A Urinary tract infections (also called bladder infection or cystitis) is uncomfortable: Burning when urinating and frequent urge to urinate are typical symptoms that cause problems for those affected. In the vast majority of cases, a bladder infection is harmless and quickly cured. Read here which other symptoms indicate a urinary tract infection, who is particularly at risk and what are antibiotics for urinary tract infections during pregnancy?
ICD codes for this disease: N30
Urinary tract infections: A brief overview
- Symptoms: frequent, painful urination of small amounts of urine, cramp-like pain in the bladder, often unpleasant-smelling, cloudy urine, rarely with blood, sometimes fever.
- Treatment: antibiotics for urinary tract infections during pregnancy, especially in pregnant women and in the case of recurring bacterial infections, if necessary after prior determination of the germs.
- Home remedies: drink a lot (>2l/day), special bladder and kidney teas, hot water bottle (relaxes cramps), warm footbaths, cranberries, nasturtiums, rest harrow or horseradish root (if you are pregnant, have diabetes or if it worsens go to the doctor!).
- Who is affected? Especially girls and women (shorter urethra!), risk increases during pregnancy and after menopause; Rarely in boys/men, then often a complicated course (causal research is important!).
- Causes: mostly bacteria, sometimes fungi, parasites or viruses, rarely drugs or other external factors.
- Triggers: spread of bacteria from the anal region, sexual intercourse (in women), obstacles to drainage in the urethra, frequent use or long-term urinary catheters, metabolic (diabetes) and immune diseases.
- Possible complications: ascending urinary tract infection, kidney (pelvic) inflammation, blood poisoning (urosepsis), epididymitis (in men), scarring in the bladder/shrinkage bladder.
- Attention: During pregnancy there is probably an increased risk of miscarriages, toxins during pregnancy and reduced birth weight, so always treat!
Symptoms of urinary tract infections
Mild urinary tract infections are sometimes only slightly noticeable. The classic signs of an ordinary (uncomplicated) bladder infection are pain when urinating (alguria), which is usually felt as a burning sensation, and a frequent urge to urinate, with only small amounts of urine being passed.
Often these are the only complaints. However, there are more symptoms that indicate a urinary tract infection and which, due to various factors (concomitant diseases, type of pathogen), can be more or less severe or not pronounced at all. The most common symptoms, although they never all appear together, include:
- Pain when urinating
- Difficult urination (dysuria)
- Frequent urination
- Increased urge to urinate at night (nocturia)
- Pain in the bladder area (suprapubic pain)
- Spasmodic, painful contraction of the bladder with a strong urge to urinate
There are also other signs that could indicate a urinary tract infections:
- Occasionally the urine will appear cloudy and/or have an unpleasant odor.
- Women may experience increased discharge (fluoride) if an infection spreads to the vagina as well.
- Back pain can occur when inflammation spreads to the kidneys or, in men, the prostate.
- Sometimes there is also a fever (rare in the case of a simple bladder infection.
- The urge to urinate can be so sudden and compelling (urge to urinate) that patients cannot make it to the toilet in time (urge incontinence).
- Visible blood in the urine can occur in rare cases. Blood admixtures that cannot be seen with the naked eye, on the other hand, are more common (microscopic hematuria).
Treatment of urinary tract infections
The main purpose of treatment for urinary tract infections is to make the annoying symptoms subside more quickly and prevent possible complications. In fact, uncomplicated urinary tract infections often heal on their own and without the use of medication. But it is better to support and accelerate the recovery with the right therapy.
As with almost all bacterial infections, antibiotics are also the drug of choice for bacterial cystitis. They are usually taken in capsule or tablet form. In more severe cases of inflammation of the renal pelvis (pyelonephritis), the active ingredients are sometimes given directly into the veins.
If fungi are the trigger of the urinary tract infection, antibiotics will not help. So-called antimycotics are used instead.
In principle, one tries to keep the antibiotic therapy as effective and short as possible in order to reduce the risk of the development of so-called resistance to antibiotics. Resistance is the insensitivity of bacteria to certain active ingredients.
The duration of application varies depending on the active ingredient. Sometimes a single dose (fosfomycin trometamol) is sufficient. This alleviates the side effects, but surviving bacteria could cause a relapse in this case. This is why antibiotics are usually taken for three to seven days (nitrofurantoin, pivmecillinam) in the case of a bladder infection.
