Why does my lower abdomen hurt when I pee?

Medications. Pentosan polysulfate sodium (Elmiron) is the only oral drug that is FDA-approved for treating interstitial cystitis. But, this medication doesn’t work for everyone, and it can take several months to take effect. Other medications used to treat IC include the antihistamine hydroxyzine (Vistaril, Atarax), and the tricyclic antidepressant amitriptyline (Elavil). Sometimes, seizure medicines such as gabapentin, (Neurontin) and topiramate (Topamax) are used. Other treatments that have been tried include immunosuppressant medications such as cyclosporine and azathioprine. More research is needed to test the safety and effectiveness for all of these treatments. For mild bladder pain, over-the-counter pain relievers such as aspirin, ibuprofen, or acetaminophen may be helpful. Prescription medications are often needed for IC.

Bladder instillation. A thin tube (catheter) is used to fill your bladder with the medications such as dimethyl sulfoxide (DMSO), heparin, steroids, or a local anesthetic. You hold the liquid in your bladder for up to 15 minutes and then release it. This treatment is thought to work by reducing inflammation and decreasing the sensation of pain.

Bladder distention. While you are asleep under anesthesia, the doctor fills your bladder with a liquid to stretch its walls. Bladder distention is a technique used to diagnose IC, but it also helps relieve pain for some patients, possibly because it increases the bladder capacity or interferes with the nerves that transmit pain signals from the bladder.

Nerve stimulation. For some patients, a technique called transcutaneous electrical nerve stimulation (TENS) helps relieve pain and the urge to urinate. Electrodes placed on the skin or implanted in the body send electrical impulses to the nerves controlling the bladder. This technique can help strengthen the muscles controlling the bladder, and may trigger the release of chemicals that block pain.

Acupuncture . Limited research has shown that acupuncture may provide relief to some people with interstitial cystitis.

Surgery. If other treatments aren’t working and your bladder pain won’t go away, the doctor may recommend surgery as a last resort.

The following lifestyle changes may also help relieve IC:

Diet. Certain foods, such as tomatoes, citrus fruits, coffee, chocolate, or alcohol, may worsen symptoms of IC for some people. To identify which foods, if any, irritate your bladder, keep a diary of what you eat during the day. When you have flare-ups of bladder pain, see if you can find a pattern in your diet.

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PMC

Discussion

Emphysematous cystitis is a rarely seen infection of bladder caused by gas-forming bacteria. It was firstly described in 1671, when a patient complained of passage of gas from his urethra. Near the end of 1800s, for the first time, Eisenlohr detected intramural gas at autopsy. In the year 1961, this condition was defined as “emphysematous cystitis’ by Bailey. Up to now more than 200 cases of EC have been cited. EC is generally seen in elderly women with diabetes mellitus. Recently, Toyota et al. evaluated 152 cases cited in the literature, and indicated that 63.4% of the cases were of female gender with a mean age of 69 years. Besides, diabetes mellitus (type I, 42.4%, and type II 57.6%) were detected in 66.7% of the cases. The effects of diabetes mellitus on urinary system include diabetic nephropathy, renal papillary necrosis, impairment of renal perfusion, and neuropathic bladder dysfunction. Together with these factors, glucosuria, and leucocytic dysfunction, and patients with diabetes mellitus are more prone to develop lower urinary tract infections. Besides, in these patients, complicated urinary system infections (renal, and perirenal abscess, fungal infections, xanthogranulomatous pyelonephritis, and infections caused by gas-producing microorganisms) are more frequently seen. Kuo et al. indicated that women are more prone to EC because of their increased predisposition to urinary tract infections.

The mechanism of gas formation in emphysematous cystitis has not been fully elucidated. The accepted mechanism is about accumulation of hydrogen, and carbon dioxide as a result of fermentation produced by infective organisms within tissues. In patients with diabetes mellitus, increased amounts of glucose in urine, and within tissues, and in non-diabetic patients albumin, and lactose have been thought to be the building blocks of gas production. Accumulation of gas as a result of fermentation increases local pressure within tissue, decreases tissue perfusion, and it might lead to tissue infarction at this level. Since infarcted tissue is a better culture media for gas-producing pathogens which also prevents gas transport, it results in the development of a worse vicious circle. Main risk factors for emphysematous cystitis consist of diabetes mellitus, urinary tract abnormalities, urinary stasis, and immune suppression. Besides, neurogenic bladder, bladder fistula, urethral catheterization, and recurrent urinary tract infections are also included among predisposing factors. In our case, EC developed following coronary angiography. However, any correlation between EC, and angiographic procedures has not been encountered in the literature.

Emphysematous cystitis has nonspecific clinical symptoms, Clinical condition may vary between asymptomatic disease or minor complaints of urinary tract infection to septic shock or peritonitis. Thomas et al . reported that 7% of the cases cited in the literature were asymptomatic, and detected incidentally during abdominal imaging procedures. Kuo et al . indicated absence of any correlation between clinical symptoms, and severity of the inflammation Pain is the most frequently observed (80%) symptom in emphysematous cytitis. In nearly 53% of the cases with urinary tract infections, classical symptoms can be observed. On physical examination mostly (65.6%) abdominal tenderness is detected. While, peritoneal signs are seen only in 6.2% of the cases. Leukocyturia, and hematuria are observed in 87,5, and 82.3% of the cases, respectively.

In the diagnosis of emphysematous cytitis, a serious clinical symptom suggestive of the disease could not be found. The diagnosis is made radiographically. Direct radiography is a relatively sensitive diagnostic method. Since, radiographic signs can be confused with rectal gas, emphysematous vaginitis, pneumatosis intestinalis, and gas gangrene of uterus, this modality has a relatively lower specificity. Grupper et al. reported that only 11.3% of their EC cases could be diagnosed correctly using radiographic means. The most reliable diagnostic imaaging modality is CT. CT clearly reveals severity, and extent of the disease (presence of an associated ascending infection). It ensures discrimination among urinary pathologies communicating with the outer environment, and hence air (urointestinal fistula, tissue infarct associated with necrosis, trauma, and instrumentation) In addition, it demonstrates enterovesical fistula which might develop in association with EC. In their case series Grupper et al. reported gas formation within the bladder wall, and its lumen in 94.4, and 3.7% of their cases, respectively. In our case gas formation was observed both within the bladder wall, and vesical lumen. Because of difficulties encountered in the evaluation of ultrasonographic, and magnetic resonance images, these imaging modalities have relatively lower degrees of sensitivity. However cystoscopy is not adequate as a single diagnostic modality for EC. However it can evaluate the presence of bladder outlet obstruction. On histopathological examination, induration, and gas filled vesicles are observed within the vesical wall. On microscopic examination especially on the bladder mucosa, gas filled vesicles, and surrounding fibrocytes, and multinuclear giant cells are seen.

