Urinary Tract Infections and Overactive Bladder

Recurrent cystitis or urinary tract infections

What are the symptoms of a urinary tract infection?

When you have a urinary tract infection (UTI), the lining of the bladder and urethra become red and sore. The usual symptoms are one or more of the following:

  • a feeling of discomfort when you pass urine, usually a stinging or burning pain in the urethra
  • a constant feeling that you want to pass urine; although you may be bursting to go, there is hardly any urine in the bladder
  • a dragging ache in your lower abdomen
  • dark or "strong" urine which may contain visible blood from the inflammation
If your kidneys become infected you may develop a fever or back pain. If you have these symptoms and you have had symptoms of a lower urinary tract infection as above, then you should seek medical advice, as these infections need to be treated promptly with antibiotics.

What causes urinary tract infections (UTIs)?

Bacteria which live in the perineal area or on your skin can travel up your urethra and infect the urinary tract. This is more commonly seen in women, who have a shorter urethra than men.

Cystsitis or infections of the lower urinary tract occur in women of all ages, and only need to be investigated if they are recurrent, or there are other worrying symptoms. Your GP or specialist will be able to discuss this with you. Some women are genetically or anatomically predisposed to getting infections. Women who have gone through menopause have a change in the lining of the vagina and lose the protective effects of oestrogen that decrease the likelihood of infections. Postmenopausal women with UTIs may benefit from hormone replacement. Sexual intercourse may predispose some women to urinary tract infections.

Disorders such as diabetes also put people at higher risk for UTIs because of the body's decrease in immune function and thus a reduced ability to fight off infections such as UTIs

You are more likely to get a UTI if you have recently had a urological operation, if you have a catheter in place, or if your urinary tract has a structural abnormality. Patients who do not empty their bladder completely may develop infections, and while this is one of the commonest causes of infections in men whose prostate enlarges and blocks off the flow of urine out of the bladder as they get older, infections in men always need thorough investigation.

How do I know if I have an infection?

If you think that you might have a urinary infection, then you should contact your doctor. A urine analysis if performed, and if there are signs of an infection a urine culture is usually obtained. Many patients are treated with antibiotics before the results of this are known.

If you are having fevers and symptoms of a UTI, recurrent infections (in women), a single infection in a man, or persistent symptoms despite therapy, then further tests are required. These might include a further urine culture, an ultrasound or CT scan (links to investigations you might require page), a flexible cystoscopy (link to flexi cysto pdf) and a flow rate and residual scan.

Advice for Men with Lower Urinary Tract Symptoms

How are urinary tract infections treated?

A UTI can be usually be treated with a short course of oral antibiotics, but some infections may need to be treated for longer. You must complete the full course of medication prescribed for you even if all your symptoms improve, otherwise the infection may return. Things which you can do to help yourself include:

. As soon as you feel the first twinges, start drinking a lot of water or another bland liquid such as milk or weak tea. Avoid strong coffee, tea or alcohol. For the first 3 hours, drink at least half a pint every 20 minutes to flush out the infection before it gets a grip

  • Take one tablespoonful of bicarbonate of soda dissolved in water as soon as possible and repeat this every 3-4 hours. This reduces the acidity of the urine and helps to relieve the stinging
  • Keep warm and place a hot water bottle over your tummy or between your thighs to ease the abdominal discomfort
  • Take a mild painkiller such as aspirin or paracetamol
  • Do not self-medicate with antibiotics left over from previous infections or from other people
  • If you have been prescribed "self-start antibiotics" by your doctor or urologist, start taking the tablets, after you have provided a urine sample for your doctor to send to the laboratory
What can be done for patients who get recurrent infections?

  • Once an underlying cause has been ruled out, a number of different approaches can be tried to decrease the chance of getting infections in the future.
  • Drink plenty (3-4 pints) of bland liquid (as above) each day to help keep the bladder clear of germs
  • Always pass urine after intercourse
  • Use plain water for washing; always wipe from "front to back"
  • Avoid bubble baths, talcum powder, all personal (vaginal) deodorants & feminine wipes
  • Always try and make sure that you have emptied your bladder, by squeezing out the last few drops if possible
  • Cranberry juice or cranberry tablets taken regularly may help reduce the chance of recurrent infections
If your symptoms are related to sexual intercourse, you should wash carefully with plain water before having intercourse. Use a special lubricant (KY Jelly) during intercourse - this is available from most chemists without prescription. It is helpful to empty out your bladder immediately after intercourse to flush out any germs which may have entered the urethra. Some women, however, continue to suffer problems despite these measures experiencing recurrent cystitis after sexual activity. In this situation, it is best to take a single antibiotic tablet (Norfloxacin, Trimethoprim or Cephalexin) immediately after intercourse and to take regular cranberry juice or tablets.

In some patients with recurrent infections self-starter antibiotics might be used. This is where patients start to take antibiotics themselves when they feel the symptoms of an infection coming on, without the need to see their doctor each time. In other patients a dose of prophylactic antibiotic may be taken each day. Your doctor will be able to discuss with you which approach is best.

Overactive Bladder

What is Overactive Bladder?

This is a common condition affecting women and men, which can have a significant impact on a patient's (and partner's) quality of life. Symptoms include urgency (the need to rush to pass urine), frequency (going to pass urine often), nocturia (needing to get up at night to pass urine) and urinary urge incontinence (urine leakage). It is caused by the bladder muscle contracting too readily, often at inconvenient times.

What Causes Overactive bladder?

By definition, the cause of OAB is unknown. However, it is important and rule out a significant underlying cause, and investigations might include a urine test to rule out infection or the prescence of abnormal cells, an scan of the bladder and bladder function test (urodynamics) . It is often helpful to complete a frequency volume chart prior to your appointment , and in men especially, to perform a flow test and residual bladder scan . Some patients may require a flexible cystosocpy.

In some patients there is an identifiable underlying cause. These can include nerve damage or neurological disease such as multiple sclerosis, Parkinson's diseas, or stroke, in which case the diagnosis is called neurogenic detrusor overactivity. More significant underlying causes which need to be ruled out include bladder cancer, urinary tract infections (see above) and benign prostatic hyperplasia.

How is Overactive Bladder Treated?

OAB is usually treated in a step wise fashion, starting with the most straightforward, least invasive treatment first, and only moving on to more complex treatments after initial treatments have not worked. Treatments include behavioural therapies, drugs (anticholinergic medication), with injection of botox (botulinum toxin) into the bladder muscle, electrical stimulation of the bladder (neuromodulation) and surgery to increase the bladder volume only being reserved for very severe cases which have not responded to other treatments.

Lifestyle changes and behavioural regimens have been shown to improve symptoms. The most straightforward is decreasing caffeine or alcohol intake. Others include losing weight and stopping smoking. Behavioural regimens range from simple manoeuvres such as timed or prompted urination and fluid management to biofeedback. Pelvic muscle exercises (Kegel exercises) may also help.

Certain drugs can inhibit contraction of the bladder muscle. They are usually called antimuscarinics, and they include: oxybutynin, tolterodine, trospium chloride, darifenacin, and solefenacin. They may improve symptoms for a number of patients, but may have side effects including a dry mouth and constipation.

 
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