“Calculated” antibiotic therapy
In the case of uncomplicated, acute cystitis – if there are no additional aggravating factors – the antibiotics are used empirically or calculated. This means that active ingredients are used that are known to usually help against the classic pathogens of a common urinary tract infection and cause as few side effects as possible.
The causative bacteria are not determined more precisely, but it is assumed that they are typical representatives such as Escherichia coli (E. coli).
So if you notice the typical symptoms of a bladder infection, it is best to go to a doctor as quickly as possible so that he can initiate the right therapy. Because even if a common urinary tract infection is relatively harmless, the risk of complications increases if you just wait and see. For example, you can significantly reduce the occurrence of recurring (=recurring) bladder infections if you take antibiotics in good time.
If the therapy works, the symptoms should improve noticeably after just one day.
Preventive administration of antibiotics
In women who repeatedly suffer from urinary tract infections, antibiotics are given in low doses, possibly even as a preventive measure (prophylactic). Before that, however, a trial lasting several months should be carried out with drugs that stimulate the immune system.
Determination of type of bacteria and effectiveness of antibiotics
Sometimes a Urinary tract infections can be more severe or chronic. Or there are special circumstances such as pregnancy or certain concomitant diseases. In such cases, it makes sense to use a patient’s urine sample to cultivate the bacteria in a culture for closer examination.
In this way, they can be precisely identified and also tested to which antibiotics they respond particularly well. These are then used specifically in the treatment of cystitis. Testing for resistance is also called an antibiogram.
If therapy with antibiotics does not work, there can be various reasons. Sometimes it is due to application errors by the patient, or unrecognized risk factors prevent success. Of course, possible resistance of the pathogens to the antibiotics used must also be taken into account.
If all these factors have been considered and there is still no sign of improvement, then a different antibiotic is switched to.
Treatment of urinary tract infections in pregnancy
Since a urinary tract infections during pregnancy can lead to serious complications, it is important to start the appropriate treatment as early as possible. Women who notice typical symptoms of a bladder infection should therefore consult a doctor immediately.
Urinary tract infection treatment during pregnancy is also based on antibiotics. However, one resorts to preparations that are well tolerated during this special phase of life. These are mainly active ingredients from the groups of penicillins and cephalosporins as well as fosfomycin trometamol.
Antibiotic therapy is usually initiated in pregnant women when the doctor detects an increased number of bacteria in the woman’s urine (bacteriuria) – even if there are no symptoms of a urinary tract infections.
Antibiotics for urinary tract infections during pregnancy
Some antibiotics for urinary tract infections during pregnancy, such as nitrofurantoin and trimethoprim-sulfamethoxazole, have been linked to birth defects.
The American College of Obstetricians and Gynecologists (ACOG) recommends avoiding these antibiotic treatments in early pregnancy if possible. A study from the Centers for Disease Control and Prevention (CDC) found that about 4 in 10 women with UTIs during early pregnancy filled a prescription for nitrofurantoin or trimethoprim-sulfamethoxazole.
Safe antibiotics for urinary tract infections during pregnancy are:
These antibiotics are considered safe for urinary infections during pregnancy.
Other antibiotics for urinary tract infections during pregnancy are:
- Ciprofloxacin (Cipro)
- Tetracycline, or trimethoprim (Primsol, Proloprim, Trimpex).
Your doctor wouldn’t prescribe these antibiotics for urinary tract infections during pregnancy, because that can affect your baby’s development.
Antibiotics for urinary tract infections during pregnancy and their dosage
|Amoxicillin-clavulanic acid (Augmentin)||B||250 mg four times daily|
|Cephalexin (Keflex)||B||250 mg two or four times daily|
|Erythromycin||B||250 to 500 mg four times daily|
|Fosfomycin (Monurol)||B||One 3-g sachet|
|Nitrofurantoin (Macrodantin)||B||50 to 100 mg four times daily|
|Sulfisoxazole (Gantrisin)||C*||1 g four times daily|
|Trimethoprim-sulfamethoxazole (Bactrim)||C†||160/180 mg twice daily|
Home remedies for urinary tract infections
There are many home remedies for urinary tract infections. Some of these can actually support the healing process. Bladder and kidney teas or their herbal active ingredients are part of this, for example. They have antispasmodic, anti-inflammatory and diuretic effects. But three to four cups a day are enough.