Treatment of the emphysematous cystitis is dependent on the severity of the disease. Generally treatment consists of administration of broad-spectrum antibiotics, bladder drainage, and correction of the underlying predisposing disease. In addition, because of its unfavourable contribution to gas production, glycemic control is extremely important. As is in our case, antibiotherapy should be admin, stered through an intravenous route. However, Thomas et al. proved that 9% of the cases reported in the literature had been treated only with oral antibiotics. In most of the cases, treatment is initiated with broad-spectrum antibiotics. Based on the pathogenic agent isolated from culture, more specific antibiotic(s) can be used instead. A consensus has not been reached about the duration of the treatment. Grupper et al. reported average duration of treatment, and hospitalization as 10, and 7 days, respectively. In serious cases or those refractory to conservative treatment, surgical treatment (partial cystectomy, cystectomy, and surgical debridement) is required Thomas et al. reported that they had treated 90% of their 135 cases with medical therapy, and the remainder (10%) of their patients had required surgical intervention. While, 15% the EC cases in Grupper et al. series required laparotomy.

Generally emphysematous cystitis has a benign course. However in 19% of their cases complications might develop. In their series, Grupper et al. detected higher complication rates in cases with diabetes mellitus, immune suppression or urinary system pathology relative to those without. Besides, they published higher mortality rate (9.4%) for their AC series. However, Thomas et al. reported mortality rates of 7, and 14% in cases confined only to bladder, and in patients with associated emphysematous infection on another extravesical location of the urinary system, respectively. Therefore presence of an emphysematous infection on other site of the urinary system is accepted as an important prognostic factor for EC.

In conclusion, clinicians should kept this clinical entity in mind in the differential diagnosis of acute lower abdominal pain in especially high-risk patients. Early diagnosis, and treatment of EC are very important issues, since it progresses rapidly leading to bladder necrosis, emphysematous pyelitis, urosepsis, and finally death. Treatment generally consists of administration of broad-spectrum antibiotics, adequate urine drainage, and glycemic control. EC usually has an excellent prognosis.

There’s a phenomenon plaguing busy women everywhere (OK, and women who just don’t feel like hitting pause on The Affair): pee procrastination. You know, the feeling that you gotta go — but then…you don’t.

Whether it’s because your schedule is slammed (guilty) or you’re just feeling lazy (also guilty), blowing off your bladder’s cue like it’s some annoying guy on Tinder can have an impact on your health. “You should be urinating every four to six hours,” says Lauren Streicher, M.D., an OB/GYN and associate professor of obstetrics and gynecology at Northwestern University’s The Feinberg School of Medicine. “If you’re always holding your pee in for too long, there are consequences.”

So what are we talking about here? Exploding bladders? Higher risks of cancer? A breeding ground for UTIs? Not exactly, Streicher says. But here’s what can happen if you piss away — or in this case, aren’t pissing away — that feeling that you need to pee.

1. An Embarrassing Accident

Just to keep it real: Peeing your pants is a real possibility because the crossingyourlegsreallytight trick is only going to work for so long. “As your bladder gets fuller and fuller, there’s a good chance you aren’t going to make it to the bathroom on time,” Streicher says. Imagine your bladder like a water balloon that’s filling up — the longer you hold off going to the bathroom, the bigger and heavier it gets. And the muscles that contract to keep your bladder sealed can only withstand the pressure for so long before it will start to leak.

So the next time the bathroom feels like 11 steps too far away and you just can’t even, think about this: Do you really want to be the grown-ass woman who just peed her pants because she didn’t feel like prying herself away from her deadline? It may not be a super scary medical condition, but still.

2. Your Pelvic Floor Might Get Weak

When you force your bladder to constantly carry around a bowling ball’s worth of pee for hours, the muscles in your pelvic floor start to lose strength. “Pelvic floor muscles contract in a coordinated fashion to help you either release pee or hold it,” Streicher says. “But if you’re continually holding urine, you can end up with some real dysfunction of your pelvic floor muscles.” Over time, that can cause you to lose control of your bladder functions.

Don’t freak out if you feel the urge to go and your boss pulls you into her office for a quick brainstorming session when you were about to jet to the ladies’ room, or if you’re on a road trip and it’s an eternity till the next rest stop. “There’s a big difference between someone who holds it once in a blue moon and someone who does it all the time,” Streicher says. “Every now and then isn’t going to cause huge problems.”

3. Long-Lasting Pain

That feeling you get after you’ve been holding it forever and finally go? Sweet relief — but maybe not. If it’s been too long, you may continue to hurt. “Once the pain signals have been trigged in the lower abdomen, the pain may not just go away,” Streicher says. “Your muscles are clenching and are almost in a spasm, so they’re not able to just relax.”

And the pain may last for days. “I see a lot of people who come in with lower abdominal pain and think that something is seriously wrong, and one of the things I look for is does the person have normal bladder habits,” Streicher says. “And a lot of times, they don’t. Well, that causes pain that may stick around for awhile.”

4. Your Bladder Might Get Stretched Out

As mentioned above, your bladder is (thankfully) not going to blow up, but it’s certainly going to get stretched to its limits. One of the big side effects of an overextended bladder? Your body may start missing cues that your bladder needs emptied, and those messages your brain sends to your body that it needs to go to the bathroom are important (for obvious reasons).

But wait — before you start bolting to the bathroom every time you feel a pang to pee, know that “you don’t have to urinate the minute you feel the urge to go,” Streicher says. “A good measure is that it should never get to the point that you’re uncomfortable. Holding it to that point is too long.”

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Everything You Need to Know About Bladder Pain

Bladder pain of any kind requires investigation because it has several possible causes, from a urinary tract infection to chronic bladder inflammation.

Urinary tract infection

A urinary tract infection (UTI) is a bacterial infection along any part of your urinary tract, including the bladder. Men and women can get UTIs, but they are more common in women. UTIs are caused by bacteria that enter the bladder through the urethra. When left untreated, UTIs can spread to your kidneys and blood stream causing serious complications.

Symptoms of urinary tract infection

Along with bladder pain, a UTI may also cause any of the following symptoms:

  • frequent painful urination
  • lower abdominal pain
  • low back pain
  • bladder/pelvic pressure
  • cloudy urine
  • blood in urine

Diagnosing urinary tract infections

Your doctor can diagnose a urinary tract infection using a urinalysis to check your urine sample for white and red blood cells, and bacteria. Your doctor may also use a urine culture to determine the type of bacteria present.

If you have recurrent UTIs, your doctor may recommend the further testing to check for abnormalities in your bladder or urinary tract. These tests may include:

  • ultrasound
  • MRI
  • CT scan
  • cystoscope

Treatments for urinary tract infections

UTIs are treated with oral antibiotics to kill the bacteria. Your doctor may also prescribe a pain medication to relieve pain and burning. Frequent UTIs may require a longer course of antibiotics. Severe UTIs and complications may require antibiotics given through an IV in a hospital.

Interstitial cystitis/painful bladder syndrome

Interstitial cystitis, also referred to as bladder pain syndrome, is a chronic condition that causes painful urinary symptoms. It affects mostly women, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The cause of the condition is currently unknown, but certain factors may trigger symptoms, such as infections, physical or emotional stress, diet, bladder injury, or certain medications.

