo color within 60 seconds if urinary nitrites are present. Urinary nitrites are produced by the action of Gram-negative bacteria (Enterobacteriaceae) metabolism on dietary nitrates through nitrate reductase. False-negatives can result from recent antibiotic therapy, low urinary pH (as occurs with high doses of ascorbic acid), lack of dietary nitrates, or when diuresis has created insufficient urinary nitrate levels. False-negatives also occur when Pseudomonas sp. or Gram-positive bacteria such as Staphylococcus sp., or Enterococcus sp., which lack nitrate reductase, are unable to produce nitrite.15 Sensitivity of the test ranges between 35%-85%, and the specificity ranges between 92%-100%.
Treatment & Prevention
When promptly treated, the period of discomfort can be shortened and the potential for more serious damage and recurrence is reduced. Treatment is usually recommended because if the infection progresses and spreads to the kidneys it is then classified as a complicated infection.
In the past, the treatment of acute female cystitis with an antibiotic for 7-14 days was the standard procedure. Although very effective, the associated adverse events, poor compliance and unnecessary costs necessitated a re-evaluation. Single-dose therapy is generally less effective than the same antimicrobial used for 7-14 days, but most antimicrobials given for three days are as effective as the same antimicrobial given for 7-14 days.
Complications
Cystitis in men is not serious if treated promptly, but the discomfort can be chronic and disabling. Untreated bladder infections can cause kidney or prostate infections and damage.
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Signs, symptoms & indicators of Cystitis, Bacterial bladder Infection:
Conditions that suggest Cystitis, Bacterial bladder Infection:
Risk factors for Cystitis, Bacterial bladder Infection: | | | | | Autoimmune |  Lupus, SLE (Systemic Lupus Erythromatosis) |
Hormones |
Progesterone Excess | One mysterious effect in the progesterone intolerant women is bladder problems. Some women have either a great increase in urinary tract infections or a feeling like they are having an infection as soon as they try taking a "normal" progesterone dose. If bladder symptoms start and stop with starting and stopping progesterone, they may be related. |
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Nutrients |
Vitamin A Requirement| | Retinoic acid (an analogue of vitamin A) is needed for the differentiation of basal cells into mucus epithelial cells. A deficiency results in keratinization of mucus membranes that line the respiratory tract, intestines, urinary tract and epithelium of the eye. This in turn decreases the protective barrier role played by these membranes, resulting in an increased number of infections and other pathologies. |
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Recommendations and treatments for Cystitis, Bacterial bladder Infection: | | | | | Botanical |  Cranberry Juice| | There is evidence to suggest that drinking cranberry juice in addition to water can help fight a bladder infection. Since the mid-1800s, cranberry juice has been associated with urinary antibiotic properties. The juice does not appear to work by acidifying the urine, but rather contains compounds that have a mild antibacterial quality or help prevent E. coli from adhering to tissues. There is evidence that if you consume a glass of cranberry juice each day, it could reduce the incidence of urinary tract infections (UTI). The most widely-accepted dose is 3 ounces of 33% pure cranberry juice daily to prevent an infection and 12-32 ounces per day for treatment.
It has been reported that cranberries contain more mannose than any other food. This sugar, D-mannose, blocks E. coli attachment. Since the mannose content in cranberries is relatively low, many natural doctors now use supplemental D-mannose to deal with the most common form of cystitis, an E. coli infection. D-mannose can be used for preventive purposes also.
A study was conducted at the Finnish Student Health Services at Oulu University with 150 women with persistent UTIs. Fifty drank just under 2oz of cranberry juice concentrate per day for six months. Another 50 drank a preparation of Lactobacillus, while the final 50 women were given no treatment. After six months, only eight women taking cranberry juice had experienced a UTI, compared with 19 of those taking Lactobacillus, and 18 not taking anything.
50ml of cranberry juice concentrate seems to be well-tolerated and is effective in preventing bladder infections. Larger quantities should be considered when an infection is present. Cranberry cocktail or juice may be very diluted and may produce no benefit if not taken in sufficient quantities to approximate a 50ml (just under 2 ounce) dose of concentrate. Check labels to ensure a high proportion of actual cranberry juice in whatever preparation you choose, or use only concentrate or powder forms. |
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Diet |
Increased Water Consumption| | The mainstay of prevention is to keep the urine dilute by drinking fluids and urinating often. Added water consumption during an infection will help flush out the problem bacteria. Repeated infections may require that routine water consumption be increased to prevent their recurrence. |
 Caffeine/Coffee Avoidance| | Coffee, soda and other caffeinated beverages may irritate the bladder lining and are not recommended. |
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Drug |
Antibiotics| | While natural means may prevent as well as treat cystitis, there are times when the judicious use of antibiotics is the best treatment choice. Natural means alone will often prevent recurrence and in some cases resolve bladder infections that have resisted antibiotic treatment. |
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Hormone |
 Natural Progesterone |
Lab Tests/Rule-Outs |
Urinalysis| | Urine culture and susceptibility testing add little to the eventual choice of an antibiotic as treatment because of the limited number of possible pathogens. Many patients, therefore, may receive an abbreviated laboratory work-up using dipstick tests to screen for the presence of bacteria and white blood cells.
