Many women are struggling with their bladders yet worried about taking antibiotics.
The symptoms of cystitis, also known as bladder infection or urinary tract infection (UTI), are familiar: pain when you pee, frequent small pees, and urgency: the feeling that you’ll wet your pants if you don’t reach the toilet immediately. You may also feel that you need to pee and nothing will come out.
When the pain is intense and keeping you home by the toilet, you may not be able to work. Also, if you don’t seek treatment and the infection lingers, it could move up into your kidneys, which can be dangerous.
The standard remedy is a one or three-day course of antibiotics. But that can lead to trouble down the line as well. The bacteria causing these infections are developing resistance to common drugs. Which drugs? That depends on your geographic area. Taking antibiotics also increases your personal risk of developing a resistant strain. You don’t want to take antibiotics unnecessarily or too often — or take the wrong one.
Don’t assume you have resistant bacteria in your system just because you have more than one infection within a few months. An estimated 27 percent of women have a second UTI within six months. Women who get UTIs frequently can suffer more than seven in a year. The average number is between two and three. It’s also common for UTIs to come in a cluster, near each other.
Risk factors for frequent UTIs include: new sexual partners; using a diaphragm, cervical cap, or condom, with or without a spermicide; a tendency towards UTI in your family; and wiping back to front instead of front to back.
What to do? Call your doctor. You can also buy over-the-counter painkillers designed for cystitis and an over-the-counter “dipstick” test. The test is easy to do yourself: you pee on it, preferably first thing in the morning, and wait three minutes. The test will give you two readings: one for nitrite and another for leukocyte, or white blood cells. A negative result or milder symptoms are reasons to drink lots of water and wait a day. Some women think they have an infection even when it has already resolved. Post-menopausal women sometimes experience urgent and frequent peeing without an infection.
Being positive on both readings is a strong indication that you have an infection. But you may get an ambiguous result. Also, you may have an infection even if the dipstick isn’t positive on either reading. Talk to your doctor about your symptoms.
Depending on what you report, a doctor may prescribe an antibiotic over the phone. If you have fever, chills, back pain, or nausea or vomiting, you should see the doctor in person. Especially if you have a recurrent problem, doctors will ask you to provide a urine sample in a lab and have your urine cultured to see exactly what’s there.
You may well be tempted to skip the trip to the lab (you’re glued to the toilet!) and prefer to take an antibiotic rather than wait for results — the culture will take more than 24 hours. That’s taking a risk.
Some women worry that they’re taking a bigger risk of a kidney infection by waiting. But some research indicates that you’re in no more danger of a more serious infection by waiting for the results of a culture, and that you’re less likely to take an antibiotic and have a recurrence.
You’re more likely to have an antibiotic-resistant infection if you are older than 60, have a chronic medical problem — or have taken other antibiotics in the last year for any reason, including UTIs. A trip abroad or hospital stay are also risk factors. Your doctors will look for alternative treatments.
To prevent future UTIs you’ll hear advice to urinate immediately after intercourse, take cranberry pills or drink unsweetened juice, take probiotic pills, or take methenamine salts. Although the evidence is not strong for any of these strategies, they may be worth a try. You may need to see a urologist to identify other causes. You may undergo a type of x-ray called an intravenous pyleogram, which involves injecting a dye into a vein and taking pictures of your kidney and bladder; an ultrasound exam, which gives a picture of your kidneys and bladder using sound waves; or a cytoscopic exam, which uses a hollow tube with special lenses to look inside the bladder.
Post-menopausal women may benefit from estrogen suppositories, which may pose fewer risks than oral hormone replacement.
Your doctor may recommend that you take an antibiotic after intercourse or on a regular schedule. However, in a time of growing resistance, this should be a last resort.
August 01, 2016
Christopher Nystuen, MD, MBA