Symptoms of interstitial cystitis

The symptoms can range from mild to severe and vary from person to person. Symptoms can include:

  • strong urgency to urinate
  • frequent urination
  • burning or pain with the need to urinate
  • bladder pain
  • pelvic pain
  • abdominal pain
  • pain between the vagina and anus (women)
  • pain between the scrotum and anus (men)
  • painful intercourse

Diagnosing interstitial cystitis

Your doctor may use the following tests to diagnose interstitial cystitis:

  • medical history, including symptoms
  • bladder diary of your fluid intake and the volume of urine you pass
  • pelvic exam (women)
  • prostate exam (men)
  • urinalysis to check for infection
  • cystoscopy to view the lining of your bladder
  • urinary function tests
  • potassium sensitivity test

Your doctor may also perform other tests to help rule out cancer as the cause of your symptoms, such as a biopsy, which is usually performed during cystoscopy or urine cytology to check for cancer cells in your urine.

Treatments for interstitial cystitis

There is no one specific treatment for interstitial cystitis. Your doctor will recommend treatments for your individual symptoms, which may include:

  • Lifestyle changes. The changes recommended will be based on what you feel your triggers are. These often include quitting smoking, avoiding alcohol, and dietary changes. Some people find that gentle exercise and stress reduction helps relieve symptoms.
  • Medication. Over-the-counter (OTC) pain medications may help relieve pain. Prescription medications such as Tricyclic antidepressants may help relax your bladder and block pain. Pentosan polysulfate sodium (Elmiron) is approved by the FDA to treat the condition.
  • Bladder training. Bladder training may help your bladder to hold more urine. It involves tracking how often you urinate and gradually extending the time between urinating.
  • Physical therapy. A physical therapist who specializes in the pelvis can help you stretch and strengthen your pelvic floor muscles and learn to keep them relaxed, which may help relieve your symptoms, including pelvic floor muscle spasms.
  • Bladder instillation. A small amount of liquid containing medication to ease irritation is placed in your bladder and held in for approximately 15 minutes before releasing it. The treatment can be repeated weekly or biweekly for one or two months.
  • Bladder stretching. The bladder is stretched by filling it with fluid. You will be given medication to help you hold the fluid and tolerate the stretching. Some people experience a temporary relief of symptoms after bladder stretching.
  • Transcranial magnetic stimulation. A small 2018 study found that repetitive transcranial magnetic stimulation improved chronic pelvic pain and associated urinary disorders in people with bladder pain syndrome.
  • Surgery. Surgery is only recommended if all other treatments have failed to provide relief and your symptoms are severe. Surgery may involve bladder augmentation or enlargement, a cystectomy to remove the bladder, or urinary diversion to reroute your urine flow.

Bladder cancer

Bladder cancer results when cells in the bladder grow uncontrollably. There are different types of bladder cancers but urothelial carcinoma, also known as transitional cell carcinoma, which begins in the urothelial cells in the lining of your bladder, is the most common type. Bladder cancer is more common in men than women and occurs most often after the age of 55. It’s also two to three times more common in people who smoke compared to nonsmokers.

Symptoms of bladder cancer

Painless blood in the urine is the most common symptom of bladder cancer. Most often, bladder cancer has no pain or other symptoms. However, if symptoms are present they can include:

  • having to urinate more often
  • pain or burning when urinating
  • urgency to urinate even when your bladder isn’t full
  • trouble urinating
  • weak urine stream

Advanced bladder cancer can affect other organs and systems, so symptoms may include:

  • inability to urinate
  • lower back pain on one side
  • bone pain
  • abdominal or pelvic pain
  • loss of appetite
  • weakness or fatigue

Diagnosing bladder cancer

Testing for bladder cancer may include:

  • complete medical history
  • cystoscopy
  • urinalysis
  • urine culture
  • urine cytology
  • urine tumor marker tests
  • imaging tests
  • biopsy

Treatments for bladder cancer

Treatment for bladder cancer will depend on the type of bladder cancer, the stage of the cancer, and other factors. Treatment for bladder cancer usually involves more than one of the following treatments:

  • Surgery. The type of surgery used to treat bladder cancer depends on the stage. Surgery may be used to remove a tumor, remove part of the bladder, or the entire bladder.
  • Radiation. High-energy radiation is used to kill cancer cells. It can be used to treat early stage bladder cancers, as an alternative for people who can’t have surgery, and treat or prevent symptoms of advanced bladder cancer. It’s often combined with chemotherapy.
  • Chemotherapy. Chemotherapy drugs are used to kill cancer cells. Systemic chemotherapy is given in either pill form or through an IV. Intravesical chemotherapy, which is only used for very early-stage bladder cancers, is administered directly into the bladder.
  • Immunotherapy. Immunotherapy uses medication to help your immune system recognize and kill cancer cells.

Painful Bladder Syndrome (PBS)

Painful bladder syndrome (PBS) is a condition that causes bladder pain, pressure, or discomfort. Some people feel the need to urinate frequently or rush to get to the bathroom. The symptoms range from mild to severe, and can happen sometimes or all the time. PBS is not caused by an infection, but it can feel like a bladder infection like a urinary tract infection or UTI. Painful bladder syndrome is also referred to as bladder pain syndrome and interstitial cystitis. In the past, doctors thought PBS was rare and difficult to treat. We now know that PBS affects many women and men and treatments are helpful.

What causes PBS?

No one knows for sure, but we think PBS happens when the inner lining of the bladder is not working properly. This means that nerves in the wall of the bladder become hypersensitive so the normal feeling of the bladder filling can be painful. There may also be inflammation or allergic reaction responses in the bladder. Some people report developing PBS after an injury to the bladder such as a severe bladder infection or major trauma, but this is not always the case. PBS is more common in people who have irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, or other chronic pain conditions. It is not clear why these problems happen together.

What are the symptoms of PBS?

Frequency is when someone feels they are urinating more than expected based on how much they are drinking. The average person urinates about seven times a day and might get up once at night. A person with PBS may have to go more often both day and night. Urgency is the need to rush to get to the bathroom. Some people feel a constant urge that never goes away, even right after they urinate.

People with PBS may have bladder pain when the bladder fills. Some people feel pain in other areas, like the urethra (the opening where the urine comes out), vagina, lower abdomen, lower back, or the pelvic or perineal (sitting) area. The pain may be constant or come and go, and may change in severity.

Many people with PBS know that certain foods or drinks make their symptoms worse. Symptoms may be worse during times of physical or emotional stress or with certain activities like sitting too long. The symptoms may change with the menstrual cycle. Some women with PBS have pain during sex and/or after sex.

How is PBS diagnosed?

There are different opinions about how to diagnose PBS because no test is 100-percent accurate. Everyone agrees that an office visit is needed to discuss symptoms, do an exam and urine tests. These tests can help make sure there isn’t another problem that might be causing the symptoms.