Certain ingredients (anthocyanidins and proanthocyanidins) in cranberry juice are said to be helpful in preventing bacteria from attaching themselves to the mucous membrane of the urinary tract and causing a urinary tract infection or causing it to come back. However, the study situation here is not unambiguous.
In the case of mild, uncomplicated urinary tract infections, essential and mustard oils such as those found in nasturtium, restharrow or horseradish root can provide relief as a phytomedical adjunctive therapy. They have an antibiotic effect and are generally well tolerated.
In general, if you have a urinary tract infection, you should drink a lot (at least 2 liters per day) – even if it hurts to urinate. Because the pathogens are flushed out with the urine. Heat, for example in the form of a hot water bottle, a grain pillow or a foot bath, relaxes the bladder muscles, which often cramp when inflamed, and can alleviate the symptoms.
Coffee, citrus juices, alcohol and sugary drinks should be off-limits when you have a bladder infection. They irritate the urinary tract or, in the case of soda and the like, promote bacterial growth.
Home remedies have their limits. If the symptoms persist over a longer period of time, do not get better or even get worse, you should always consult a doctor.
Homeopathy – treat urinary tract infections without antibiotics?
There are numerous homeopathic remedies that are said to help with different forms of Urinary tract infections. However, globules & co. do not replace antibiotics. A visit to the doctor is therefore advisable in any case, especially for high-risk patients such as pregnant women and diabetics.
Homeopathic remedies can then be used in addition to the conventional medical treatment of urinary tract infections. However, the concept of homeopathy and its specific effectiveness are controversial in science and not clearly proven by studies.
What happens when you have a urinary tract infections?
When a urinary tract infection occurs, the urothelium – the mucous membrane in the bladder – is affected. On the one hand, this can lead to pain, on the other hand, it often has an influence on the frequency of urination: the attacked bladder wall reacts more sensitively to stretching stimuli and gives the command to empty, so to speak, more quickly. This results in the frequent urge to urinate (pollakisuria) in the case of a Urinary tract infection.
Blood in the urine can also occur as a result of the irritated bladder mucosa, but is one of the rarer symptoms. See “Symptoms” for more information.
Since it is usually not only the bladder that is affected by inflammation, but also the urethra, doctors often speak of a urinary tract infection (UTI). In unfavorable cases, the infection even spreads to the ureters and kidneys. Inflammation of the renal pelvis (pyelonephritis) in particular can then be a serious complication.
Special types of urinary tract infections
In addition to classic urinary tract infections, there are a few other, much rarer forms such as hemorrhagic urinary tract infection, in which there is a large amount of blood in the urine. The triggers are often viruses.
Interstitial cystitis is chronic and has no bacterial or viral cause. In emphysematous cystitis, gas builds up in the bladder, and diabetics are often affected.
Complicated or uncomplicated urinary tract infections?
Depending on the accompanying circumstances of a bladder infection, a distinction is made in medicine between a “complicated” and an “uncomplicated” variant. According to this classification, a bladder infection is uncomplicated as long as there are no functional limitations or malformations in the urinary tract and no relevant kidney dysfunctions or other impairing concomitant diseases.
However, if one of these factors is met, it can promote the development of a urinary tract infection and cause complications, so it is then “complicated”.
Who is affected by a urinary tract infection?
Urinary tract infections in women
Women suffer from urinary tract infections much more often than men. This is mainly due to anatomical reasons. Because the female urethra is only about two and a half to four centimeters long, while the male one is about twenty centimeters.
In women, inflammatory pathogens such as bacteria therefore have to travel a much shorter route to reach the bladder. In addition, the opening of the urethra in women is closer to the anal region, where certain bacteria that are among the common triggers of cystitis are more prevalent.
After the menopause, the risk of cystitis increases again slightly, as the mucous membrane in the urethra becomes thinner due to the drop in estrogen levels. This also makes it easier for germs to penetrate the bladder.
Urinary tract infections in men
Urinary tract infections in men are much less common, but when they do occur, they are often more persistent than in women. Bladder infections also become more common among men with age because they often suffer from an enlarged prostate. You can find out more under “Causes and risk factors”.
Urinary tract infections in children
Bladder infections can also occur more frequently in children of both sexes, if only because the immune system is not yet as well developed as in adults. In young boys, however, possible malformations in the urogenital tract should be considered if urinary tract infections occurs particularly frequently.
Causes and risk factors of urinary tract infections
By far the most common cause of urinary tract infections are bacteria. In most cases, the pathogens come from the intestines, penetrate through the urethra and “climb” up to the bladder. One then speaks of an ascending, i.e. ascending infection.
