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Offended bladder

Questions & Answers Many women are familiar with burning sensation and pain when urinating - these symptoms are often typical of a bladder infection. Urologist OA Dr. Michael Rutkowski. - By Mag. Silvia Feffer-Holik

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What are the most common signs of a cystitis?

OA Dr. Michael Rutkowski,
Urological department at the State Hospital Korneuburg, board member of the Medical Continence Society Austria (MKÖ)
Typical symptoms are a constant need to urinate with the feeling that the bladder is not emptying, as well as burning and pain when urinating. Affected people have to go to the toilet constantly, although only small amounts of urine can be passed. The urine is often foul-smelling, sometimes with blood.

What can those affected do in the event of an acute infection?

If there are mild symptoms - this includes a slight burning sensation, frequent urination, slight pain - then it helps to slightly increase the amount of water you drink throughout the day, i.e. to drink a maximum of two and a half liters of fluid - from bladder tea to non-carbonated water. If necessary, a pain reliever will help. It is also helpful to lower the pH value in the urine.

How does it work, how can the urine be acidified?

It is best to mix a quarter of a liter of water with two tablespoons of apple cider vinegar in the evening, this apple cider vinegar drink leads to an acidic urinary pH value. The bacteria don't like that.

When should I see a doctor?

When blood is visible in the urine. Furthermore, if the urge to urinate does not stop, is very painful, persists for a long time and especially if there is a fever or kidney or flank pain. The bacteria of the urinary tract infection can cause inflammation of the kidney pelvis. At this point, at the latest, antibiotics must be used, as untreated kidney inflammation can also lead to dangerous situations such as blood poisoning.
An examination by a urologist is also absolutely necessary if urinary tract infections are an issue over a long period of time.

What should be considered when taking antibiotics?

A urine culture should be made before taking the first antibiotic. If the antibiotic does not work because it cannot harm the bacteria - i.e. the bacteria are insensitive to the active ingredient, i.e. resistant - an alternative must be found quickly. The urine culture allows a precise diagnosis of the bacterial strain and makes new resistance build-up more difficult, which is also increasingly proving to be a problem.

How can cystitis be prevented?

Many women do not sit on the toilet seat in unfamiliar toilets for fear of infection. You urinate in a squatting position, which involuntarily tenses the muscles of the pelvic floor. This in turn prevents relaxed urination. Bacteria in the urine that are normally excreted are instead swirled up the urethra and into the bladder.
If you have the feeling that the pelvic floor is tense, then the urologist can measure the urine flow with a simultaneous assessment of the muscles involved (a so-called flow EMG). Physiotherapy with biofeedback 'relaxes' the pelvic floor, stress-free urination is possible again.

As a protection against cystitis, is it better to urinate more or less often?

If you are prone to a bladder infection, you should definitely urinate relaxed, do not press and go to the toilet as soon as possible if you urge to urinate. The capacity of the bladder cannot be trained by letting it become too full. This is also no protection against the reproduction of bacteria. On the contrary - it is damaging to the bladder if you do not pass it as soon as possible despite the urge to urinate.

Are heavy drinkers also less likely to develop bladder infections?

Two to two and a half liters of fluid per day - in the form of unsweetened (bubble) tea and water - are very important for the bladder. However, it is also not beneficial to drink too much, i.e. up to four liters a day. This dilutes the urine and decreases its ability to kill harmful bacteria. Furthermore, bacteria thrive more difficult in an acidic environment, cranberries can help to lower the pH value of the urine. The apple cider vinegar already mentioned is also suitable.

What else should you watch out for as a preventive measure?

Urinating after intercourse helps flush bacteria out of the body. However, excessive hygiene should be avoided, too intensive washing with soap destroys the vaginal flora and this leads to infections.

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Tips for a strengthened bladder

  • Comfortable warmth.
    Keeping feet and abdomen warm, this also protects the bladder and makes it harder for bacteria to settle. Wet swimwear, sweaty clothes, cold seats or freezing feet, on the other hand, weaken the immune system.
  • Avoid excessive hygiene.
    Coli bacteria that are excreted during bowel movements can easily cross the transition between the anus and the ureter - especially if you mistakenly wipe in the direction of the vagina and ureter when using toilet paper. If you are particularly sensitive, you should clean the anal region with running water or a damp disposable cloth after defecation. Use soap and shower gels in the genital area very sparingly, as otherwise the skin's natural protective acid mantle is reduced.
  • Healthy vaginal flora.
    If the vagina is sufficiently colonized with lactic acid bacteria (lactobacilli), these can displace intestinal bacteria.
  • Change tampons and sanitary towels.
    They are also a good breeding ground for bacteria, so change them more frequently. Tampons can also dry out the vagina and put pressure on the ureter, which can produce residual urine.

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Wash away annoying germs

Cystitis is primarily a problem for women. Common causes are bacterial infections and hormonal changes, such as during the menopause.

Severe bladder pain remains a one-time episode in around three quarters of women. The remaining quarter suffer from cramp-like pain and burning sensation when urinating three to four times a year, as well as a constant need to urinate. This is mostly due to germs rising from the vagina and intestinal anus. Escherichia Coli, an indispensable bacterium in the intestine, is responsible for around 80 percent of all uncomplicated urinary tract infections.
Women are particularly vulnerable because their urethra is short and bacteria can quickly ascend into the bladder. Once there, they attach themselves to the wall of the bladder and damage the mucous membrane. Drinking a lot and urinating regularly - especially after sexual intercourse - ensure that the bacteria are flushed out of the bladder with the urine. Cranberry extracts can make it difficult for bacteria to attach to the bladder wall. Acidifying the urine with apple cider vinegar also makes life difficult for the bacteria.
 
Why it often affects young women

Weak points in the immune system, first sexual contacts, frequent partner changes, the improper use of a vaginal diaphragm for contraception or ointments that kill sperm - all of this can affect the vaginal flora and thus facilitate the penetration of coli bacteria.
In pregnant women, the hormonal changes and the growth of the child can cause the smooth muscles of the upper urinary tract to relax. This increases the urge to urinate, especially in the last trimester of pregnancy. Urinary tract infections are not more common during pregnancy than in other women. However, if they occur during the nine months, if left untreated, they can lead to kidney inflammation more quickly. Therefore, pregnant women should have the infection clarified by a doctor as quickly as possible and not wait long.

Problems with the bladder

With the menopause there is a decrease in the hormone estrogen, which also moisturizes the vagina. If the body gradually curbs the production of estrogen, the vagina becomes drier, the number of lactobacilli in the vagina decreases and the passage of coli bacteria towards the bladder is made easier. To counteract bladder infections, it makes sense to enrich the vaginal flora with lactobacilli. On the other hand, an estrogen hormone therapy that acts locally - only in the vagina - in the form of ointments and suppositories can help.
Urinary tract infections are particularly common in the course of diseases such as diabetes, multiple sclerosis, bladder and kidney stones, urinary incontinence and stroke. Men are rarely affected by urinary tract infections - usually due to the onset of prostate enlargement - which are then more complicated than in women.

Status 04/2018