Do I need cystoscopy?

Cystoscopy is a test that allows a doctor to look inside the bladder. This is done by inserting a camera attached to a small tube (cystoscope) inside the urethra and bladder. This test may or may not be necessary and is up to you and your doctor to discuss.

Cystoscopy can be done in the office, however someone with PBS symptoms might need a special cystoscopy known as “cystoscopy with hydrodistention” that would be done in the operating room under anesthesia so the bladder can be overfilled to look for possible changes found in PBS. It’s also possible for a person with PBS to not have these changes seen on cystoscopy. Therefore, this test may or may not be helpful, and is not necessary for every patient.

How is PBS treated?

Because there are several different causes of PBS, no single treatment works for everyone and no treatment is “the best.” Treatment must be chosen individually for each person, based on symptoms. Usually, PBS is managed by trying different treatments, or combinations of treatments, until the symptoms improve.

Simple changes to diet or routines can help some people with bladder pain. Steps might include

  • Changing what you drink. Some people feel better by drinking more water to dilute the urine. Avoid foods/ drinks that can irritate the bladder (see “How does diet affect PBS” below).
  • Avoiding going to the bathroom every time you feel an urge. Try to wait at least one to two hours between bathroom trips.
  • Applying ice or heat to the lower abdomen or vulvar area.
  • Physical therapy (PT) can also help most people with PBS. This involves working with a specialized physical therapist one-on-one to treat the muscles, tissues and nerves in the pelvis, abdomen and hips that can become painful due to PBS. The treatment includes stretching and releasing tight and tender areas inside and outside of the vagina and often reverses the changes in the body caused by PBS. PT is usually done once or twice per week for eight to 12 weeks. Your physical therapist will discuss and determine your best treatment schedule, and will also recommend home exercises.

Dear Editor-in-Chief

Interstitial cystitis (IC) or bladder pain syndrome (BPS) is considered a devastating condition of chronic nature (1) which can have negative impact on the patients’ quality of life (2). American Urological Association describes the term IC/BPS as “An unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of longer than 6 weeks’ duration, in the absence of infection or other identifiable causes” (3).

The level of distress can be variable from abdominal tenderness to severe bladder spasm (1). The diagnosis of this condition is still not very clear and depends on ruling out other diseases (3). The etiology of BPS is still undetermined mainly due to disagreement on its classification (1). Recent studies show the significant association of environmental factors such as diet, drinking behavior, physical activity and smoking with occurrence of BPS/IC (2).

In this article, we present an interesting and important etiology, which may justify some types of pain in interstitial cystitis.

In historical medical manuscripts, Avicenna (980–1037 AD), the famous Iranian physician, described gas in the bladder as a possible cause of bladder pain and urinary tract symptoms (inability to Urinate normally from the bladder), without infection and other urinary disorders. In this disorder excess moisture (Rotubat) and coldness in temperament of bladder, tissues weaken the bladder cells function which through incomplete metabolism leads to the production of gas trapped in these tissues (4). According to this opinion, entrapped gas can cause pain by stretching and compression of tissues. The site of pain could change according to the displacement of gas bubbles (5, 6). In addition, excessive consumption of flatulent foods is another reason for development of this disease. Avicenna called this disease “the bladder gas” (5). In Iranian traditional medicine, this “Gas” is one of the causes of pain and dysfunction in other organs such as the neck, waist, and kidneys as well (6, 7).

Iranian medicine treatment of this condition generally consists of three major steps: 1. Lifestyle modification 2. Using topical and oral medications 3. Manipulation (aamale yadavi) if needed (5, 8). In the case of bladder Gas Traditional medicine texts such Al-Qanun fi Tibb have suggested a wide range of recommendation that includes regimental therapy along with numerous oral and topical medications such as figs and fragrant and solver oils like iris oil and saffron oil (5). Using warm compress and dry cupping is also recommended as well as conventional medicine (1, 4, 5).

In conventional medicine first report of gas in the spine was in 1937 and this view has since been confirmed in a number of studies (6). Moreover, there is report of Intra-osseous gas in CT examinations of patients with sacral insufficiency fracture (9, 10). Pain, spasm, lower urinary tract symptoms, therapeutic response to dietary changes and Warm-up bladder, the absence of infection and other urinary disorders are obvious similarities between Interstitial cystitis in conventional medicine and bladder Gas in traditional medicine (1, 2, 3, 5). A significant overlap exists between the two diseases and clinical study of traditional medicine ideas could open a new window in the treatment of patients with interstitial cystitis.

There has been no previous article with direct suggestion of possibility of the gas as a cause of interstitial cystitis.

4 Hidden Causes of Bladder Pain: Know the Signs

1. Urinary Tract Infections (UTIs): More Common in Women

Urinary tract infections, sometimes called bladder infections, strike women more often than men, and simple anatomy is the cause.

The female urethra is closer to areas that have natural bacteria, such as the anus and vagina. It’s also shorter than a man’s urethra, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Bladder pain from UTIs can happen at any age. In young women, it is a common symptom of urinary tract infections, along with frequent and painful urination. Symptoms in older women can vary but typically include muscle aches, abdominal pain, fatigue, and weakness.

It’s important to see your doctor because treatment with antibiotics, like Cipro (ciprofloxacin) or Bactrim (trimethoprim-sulfamethoxazole), can usually clear up a urinary tract infection, the NIDDK notes.

And though the infection may go away without treatment, antibiotics can speed healing and quickly eliminate uncomfortable symptoms. Drinking extra fluids and urinating frequently will also help treat the infection and your discomfort.

2. Interstitial Cystitis: A Severe Form of Bladder Pain Syndrome

More than 3 million American women live with pelvic pain related to interstitial cystitis, a condition in which the bladder wall becomes irritated and inflamed, according to the NIDDK. “Interstitial cystitis is a severe form of bladder pain syndrome,” Dr. Siddiqui says.

Bladder discomfort from interstitial cystitis may range from tenderness to severe pain, according to the institute. Another clue that interstitial cystitis is the culprit: Menstruation tends to worsen bladder pain.

Interstitial cystitis is not caused by a urinary tract infection, although the symptoms may worsen if you have interstitial cystitis and get a UTI. While the cause is not understood, according to the NIDDK, certain events or factors seem to trigger flares in symptoms. These include stress, changes in diet, allergies, and taking certain drugs, among other things.

Treatment options for interstitial cystitis include distending or cleansing the bladder, taking oral medication, physical therapy, and using electrical nerve stimulation to alleviate pain, but there is no known cure. In severe cases, where other treatments haven’t worked, sometimes surgery is an option.

3. Changes in Your Reproductive System

Bladder pain in women may also be a result of thinning vaginal skin, says Karl Luber, MD, a urogynecologist and a founder of the female pelvic medicine and reconstructive surgery fellowship program at UCSD–Kaiser Permanente, in San Diego.

“This is called atrophy and it’s most common when menopause deprives the tissues surrounding the vagina of estrogen,” he explains. Oral estrogen doesn’t help, but a vaginal estrogen cream may ease symptoms.