If treatment does not improve symptoms, further testing should be done. Cultures need to be performed when the diagnosis is unclear or when there are other risk factors such as a history of recurrent infections. Cultures should also be performed when symptoms such as fever, lower back pain or signs associated with vaginitis are present.
During urinalysis, urine pH is determined. If elevated, lowering it will assist in resolving the infection. |
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Mineral |
Colloidal Silver |
Physical Medicine |
Not recommended:
 Hydrotherapy |
Vitamins |
Vitamin C (Ascorbic Acid)| | The urine pH is often elevated in times of bacterial infection but can be lowered by some medications or unbuffered vitamin C. This produces a less favorable growth environment for some bacteria. |
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Preventive measures against Cystitis, Bacterial bladder Infection: | | | | | Habits | Personal Hygiene Changes| | For women, poor personal hygiene following urination or defecation can expose the vagina and urethra to bacteria from the surrounding area. To prevent bladder infections, practice good personal hygiene by always "wiping front to back" to keep bacteria from entering and colonizing the vagina and urethra. Wash the skin around the vagina, perineum and rectum daily. Shower or bathe but avoid bubble baths, bath oils and scented soaps, which can act as irritants. During menstruation, change sanitary pads every 2-3 hours and tampons every 4-5 hours. Sanitary pads and tampons containing deodorants or perfumes can irritate the skin, allowing bacteria to enter. |
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KEY | | Weak or unproven link |  | | Strong or generally accepted link |  | | Proven definite or direct link | | | May do some good | | | Likely to help | | | Highly recommended | | | Reasonably likely to cause problems |
GLOSSARY
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Antimicrobial
Tending to destroy microbes, hinder their multiplication or growth.
Bacteria (Bacterial, Bacterium)
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Chlamydia
A sexually-transmitted disease that is often without symptoms. Some females experience a white vaginal discharge that resembles cottage cheese, a burning sensation when urinating, itching, and painful intercourse. A clear watery urethral discharge in the male probably is a chlamydia infection.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Cystitis
Inflammation of the urinary bladder.
Diuresis
Excessive discharge of urine.
Enzymes (Enzyme)
Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.
Epithelial
Referring to the cells that line and protect the external and internal surfaces of the body. Epithelial cells form epithelial tissues such as skin and mucous membranes.
Gonorrhea
A sexually-transmitted disease that is often without symptoms. If there are symptoms in the female, they include frequent and painful urination, cloudy vaginal discharge, vaginal itching, inflammation of the pelvic area, and abnormal uterine bleeding. If the male has a purulent (pus-like) urethral discharge, he should assume he has gonorrhea until proven otherwise.
Herpes Simplex
An infection, often recurrent, caused by herpes virus type 1 and 2. It causes cold sores around the lips and mouth, and also causes painful blisters on the genitals and in the pubic area, thighs, and buttocks.
Kidneys (Kidney, Renal)
Bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage. The kidneys are sophisticated reprocessing machines, each day handling about 50 gallons of blood to sift out about half a gallon of waste products and extra water. The waste and extra water become urine, which flows to the bladder through tubes called ureters. The actual filtering occurs in tiny units inside the kidneys called nephrons. Every kidney has about a million nephrons. In a nephron, a glomerulus -- which is a tiny blood vessel, or capillary -- intertwines with a tiny urine-collecting tube called a tubule. A complicated chemical exchange takes place, as waste materials and water leave your blood and enter your urinary system. The kidneys recycle chemicals such as sodium, phosphorus, and potassium and thus regulate their levels. Renal: Pertaining to the kidneys.
Lactobacillus
A genus of gram-positive, acid-resistant bacteria in the Lactobacillaceae family. We know of lactobacillus because of its use in making yogurt and the conventional wisdom of taking it in one form or another after antibiotic therapy, but it is an integral part of the colon and mouth flora, and is the critical acidifying agent in vaginal flora. There is a growing body of rather ignored data showing the value of regular consumption of a lactobacillus-containing food in immunosuppression, slow virus, and candidiasis conditions.
Leukocyte (Leukocytes)
A white blood cell which appears 5,000 to 10,000 times in each cubic millimeter of normal human blood. Among the most important functions are destroying bacteria, fungi and viruses and rendering harmless poisonous substances that may result from allergic reactions and cell injury.
