"Restrooms Closed" signby James Hubbard, M.D., M.P.H.

Sometimes I work at an urgent care facility on Friday nights, and it never fails. A minimum of three of the ten or so patients I see from five until nine will be women with bladder infections. The story is the same. It’s starting to burn when they pee, they’ve had this before, and there’s no way they’re going to suffer until Monday to see their regular doctor. Oh, and if they’re peeing blood, they’re scared to death. Who wouldn’t be?

It’s usually a pretty easy diagnosis. Yes, the burning can be awful, the blood really scary, but ninety-nine times out of a hundred (I never say a hundred percent) it’s a simple bladder infection–cystitis.

This being National Women’s Health Week, I wanted to write about a couple of problems I see women more than men for. Problems that might even be more common in emergency situations. Because of the stress and no time for hygiene or proper toilet facilities, yeast and bladder infections come to mind. I’ve already posted on yeast infections, so I thought I might tell you how I’d diagnose and handle cystitis in an office in hopes that you could glean tips of your own for when it’s impossible for you to make it in.

So here’s what I do if I suspect cystitis:

First, I get a urine specimen to look for white blood cells. Many times it’s cloudy, often smelly, sometimes bloody.

More complicated: If the infections are recurrent (more than one per year) I may do a culture and sensitivity of the urine to make sure we’re not dealing with some antibiotic-resistant bacteria.

I ask you about fever or abdominal pain. Back and mild lower-abdominal pain is common with cystitis.

More complicated: Fever or side pain makes me think pyelonephritis. That means the infection has gotten into a kidney and the bloodstream. It makes you way sicker and sometimes requires hospitalization to get intravenous antibiotics. At best, you’re going to have to rest for several days and take antibiotics for ten days.

I ask about vaginal irritation or discharge. If you have that, I’ll do a pelvic exam since a vaginal infection can be the cause of burning on urination.

I examine you and press on your abdomen. You’ll usually hate this because it makes you feel like you need to urinate. Again, mild lower-abdominal tenderness is common.

More complicated: Quite a bit of tenderness in one side or the other makes me think pyelo.

Time to Medicate

If I think it’s cystitis, I prescribe antibiotics (ciprofloxin, sulfa, nitrofurantoin, or amoxicillin) for three to seven days. If there’s a chance you’re pregnant, it’s amoxicillin or cephalexin. I tell you the common side effects.

  • Don’t take ciprofloxin with milk or calcium products. It doesn’t absorb as well. It can weaken your tendons slightly, so don’t go all jock while taking it.
  • Sulfa makes you more sensitive to sunlight, so use extra protection if you’re going to be out.
  • Don’t take amoxicillin if you’re allergic to penicillin.

You can read the insert for more.

If you’re having a lot of burning, phenazopyridine (Azo Standard) helps numb the bladder. It does nothing to cure the infection, but it helps you get by until the antibiotics kick in. If the over-the-counter’s not helping, I prescribe the prescription strength.

cotton boll

With cystitis, breathable cotton is your friend. Wearing cotton underwear will also help you prevent another bout of cystitis.

After the Cystitis Diagnosis

I tell you if the pain increases or you develop fever, come back right away. Either way, get another urine check in about two weeks to make sure the infection is cleared. If the blood cells aren’t gone you could have another problem. Kidney stones and bladder cancer (rare) come to mind.

Next, I go into tips that facilitate treatment and hopefully keep you from getting another cystitis.

  1. Drink plenty of water and juices—a couple of quarts a day–unless your doctor has told you to limit your fluids. This flushes your kidneys.
  2. Avoid caffeine. A couple of cups of coffee a day is okay, but a lot can irritate your bladder.
  3. Try cranberry juice or berries. They seem to help some people. Not so much with others. The theory is they keep bacteria from adhering to the bladder wall.
  4. Urinate when you need to. Don’t hold it. Bacteria grow in stagnant urine.
  5. Urinate immediately after sexual intercourse. This flushes out the bacteria that may have entered your urethra (bladder opening).
  6. Wear loose, breathable clothing and cotton underwear.
  7. No strong soaps, bubble baths, douches, or scented sprays.
  8. No scented feminine protection. The pads may cause fewer problems than the tampons.
  9. After bowel movements, wipe front to back.

Common Questions You May Ask

What would have happened if you hadn’t come in? If you were in good health, you’d have probably suffered for a few days, your body would have fought off the infection, and the cystitis would have gone away. On the other hand, it could also have migrated into your kidney, and then you would have developed the much more serious pyelonephritis. Don’t take that risk.

What’s the difference between a urinary-tract infection and a bladder infection? In my thinking, a urinary tract infection (UTI) is a general term for any infection along the bladder or kidneys. The more specific term “cystitis,” or bladder infection, is a UTI of the bladder. Pyelonephritis is a UTI of the kidney. Kidney infection? It could mean UTI or pyelo, depending on who you’re talking to.

Why don’t men get more bladder infections? Anatomy. A man’s urethra, which connects the bladder with the outside world, is longer. In fact, as often as not in men, burning on urination is something else, like a prostate infection or an STD. If it’s a true cystitis, there may be an underlying problem such a kidney stones (infections like to start on stones) or a large prostate causing urine retention in the bladder.

So, what if you can’t get antibiotics? Go with the other things I’ve mentioned, and hope you don’t get signs of pyelo. If you do, it becomes essential to get medical help any way you can.

Please add any cystitis treatments, preventions, or experiences of your own.

“No restroom” photo by Daquella Manera on Flickr. Cotton boll photo by Calsidyrose on Flickr.