Talking with your doctor about bladder pain and discomfort can help determine where the problem really lies, Dr. Luber says.

RELATED: 8 Rules for a Healthy Vagina

4. Bladder Cancer: Less Common in Women

Bladder cancer is rare, especially in women. Of the roughly 79,000 new diagnoses each year in the United States, about 18,500 are in women, according to the American Cancer Society (ACS). The most common symptom is blood in the urine; some women also experience a painful, burning sensation when urinating.

Bladder cancer treatments include surgery, chemotherapy, and radiation therapy. According to the ACS, most people need surgery to remove a tumor or tumors. All or parts of the bladder are removed in severe cases.

Get a Diagnosis, Not a Self-Diagnosis

It’s also important to consider whether the uterus and other organs of the gynecological system could be causing bladder pain, Siddiqui says, as they are close to the bladder. Pelvic floor dysfunction, such as tightness or spasms of the pelvic muscles, commonly occurs with bladder pain and may make bladder pain worse, she explains.

“If none of these conditions are present and women have ongoing bladder pain, they are typically treated for ‘bladder pain syndrome,’ which refers to painful conditions of the bladder where other causes such as UTI and cancer have been excluded,” says Siddiqui.

The bottom line for women to keep in mind: Don’t self-diagnose your bladder pain. Addressing and treating the issue can offer relief for body and mind.

Bladder Cancer and Symptoms

Any cancer is difficult on a person who is diagnosed and hard for their family to cope with. All parties involved go through painful experiences and find themselves in the midst of trying to learn as much information as possible about the cancer, and the best way to care and manage the disease for themselves or a loved one.

Bladder cancer is an abnormal growth generally affecting older adults, however, it can happen at any age and most often begins in the cell lining of the bladder — a balloon shaped, hollow organ in the pelvic region with the purpose of storing urine. Men are three times higher at risk than women of getting the illness, with both often experiencing incontinence.

Bladder cancer and symptoms that come with the disease can be painful for those inflicted by it, and be difficult on family members caring for their loved ones. Fortunately, most cases are diagnosed when highly treatable in the early stages. However, even when diagnosed early, it is likely the cancer will reoccur. For this reason, patients of the disease frequently undergo follow-up testing for years after successful treatment to check for the recurrence of the cancer.

Doctors rate bladder cancer in stages from zero to five, with zero being the best rating. Learning the signs and seeking medical attention from your doctor early is best for successful treatment.

  • Stage 0 — cancer has not spread past the bladder’s lining.
  • Stage 1 — cancer has spread past the bladder’s lining, but not reached the bladder’s muscle layer.
  • Stage 2 — cancer has spread into the bladder’s layer of muscle.
  • Stage 3 — cancer has spread into the bladder’s surrounding tissue.
  • Stage 4 — cancer has spread beyond the bladder into neighboring areas within the body.

The Symptoms of Bladder Cancer

Symptoms are signs, or alerts, that there may be an issue with a person’s health. Symptoms vary person to person, and each may not experience the same symptoms as another inflicted with the disease. Blood in the urine, incontinence (urine leakage) and fatigue are just a few signs you or a loved one may have the disease. There are symptoms that are commonly associated with the illness (listed below.) However, less common symptoms can be present as well — weight loss, swelling of the legs, bone pain, rectal/anal/pelvic area pain. As with any illness, it also possible for a person to be unaware they may have bladder cancer and experience no symptoms. To know for sure, seek medical advice from your doctor.

Abdominal Pain

Pain felt anywhere between the chest and groin is abdominal pain — often referred to as the belly or stomach area. The types of pains can vary and include:

  • Generalized pain — felt in more than half of the stomach area.
  • Cramp-like pain — less serious and most likely due to bloating and gas.
  • Localized pain — occurs in a specific area of the belly.
  • Colicky pain — can be severe discomfort, comes in waves and usually starting and ending suddenly. Commonly associated with gallstones and kidney stones.

Blood in the Urine

Hematuria — blood present in the urine — is the most common symptom. Blood in the urine can be microscopic not always visible to the eye and would require tests — cystoscopy, CT Scan, MRI, ultrasound, urine culture, IVP and urine cytology — to detect if any is present. The two terms used to describe the level of hematuria are:

  • Gross — visible to the eye
  • Microscopic — visible only through testing

If you think your or a loved one may have blood present in the urine, see a doctor for examination to rule the disease out.

Bone Pain or Tenderness

One of the less common symptoms, bone pain or tenderness occurs when the cancer has spread into the bone.

Incontinence (Urine Leakage)

Urinary leakage — incontinence — is a common normality once a person gets up in age. However, incontinence can be a side effect and indication you or someone you know has bladder cancer.

Urinary incontinence happens when the bladder experiences any involuntary or accidental loss of urine. Bowel or fecal incontinence happens when any involuntary or accidental bowel movement, feces or wind exits the bowel.

Fatigue

What is bladder cancer fatigue? Often confused with being tired, fatigue is different in that it is a lack of energy rather than an expected tiredness from doing an activity. It happens suddenly and is not induced by activity, and sleep does not relieve it. Fatigue can be short term lasting less than a month, or long term lasting one to six months or longer. Being fatigued can interfere with your life preventing you from your daily routine and enjoying the things in life you like to do. Simple things in life, such as going to the bathroom can be affected and the associated symptom of incontinence can be difficult to manage.

Fatigue — one of the most common side effects related to cancer — is not predictable by the stage of the disease, type of tumor or treatment.

Painful Urination

The medical term for pain during urination or difficult urination is Dysuria. The pain can be a discomforting annoyance or become more severe. Some people who experience painful urination have complained of pain in the back, abdomen and flank. Burning and irritation sensations in the urethra — tube carrying urine from the body — have also been reported. It is also common for a person to feel and urgency to urinate, but when they go to the bathroom, a small amount of urine is released.

Urinary Frequency

Urinary frequency is defined as feeling the need to urinate — once every one or two hours — more frequently than your normal urination routine. This can include passing more urine than normal or small amounts. Associated with incontinence, this can occur day or night, but may only occur during nighttime hours — known as nocturia — and can affect sleep, a person’s work and overall health and general well-being. Often those inflicted with urinary frequency find adult diapers are a valuable aid in preventing embarrassing accidents.

Urinary Urgency

Urinary urgency is a compelling or sudden urge to urinate. Often, it may be associated with polyuria, urinary incontinence, interstitial cystitis and nocturia, though may not be. Urinary urgency tends to increase and be associated with age, and when it is uncontrollable, it can cause urge incontinence. As with urinary frequency, those who experience urinary urgency may find it difficult to make it to a bathroom in a timely manner causing leakage and find adult diapers omit embarrassing conditions.