However, inflammation can also start in the kidneys. The germs then descend from there via the ureters to the bladder (descending infection). However, this is very rare.
In by far the majority of cases, the triggering bacteria are representatives of the species Escherichia coli (E. coli for short), which are completely normal in the intestine. However, if they get into the urinary tract, they can cause inflammation there.
In addition to E. coli, other types of bacteria (e.g. Proteus, staphylococci) and, in rarer cases, fungi (including Candida albicans), parasites and viruses (e.g. adenoviruses, polyoma) can also trigger a bladder infection.
If a bladder infection occurs after a tropical trip, schistosomiasis can also be the trigger. The disease-causing fluke preferentially affects the urinary tract. Definitely see a doctor.
Otherwise, urinary tract infections can also occur as a side effect of certain medications, such as cyclophosphamide, which is used in tumor diseases. Likewise, radiation in the pelvic region can lead to bladder infection (radiation cystitis).
Triggers of urinary tract infections
Certain risk factors or circumstances increase the likelihood of urinary tract infections. This includes:
- Frequent sexual intercourse (honeymoon cystitis). The mechanical friction makes it easier for intestinal pathogens to get from the anal region into the urethra.
- The use of some birth control methods, such as a diaphragm or spermicide.
- Longer urinary catheters.
- Bladder dysfunction: If the urine accumulates, bacteria find an optimal breeding ground in it to multiply. The result can be recurring urinary tract infections.
- Diabetes mellitus, because those affected are generally more susceptible to infections and the increased sugar in the urine also serves as a nutrient for bacteria.
- A weakened immune system, e.g. B. by hypothermia or psychological influences such as stress.
- A urinary outflow disorder. This is caused, for example, by a narrowing of the urethra or when the valve mechanism between the ureter and bladder is not working properly and urine flows back from the bladder into the ureter (reflux). An enlarged prostate can also cause urinary retention in men.
- Mechanical interventions such as cystoscopy and flushing.
- Pregnancy and postpartum : Due to the changed hormone levels during pregnancy and in the first few weeks after birth, the urinary tract is widened, germs can penetrate and rise more easily.
- Wrong “wiping technique” after a bowel movement. If you wipe from back to front, intestinal bacteria are transported towards the entrance to the urethra.
Due to the anatomical features mentioned, the greatest risk factor is the female gender. Bladder infections are most common in young, sexually active women.
Possible complications of urinary tract infections
A simple urinary tract infection heals either spontaneously or after a few days with the right antibiotic therapy. In unfavorable cases, however, complications can arise.
Recurring cystitis : In people who suffer from cystitis particularly often, doctors also speak of chronic urinary tract infections. By definition, at least two bladder infections must occur every six months or three per year. Here, too, symptoms of bladder irritation such as burning when urinating occur (as with a simple bladder infection).
In contrast to normal cystitis, atypical pathogens are often the trigger for the recurring form, which is why a urine culture is useful to determine the germs (see “Diagnosis”). Timely treatment of simple cystitis with antibiotics can reduce the risk of recurring cystitis.
Inflammation of the renal pelvis : Inflammation of the renal pelvis (pyelonephritis) is a more dangerous complication of cystitis. It occurs when the pathogens ascend from the bladder via the ureters to the renal pelvis. The renal pelvis function as a kind of collecting funnel and describe the place where the ureters leave the kidneys. The primary urine filtered out by the kidneys is collected here. Part of the kidney tissue is also inflamed in pyelonephritis.
In addition to a general, severe feeling of illness, pyelonephritis also has the symptoms typical of an infection of the upper urogenital tract. Bladder infection-specific symptoms are often added. The kidney function, however, is not impaired.
Blood poisoning : The life-threatening urosepsis, i.e. blood poisoning caused by the causative pathogen, is particularly feared in connection with inflammation of the renal pelvis. This occurs when the germs enter the bloodstream in large numbers from the kidney tissue. This can easily happen because the kidneys are very well supplied with blood. Timely therapy with antibiotics is therefore particularly important.
Epididymitis : Just as the pathogens sometimes ascend the ureters to the renal pelvis, in men they can travel through the vas deferens to the epididymis, which is directly attached to the testicles. The result is an inflammation of the same (epididymitis), which is accompanied by swelling and sometimes severe pain. Since the sperm cells mature in the epididymis, in extreme cases it can even lead to infertility.
