Bladder Health For Women
by Elson M. Haas, MD © 2015 (Judy Lane, NP, collaborator)
Women are prone to bladder infections, much more so than men. Due to the very short length of the urethra, bacteria can more easily migrate up into the bladder, and then multiply and irritate/infect the bladder. On some occasions, the bacteria can go higher up the ureters into the kidneys and cause more serious infections. Any woman who has ever experienced this problem will recognize the symptoms: feeling the need to urinate frequently and often urgently, but little comes out at a time, and urinating can be painful and burning. One doesn’t need to have all the symptoms for an infection to be present.
Drinking water is one of the best ways to prevent and resolve early infections. One of my favorite sayings is, “Dilution is the Solution to Pollution.” This relates to many areas of health, and is especially important to keeping the bladder and kidneys healthy, or in preventing infections and kidney stones if one is prone to these medical problems.
Besides dehydration, poor hygiene and sexual activity are other factors related to bladder infections, or UTIs (Urinary Tract Infections), also called “cystitis” (cysto being the Latin derivative for bladder). The bladder opening, or urethra, is just above the vaginal opening, which is just above the rectum. Both these areas have bacteria present. When these bacteria are wiped across the urethra, they can more easily climb up into the bladder. That’s why we say it so important to “always wipe from the front to the back”.
With sexual activity and the friction and sometimes irritation that happen, the bacteria are driven even more easily into the bladder. Sometimes when there is a lot of lubrication, the bacteria can move more easily from vaginal or peri-rectal areas into the urethra. Then, if the woman does not urinate soon after or keep hydrated to flush out these bacteria, they can multiply and cause problems. Bladder infections occur more with or after an episode of increased sexual activity. There’s even a medical diagnosis for this, termed “honeymoon cystitis,” for obvious reasons. Therefore, if a woman isn’t really ready to urinate before sex, it’s better to wait and have a good stream to flow out as soon after sex as is comfortable.
Women going through menopause often experience a weakness and/or sensitivity in their tissues and can be more prone to bladder and vaginal infections, especially with sexual activity. This thinning of urethral as well as vaginal tissues happens is some women, but not all, when estrogen levels decline. When women are prone to this problem, just a bit of estrogen therapy locally to the vaginal and/or urethral tissues can often help a great deal.
Bladder infections are diagnosed using laboratory testing. First, a urinalysis reveals an increase in white blood cells (WBCs), showing the body is attempting to fight off the bacteria. There is also often a culture done in the microbiology lab, meaning they isolate and grow the bacteria. Then, often a “sensitivity” test is done, meaning the technician exposes the bacteria to specific antibiotics, and over 24 hours or so watches to see whether the bacteria grow or not. Obviously, we want to choose the antibiotic that suppresses or kills the germs, not the one that has the bacteria growing all over it, which means the bacteria is “resistant” to that antibiotic, i.e. it doesn’t work.
A useful tip for women who find themselves very uncomfortable, is to take a urinary antiseptic which will not influence the outcome of a urine culture but can start relieving symptoms quickly. It turns the urine orange and will not clear the infection but can be taken right away to ease the pain, and is available without prescription. One brand of phenazopyridine is called Azo. Pyridium is a similar medicine. A follow-up culture is sometimes done to make sure the infection has resolved after the appropriate treatment.
As with many illnesses, there can be degrees of severity for bladder infections. Antibiotics work quite well in treating infections, and there have been some positive steps in the recent decades showing that UTIs often respond to lower amounts and fewer days of an antibiotic treatment. For example, a sulfa medicine called Septra DS or Bacterim DS (DS means double strength) used to be used twice daily for 10 days. Now three to five days is often sufficient. Typically, the bladder infections respond quite quickly to antibiotic treatment. Other medications other than sulfas include ampicillin (and amoxicillin) and ciprofloxacin (Cipro). I would use the penicillin-based drugs for women who don’t tolerate sulfa medicines, and Cipro for more severe cases or recurrent infections or with back pain and possible kidney involvement. Ideally, we want to use the least amount of medicines to get the job done, meaning clear the infection. There’s another drug that, when it works (as shown by sensitivity testing), is often wise to use. It is nitrofurantoin with a brand name example of Macro-Bid. It has less systemic side effects because it is cleared by the kidneys rather quickly and concentrates itself in the bladder, where it kills the bacteria.
Because many antibiotics kill off normal and needed intestinal bacteria, it’s important to replace the normal bacteria that live in the gut and vagina. Using an acidopilus (probiotic, healthy bacteria) or combination probiotic product during treatment can prevent a vaginal yeast infection, which happens to some women with antibiotic treatment. Ingest it away from the antibiotics and continue for at least 1-2 weeks after finishing the treatment. Occasionally, a vaginal yeast infection will occur with treatment and these can usually be treated locally with OTC antifungal medication available at pharmacies or a natural product from the health food store or natural pharmacy. Sometimes a small douche with a natural product or acidophilus will do the trick.
Most Western doctors always prescribe antibiotics when women have symptoms of a UTI. Clearly, when women present with bladder pain and visible blood in their urine, we most typically would prescribe an immediate antibiotic. However, natural therapies can often be successfully used for mild to moderate infections, or for early symptoms of burning or frequency (going more often than usual), or sometimes just a feeling of pressure. Occasionally, women have WBCs or infection in their bladders and have no apparent symptoms at all.
In review then, a natural approach to keeping the bladder healthy and not getting infections begins with proper hydration followed with proper hygiene. Hygiene may refer to keeping our body clean inside and out, and this even relates to proper nutrition, obtaining all the needed nutrients—vitamins, minerals, amino acids, fatty acids, and phytonutrients—to maintain healthy tissues and immune function. Avoiding toxins, many of which can irritate the bladder or weaken immune function, is also helpful, and this includes no or limited use of chemical products as well as excess sugar, caffeine, alcohol, and nicotine. A clean and healthy body does not get sick, at least very easily.
For early infections or irritation in the bladder, the most commonly known remedy is cranberry juice or cranberry extract. Buying non-sugary juice or extract and making a drink several times a day can help to purify/disinfect the bladder. In our clinic, we also suggest cranberry capsules, one to two several times daily to see if it helps reverse the early symptoms. Also, this cranberry extract is especially useful, 2 at bedtime, for prevention of UTI associated with sexual activity. D-mannose is another product we use and it’s a natural sugar that reduces E. coli, the most common bladder bacterial infection.
Herbal combination formulas are also popular for prevention and early treatment. These may include such herbs as uva ursi as a disinfectant diuretic, marshmallow root as a tissue soother, and others such as corn silk, plantain leaf, and St. John’s wort. Also, the homeopathic remedy, cantharis, any potency 30 C or below, can be used for burning. There are other homeopathic remedies for bladder and kidney issues in your natural food store or through your local homeopath.
In summary, bladder infections are much more common in women. With care, they can be prevented. For early onset or milder infections particularly, natural therapies can be quite helpful in resolving the problems. If these do not resolve the infection, or for more intense issues, antibiotics can be used quite successfully on a short-term basis. Checking the urine for cells and bacteria is the best way to monitor whether the infection is present or gone.