Additional resources
Cancer Treatment Centers of America – Important information — What is bladder cancer?
Mayo Clinic — What are the symptoms?
MedicineNet — Cancer of the urinary bladder facts.
WebMD — An overview of the disease.
Healthline — Highlights and risk factors.
Cancer.Net — Urinary incontinence and causes explained.
Cancer.org — Associate lifestyle changes after being diagnosed.
BCAN — Women and bladder cancer.
NCBI — Dysuria, Frequency, and Urgency

Diagnosing and treating interstitial cystitis

Updated: May 1, 2018Published: August, 2011

Also called painful bladder syndrome, this frustrating disorder disproportionately affects women.

Interstitial cystitis is a chronic bladder condition that causes recurring bouts of pain and pressure in the bladder and pelvic area, often accompanied by an urgent and frequent need to urinate — sometimes as often as 40, 50, or 60 times a day, around the clock. Discomfort associated with interstitial cystitis can be so excruciating that, according to surveys, only about half of people with the disorder work full-time. Because symptoms are so variable, experts today describe interstitial cystitis as a member of a group of disorders collectively referred to as interstitial cystitis/painful bladder syndrome. (In this article, we’ll call it interstitial cystitis, or IC.)

Among the one to two million Americans with IC, women outnumber men by as much as eight to one, and most are diagnosed in their early 40s. Several other disorders are associated with IC, including allergies, migraine, irritable bowel syndrome, fibromyalgia (a condition causing muscle pain), chronic fatigue syndrome, and vulvodynia (pain or burning in the vulvar area that isn’t caused by infection or skin disease).

There’s no cure for IC, but many treatments offer some relief, either singly or in combination. Figuring out what works can be hit-or-miss; there’s no way to predict who will respond best to which treatment.

Glomerulations and interstitial cystitis

A defect in the layer of mucus (mucin layer) that protects the cells lining the bladder (the urothelium) may permit toxic substances from urine to seep through and inflame tissues. Irritated blood vessels produce tiny areas of bleeding in the bladder lining called glomerulations. Most people with interstitial cystitis have glomerulations.

Possible causes

No one knows the exact cause of IC; more than one mechanism is probably involved. Biopsies of the bladder wall in people with IC indicate various abnormalities, but it’s not clear whether these are the cause of the condition or the result of some other underlying process. Some research has focused on defects in the glycosaminoglycan (GAG) layer, part of the layer of mucus that lines and protects the bladder. Defects in the GAG layer may allow toxins in the urine to leak through and damage underlying nerve and muscle tissues; this in turn may trigger pain and hypersensitivity.

Another line of research centers on antiproliferative factor (APF), a substance that’s found only in the urine of people with IC. APF appears to block the normal growth of cells that line the bladder and may hinder the healing process that follows any damage or irritation to bladder tissues. Scientists seeking a diagnostic test for IC are considering APF as a possible biomarker.

There are several other theories about the cause of IC. It may be an infection with an unknown agent, such as a virus. Or it may be an autoimmune disorder set in motion by a bladder infection. It’s possible that mast cells normally involved in allergic responses are releasing histamine into the bladder. Another idea is that sensory nerves in the bladder somehow “turn on” and spur the release of substances that contribute to symptoms. Because interstitial cystitis is mainly a woman’s disease, many researchers think that hormones play a role.

Variable symptoms

The onset of IC is usually gradual, with bladder pain and urinary urgency and frequency developing over a period of months. The course of the disorder and its symptoms can vary greatly from woman to woman and even in the same woman. Symptoms may change from day to day or week to week, or they may remain constant for months or years and then go away, only to return several months later. Pain ranges from dull and achy to acute and stabbing; discomfort while urinating fluctuates from mild stinging to burning. But virtually everyone with IC has pain associated with bladder filling and emptying. Some women with IC have a constant need to urinate, because urinating helps relieve the pain.

In women who also have chronic abdominal or pelvic pain from other causes, such as irritable bowel syndrome or endometriosis, IC may flare up when those symptoms are at their worst. Sexual intercourse can trigger pain lasting several days, and symptoms may worsen with menstruation. On the other hand, some women experience complete relief during the second and third trimesters of pregnancy. Some find that their symptoms are worse after consuming certain foods or drinks, including strawberries, oranges, tomatoes, chocolate, spices, caffeine, alcohol, and beverages that acidify the urine, such as cranberry juice.

Diagnosis of exclusion

IC is not a urinary tract infection, and it can’t be identified by a simple urinalysis or urine culture. Rather, it’s a diagnosis of exclusion, which means that it’s diagnosed only after a number of other conditions have been ruled out. A clinician — usually a urologist or a gynecologist — will first take a thorough history, then conduct a physical exam (including a pelvic exam, if it’s not too uncomfortable) and perform tests for infection, bladder stones, bladder cancer, kidney disease, multiple sclerosis, endometriosis, sexually transmitted diseases, and other disorders. The AUA guidelines also recommend an early assessment of pain, urinary frequency, and urine volume, to help evaluate the effectiveness of later treatments.

If a diagnosis is uncertain or there are symptoms (such as blood in the urine) that suggest other problems, the next step is usually cystoscopy, which involves inserting a fiber-optic tube through the urethra to look at the bladder wall. During the procedure, a tissue sample may be taken to rule out bladder cancer. Some clinicians favor hydrodistention under local or regional anesthesia, which involves filling the bladder during cystoscopy with a liquid that stretches it, providing a closer view of the bladder wall. However, AUA guidelines do not recommend hydrodistention for either diagnosis or treatment. In people with IC, glomerulations — tiny pinpoint spots of blood — are usually visible on the bladder wall during cystoscopy with hydrodistention, but these lesions are often seen within the normal bladder as well.

One finding from cystoscopy that can help in making an IC diagnosis is the presence of reddened patches or lesions called Hunner’s ulcers, which can stiffen tissue and cause reduced bladder capacity. However, Hunner’s ulcers, which occur in 10% to 15% of cases, aren’t required to make an IC diagnosis.

Selected resources

American Urological Association Foundation
800-828-7866 (toll-free)

Interstitial Cystitis Association
800-435-7422 (toll-free)

Managing IC

There’s little consensus on the best way to treat IC, but treatment generally starts with conservative measures and proceeds to more invasive ones if symptoms don’t improve. Usually a combination of approaches is needed, including these:

Psychosocial support. Chronic pain can be an isolating experience, so it may help to be in touch with others who feel your pain and understand what you’re going through. Local pain support groups or national support groups like the Interstitial Cystitis Association (see “Selected resources”) can serve that purpose. Learning as much as you can about IC may also give you a greater sense of control over your condition. Chronic pain can cause depression, so don’t hesitate to consult a mental health professional if you’re feeling overwhelmed. (Support groups can usually refer you to counselors.) You may also want to talk to someone who specializes in stress reduction techniques, such as guided imagery, which was shown in one controlled study to improve IC patients’ response to therapy. Some people say they’ve been helped by biofeedback, which trains people to use their minds to control physiological processes, such as muscle tension, that may be contributing to symptoms.