Menstruation (Menses, Menstrual, Menstrual Cycle, Menstrual Cycles, Menstrual Flow, Menstrual Phase, Monthly Cycle)
The periodic discharge of blood, tissue fluid and mucus from the endometrium (lining of the uterus) that usually lasts from 3 - 5 days. It is caused by a sudden reduction in estrogens and progesterone.
Metabolism (Metabolic, Metabolize, Metabolizes, Metabolizing)
The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds. Also defined as the sum total of changes in an organism in order to achieve a balance (homeostasis): Catabolic burns up, anabolic stores and builds up; the sum of their work is metabolism.
Milliliter (mL)
0.001 or one thousandth of a liter.
Mucous Membranes (Mucosa, Mucous Membrane, Mucus Membranes)
The membranes, such as the mouth, nose, anus, and vagina, that line the cavities and canals of the body which communicate with the air.
Mucus (Mucous)
The viscous, slippery substance that consists chiefly of mucin, water, cells, and inorganic salts and is secreted as a protective lubricant coating by cells and glands of the mucous membranes.
Nausea
Symptoms resulting from an inclination to vomit.
Neutrophils (Neutrophil)
Another name for polymorphonuclear leukocytes, the most common type of blood-carried white blood cell, and the first mobile resistance cell to come to the rescue in injury.
Ounce (Ounces, oz)
Approximately 28 grams.
pH
A measure of an environment's acidity or alkalinity. The more acidic the solution, the lower the pH. For example, a pH of 1 is very acidic; a pH of 7 is neutral; a pH of 14 is very alkaline.
Progesterone
This is the hormone secreted after ovulation by the corpus luteum. It is a steroid (similar to a cholesterol), enters receptive cells to stimulate their growth, and acts as an anabolic agent. Estrogen should be viewed as the primary coat underneath all the cycles during a woman's reproductive years, with progesterone, its antagonist, surging for ten or twelve days in ovulatory months. Most of the actions of progesterone cannot occur without estrogen having previously induced the growth of progesterone-receptive binding sites.
Prostate
The prostate gland in men that surrounds the neck of the bladder and the urethra and produces a secretion that liquefies coagulated semen.
Protein (Proteins)
Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.
Pus
White cells that the body sends to fight an infection.
Staphylococcus (Staph, Staphylococcal)
A genus of micrococci bacteria with many members that can cause disease. They are gram-positive, nonmotile bacteria
that are aerobic-(unless they need to be anaerobic). Staph of various types are responsible for boils and carbuncles; they may be involved in impetigo, toxic shock syndrome, endocarditis, osteomyelitis, and urinary tract infections, as well as some food poisoning. They stay around hospitals and veterinary clinics waiting to get you. They are also a normal part of the mouth, throat, and skin flora in a third to a half of all of us, causing no problems, but just waiting. Staph has always been with us. Some even eat our antibiotics for breakfast.
Urethritis
Any inflammation of the urethra, whether from external irritation, overly acidic or scalding urine, passage of stones, or an active infection of the canal.
Urinary Tract (UT)
The kidneys and the lower urinary tract, which includes the ureters, bladder, and urethra.
UTI
Urinary Tract Infection.
Vaginitis (Vaginosis)
An inflammation of the vagina, either from simple tissue irritation or from an infection. Vaginosis: A vaginal infection characterized by a smelly discharge and the presence of Gardnerella, Mycoplasma, or other anaerobic bacteria, with thevlack of Lactobacillus species.
Vitamin A
A fat-soluble vitamin essential to one's health. Plays an important part in the growth and repair of body tissue, protects epithelial tissue, helps maintain the skin and is necessary for night vision. It is also necessary for normal growth and formation of bones and teeth. For Vitamin A only, 1mg translates to 833 IU.
Vitamin C (Ascorbic Acid)
A water-soluble antioxidant vitamin essential to the body's health. When bound to other nutrients, for example calcium, it would be referred to as "calcium ascorbate". As an antioxidant, it inhibits the formation of nitrosamines (a suspected carcinogen). Vitamin C is important for maintenance of bones, teeth, collagen and blood vessels (capillaries), enhances iron absorption and red blood cell formation, helps in the utilization of carbohydrates and synthesis of fats and proteins, aids in fighting bacterial infections, and interacts with other nutrients. It is present in citrus fruits, tomatoes, berries, potatoes and fresh, green leafy vegetables.
White Blood Cell (WBC, White Blood Cells)
A blood cell that does not contain hemoglobin: a blood corpuscle responsible for maintaining the body's immune surveillance system against invasion by foreign substances such as viruses or bacteria. White cells become specifically programmed against foreign invaders and work to inactivate and rid the body of a foreign substance. White blood cells are composed primarily of neutrophils, monocytes and lymphocytes. Lymphocytes are either T-cells or B-cells. T-cells (CD3 cells) are divided into T-helper (CD4 cells) and T-suppressor/cytotoxic (CD8 cells) cells.
Last updated: Jun 15, 2008
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