Behavior changes. Avoid anything that appears to cause flare-ups, whether that’s a certain kind of exercise, sexual activity, constipation, tight clothing, or a specific food. (Because high-acid foods seem to cause flare-ups, some clinicians suggest taking an antacid with meals.) Expanding your bladder capacity is also important (constantly succumbing to the urge to go all the time can shrink bladder capacity). For example, if you’re urinating every 30 minutes, try holding off for 45 minutes; if you manage that for a week, increase the interval to 60 minutes the second week, and so forth.

Medications. Various medications may help relieve pain and reduce inflammation. (See “Medications for the treatment of interstitial cystitis.”) Some are taken orally; others are bladder instillations — drugs that are introduced into the bladder by catheter and held for a few seconds up to 10 or 15 minutes. Instillation usually takes place in a clinician’s office, although in some cases, these drugs can be self-administered at home.

Medications for the treatment of interstitial cystitis

Treatment

Comment

Oral drugs

Tricyclic antidepressants

Taken at low doses, tricyclic antidepressants relax the bladder and hinder the release of neurochemicals that can cause bladder pain and inflammation. They may also improve sleep. Amitriptyline (Elavil) is the medication most commonly prescribed for interstitial cystitis. Side effects include sleepiness, dry mouth, and weight gain.

Pentosan polysulfate sodium (Elmiron)

The only oral medication approved by the FDA specifically for the treatment of IC, Elmiron is thought to help repair defects in the bladder lining. It can take several months to reduce pain and urinary frequency, and the effect may be modest. Serious side effects are rare. If Elmiron doesn’t work in six months, stop taking it.

Antihistamines

The antihistamine hydroxyzine (Atarax, Rezine, Vistaril, others) is thought to block mast cells’ release of histamine in the bladder. It helps in relieving pain, urinary frequency, and (because it’s sedating) nighttime urination. Some clinicians recommend cimetidine (Tagamet) and ranitidine (Zantac), which are a different type of antihistamine, but there’s little evidence to support their use.

Painkillers

Nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen, naproxen sodium) and acetaminophen can help relieve pain.

Cyclosporine A

In early studies, this immunosuppressant drug helped relieve symptoms, but its use is limited by serious side effects — including uncontrollable trembling, muscle or joint pain, and enlarged gums.

Bladder instillations

Dimethyl sulfoxide (DMSO)

DMSO instilled in the bladder was FDA-approved for the treatment of IC in the 1970s. It helps relax the bladder and alleviate pain. Treatment involves weekly instillations for six to eight weeks and then every two weeks for three or more months.

Heparin and lidocaine

Some clinicians combine one or both of these drugs with Elmiron (as a bladder instillation) and other medications in “rescue instillations” administered to quickly reduce pain and inflammation and help restore the mucus in the bladder.

Specialized physical therapy. Working with a physical therapist trained in pelvic soft tissue manipulation and rehabilitation may help to release scars and other sources of pelvic pain. Exercises that relax the pelvic floor are okay, but the AUA recommends that people with IC avoid exercises that strengthen pelvic floor muscles (Kegels).

Additional options. If standard treatments don’t work, your clinician may suggest a trial of an implantable device called InterStim, which stimulates the sacral nerve in the lower back and may help alleviate urinary urgency and frequency in some women. If the device helps, it can be permanently implanted. Researchers are also studying the instillation of botulinum toxin into the bladder, but so far, the side effects and complications have been too serious to recommend its general use.

What doesn’t work. The AUA found no evidence that the following therapies help relieve IC symptoms, and some evidence they may be harmful: long-term oral antibiotics, bladder instillation of bacillus Calmette-Guerin (BCG), and bladder instillation of resiniferatoxin (RTX).

Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Reactive Arthritis

What is reactive arthritis?

Reactive arthritis is a type of arthritis that occurs because of an infection. Arthritis is when joints become inflamed and painful. Reactive arthritis is not contagious. It was formerly known as Reiter’s syndrome. It affects men more often than women. It develops most often between ages 20 and 50.

What causes reactive arthritis?

Reactive arthritis is not contagious, but it’s caused by some infections that are contagious. The infections that most often cause the disease are spread through sexual contact. The bacteria Chlamydia trachomatis. It can cause infections in the bladder, urethra, penis, or vagina.

Other infections that can cause reactive arthritis infect the gut. One cause is salmonella. This infection can come from eating food or handling objects that have the bacteria.

Reactive arthritis may also be linked to genes. People with reactive arthritis often have the HLA-B27 gene. But many people have this gene without getting reactive arthritis.

Who is at risk for reactive arthritis?

Risk factors for getting reactive arthritis include:

  • Having an infection from sexual contact
  • Having an illness from contaminated food
  • Being male

What are the symptoms of reactive arthritis?

Reactive arthritis may cause arthritis symptoms, such as joint pain and inflammation. It can also cause urinary tract symptoms and eye infection (conjunctivitis). Symptoms can last from 3 to 12 months. In a small number of people, the symptoms may turn into chronic disease. Symptoms can happen a bit differently in each person, and may include:

Arthritis Symptoms

  • Joint pain and inflammation that often affect the knees, feet, and ankles
  • Inflammation of a tendon that is attached to bone. This may cause heel pain or shortening and thickening of the fingers.
  • Bony growths in the heel (heel spurs) that can cause chronic pain
  • Inflammation of the spine (spondylitis)
  • Inflammation of the lower back joints (sacroiliitis)

Urinary Tract Symptoms
Men:

  • Increased urine
  • Burning sensation during urination
  • Discharge from penis
  • Inflamed prostate gland (prostatitis)

Women:

  • Inflamed cervix
  • Inflamed urethra. This causes a burning sensation during urination.
  • Inflamed fallopian tubes (salpingitis)
  • Inflamed vulva and vagina (vulvovaginitis)

Eye Symptoms

  • Red eyes
  • Painful and irritated eyes
  • Blurry vision
  • Inflamed mucous membrane that covers the eyeball and eyelid (conjunctivitis)
  • Inflammation of the inner eye (uveitis)

The symptoms of reactive arthritis can be like other health conditions. Make sure to see your healthcare provider for a diagnosis.

How is reactive arthritis diagnosed?

The process starts with a health history and a physical exam. Diagnosis can be difficult. This is because there are no specific tests that can confirm the condition. Some blood tests may be done to rule out other conditions, such as rheumatoid arthritis and lupus. Other tests may include:

  • Erythrocyte sedimentation rate (ESR or sed rate). This test looks at how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the blood’s proteins clump together and become heavier than normal. They fall and settle faster at the bottom of the test tube. The faster the blood cells fall, the more severe the inflammation.
  • Tests for infections. This includes a test for chlamydia. It may also include tests for other infections that are linked to reactive arthritis.
  • Joint aspiration (arthrocentesis). A small sample of the synovial fluid is taken from a joint. It’s tested to see if crystals, bacteria, or viruses are present.
  • Urine and stool samples. These are used to look for bacteria or other signs of disease.
  • X-rays. This test uses a small amount of radiation to create images of tissues, bones, and organs. X-rays are used to look for swelling or damage to the joint. This can check for signs of spondylitis or sacroiliitis.
  • Gene testing. A test may be done to check for HLA-B27.

You may also have testing to rule out other forms of arthritis.

How is reactive arthritis treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is. Treatment may also include:

  • Antibiotics to treat the infection
  • Nonsteroidal anti-inflammatory medicines to reduce inflammation
  • Corticosteroids to reduce inflammation
  • Immunosuppressive medicines such as methotrexate to control inflammation
  • Strong biological immunosuppressants given as a shot
  • Rest to ease pain and inflammation
  • Exercise to strengthen muscles and improve joint function

What are the complications of reactive arthritis?

The main symptoms of reactive arthritis will often go away in a few months. Some people may have mild arthritis symptoms for up to a year. Others may develop mild, long-term arthritis. Up to half of people will have a flare-up of reactive arthritis in the future. In rare cases, the condition may lead to chronic, severe arthritis. This can lead to joint damage.

When should I call my healthcare provider?

If your symptoms get worse or you have new symptoms, let your healthcare provider know.

Key points about reactive arthritis

  • Reactive arthritis is a type of arthritis caused by an infection. It may be caused by Chlamydia trachomatis, salmonella, or another infection.
  • The condition may cause arthritis symptoms, such as joint pain and inflammation. It may also cause symptoms in the urinary tract and eyes.
  • Treatment includes antibiotics for the infection, plus medicines to reduce the joint pain and inflammation.
  • Most people recover fully from reactive arthritis.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much will you have to pay for the test or procedure

A urinary tract infection, or UTI, is a bacterial infection of any part of the urinary tract, which includes the bladder, kidneys, ureters (tubes that connect the kidneys to the bladder) and the urethra (the tube that allows the bladder to be emptied). Infections of the bladder or the urethra are the most common.

In the United States, about 8.1 million people visit the doctor due to a urinary tract infection each year, according to the American Urological Association.

Causes

Most often, a UTI occurs because bacteria enter the urethra and travel up to the bladder, where they multiply.

Bladder infections are typically caused by Escherichia coli (E. coli) bacteria, which are common bacteria in the human gut, according to the Mayo Clinic. Infections of the urethra can be caused by E. coli, or by sexually transmitted infections, such as herpes or chlamydia.

Bacteria in the bladder can also move up to the kidneys and cause a kidney infection (known as pyelonephritis), which can cause permanent kidney damage. An untreated UTI in the bladder can lead to such an infection.

Symptoms

According to the National Institutes of Health, symptoms of a UTI include:

  • A strong and frequent urge to urinate often, even after you’ve just emptied your bladder
  • Pain or burning while urinating
  • Cloudy or bloody urine
  • Pain in the lower abdomen or back (pelvic pain for women, rectal pain for men)

Signs of a kidney infection may include:

  • Chills or night sweats
  • Fever
  • Pain in the side, back or groin area
  • Flushed or reddened skin
  • Nausea and vomiting

In older adults, mental changes or confusion are often the only signs of a UTI, according to the NIH. For this reason, UTIs in the elderly are often missed, said Dr. Ketul Shah, a urologist from The Ohio State University Wexner Medical Center. If an elderly patient comes to the hospital because they are confused and not feeling well, it’s important that doctors rule out common problems (such as UTI) first, before they start treatment for other, less common problems, Shah said.

Risk factors

Women are more likely than men to get a UTI. One reason for this is that women have a shorter urethra than men do, and it is closer to the anus. Both of these reasons explain why bacteria can reach the bladder more easily in women. Sexual activity also increases a woman’s risk of UTI.

The drop in estrogen levels that women experience after menopause also can make the urinary tract more vulnerable to infection, according to the Mayo Clinic.

Blockages of the urinary tract, such as those caused by a kidney stone or an enlarged prostate, can block the flow of urine and increase the risk of UTI.

People with an impaired immune system, such as those with diabetes and other conditions, have a decreased ability to fight off infections, which can increase the risk of UTI.

People who have a urinary catheter are also at increased risk for UTI.

People who hold their urine for long periods of time may also be at risk for a urinary tract infection, Shah said. Urine has a high amount of glucose and proteins, which can allow bacteria to grow, Shah said. “The bacteria has more time to multiply” when people hold their urine, Shah said.

Diagnosis

To diagnose a UTI, doctors collect a urine sample to look for bacteria or byproducts from bacteria, such as red and white blood cells, Shah said. Doctors can also perform a urine culture — in which the urine sample is cultured in a lab to see if it grows bacteria — which takes about 24 to 48 hours, Shah said. The latter test can help doctors determine which antibiotics are most suitable to treat the infection, Shah said.

Treatment

Usually, a urinary tract infection is treated with antibiotics to prevent the infection from spreading to the kidneys. Symptoms of a bladder infection usually go away within one to two days after starting antibiotics.

Patients who are prescribed antibiotics should take them exactly as it was recommended by your healthcare provider, and they should not stop taking the drug until your provider says it is safe to do so, according to the Centers for Disease Control and Prevention.

A recent opinion article published in The BMJ (British Medical Journal) has questioned the long-held advice of finishing a course of antibiotics even if a person is feeling better to prevent the relapse of an infection. The article suggests this advice might be contributing to an increase in antibiotic-resistant bacteria.

Women with recurrent UTIs — meaning having more than two or three UTIs in a year — may be told to take antibiotics after sexual activity to prevent infection. Longer courses of antibiotics, or stronger doses, also may be required for people with recurrent infections.

A more severe infection of the kidneys may require hospital treatment. Hospital treatment involves injecting fluids and antibiotics through a vein. Some people may need surgery if the infection is caused by a problem with the structure of the urinary tract, according to the NIH.

UTIs in children can be serious because the infection can sometimes affect the growth of the kidneys, Shah said. Children who have had a UTI may require further testing to make sure their urine is not traveling back up into the kidneys, Shah said.

Prevention

Ways to help prevent UTIs include drinking plenty of water to dilute urine and flush out bacteria, and urinating after intercourse. Women who’ve gone through menopause may use estrogen cream around the vagina to reduce the risk of infections, the NIH says.

A 2012 review suggested that cranberries may help prevent UTIs, according to the University of Maryland Medical Center. Cranberries may interfere with the way bacteria attach to urinary tract cells.

The idea that cranberry juice can prevent UTIs is controversial, because although some studies show a benefit, other studies find little evidence of a benefit, or suggest that the benefit is a placebo effect, Shah said. Still, because cranberry juice is safe and not very expensive, Shah said he does recommend it as a way to help prevent UTI.

Additional reporting by Cari Nierenberg, Live Science Contributor.

Follow Rachael Rettner @RachaelRettner. Follow Live Science @livescience, Facebook & Google+.

Additional resources

  • NIH: What you need to know about urinary tract infections
  • Mayo Clinic: The basics, risk factors, complications and home remedies for UTIs
  • CDC: Urinary Tract Infections — Incidence, transmissions, trends and challenges

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