Shrinkage bladder : This is a reduced bladder with a rigid bladder wall. It holds less volume, those affected often feel a strong urge to urinate, but can hardly urinate. In many cases, a bladder infection that has not healed or is chronic causes a bladder to shrink because it permanently damages the organ and causes the tissue to scar.
Pregnancy Complications : Women are more likely to experience cystitis during pregnancy due to certain hormonal changes. Experts assume that premature births, reduced birth weight and a certain form of high blood pressure during pregnancy (pre-eclampsia) can be the result of such a bladder infection.
However, this does not mean that every cystitis during pregnancy has to trigger such complications. On the contrary, this only occurs in rare cases and in particularly unfavorable cases.
Pregnant women who suspect they have a bladder infection (symptoms such as painful urination, frequent urges to urinate, etc.) should see a doctor as soon as possible. This is the only way to start a suitable antibiotic therapy in good time, which minimizes the risk of complications.
Hemorrhagic cystitis : Strictly speaking, this is not a complication, but a special form of cystitis. In contrast to normal cystitis, it has rather atypical pathogens as triggers, namely mostly viruses or so-called Enterobacter. However, as with normal cystitis, symptoms such as pain when urinating occur.
In addition, as a special feature of hemorrhagic cystitis, there is a larger amount of blood in the patient’s urine. Blood in the urine always looks dramatic, but in this case it does not mean that hemorrhagic cystitis is particularly dangerous.
Is a urinary tract infections contagious?
Even if the risk is low with appropriate hygiene, a bladder infection can be contagious. Since it is mainly caused by E. coli bacteria, public toilets, where they like to romp, are a potential source of infection. Bacteria can also get to the hands via the shopping trolley pole, handles on public transport or doorknobs and water taps in the office and from there at some point through touching the intimate area. Regular hand washing can prevent such transmission.
A direct infection is also possible through
- E. coli bacteria in human stool. However, the risk of them getting from the anus into the urethra is lower if you wipe from front to back after having a bowel movement.
- intercourse. Here, condoms can prevent the bacteria from getting into the urethra via the penis.
Diagnosis of urinary tract infections
First, the doctor collects the medical history of the patient, whereby above all the symptoms and possible risk factors must be queried. It also plays an important role for subsequent examinations and treatment, to which group the patient belongs.
In a young, otherwise healthy woman, a bladder infection has a different status than in a young man, a pregnant woman or a diabetic.
The medical history often shows whether the cystitis is complicated or uncomplicated.
If a complicated cystitis can be ruled out, young women are not examined further if they are otherwise healthy. The most typical symptoms are already sufficient to make the diagnosis. Standardized therapy is then initiated. Nothing special is to be expected.
In other cases, such as pregnant women or young men, further examinations follow the collection of the medical history. Urine diagnostics are of particular importance when a bladder infection is suspected. The patients’ urine is examined for bacteria and blood, using various methods:
- The urine test strip: With the help of this simple procedure, the number of bacteria in the urine can be roughly determined and any blood can be detected.
- The microscopic examination of urine, which allows a more accurate estimation of bacterial counts and identification of cells.
- The urine culture: Here, the pathogens present in the urine are cultivated on a special culture medium in order to then be able to identify them precisely.
The urine strip is not sufficient as the sole diagnostic tool. However, it can help if the question first needs to be clarified as to whether there are large numbers of bacteria in the urine at all. The sole examination with test strips, without existing symptoms of a bladder infection, is not useful, since without symptoms, even with an increased bacterial count (asymptomatic bacteriuria), no further steps need to be taken.
Pregnant women are an exception: Asymptomatic bacteriuria leads to kidney inflammation in about 30 percent of pregnant women and must therefore always be treated.
If the patient is asked for a urine sample for examination, he should definitely use the so-called “midstream urine”. This means that the urine from the urine stream that is already running should be intercepted and the first or last milliliters discarded.
The reason is that the urine should be contaminated as little as possible with the normally occurring bacteria on the mucous membrane, which can otherwise falsify the result. Therefore, the genitals must be thoroughly cleaned with water beforehand. Women should also spread the labia when urinating.
If kidney inflammation or other complication factors are suspected, sonography (ultrasound) is available as a further examination, with which residual urine can be determined. This also allows conclusions to be drawn about a bladder emptying disorder, as can a urine flow measurement (uroflowmetry) or a voiding cystogram.
In the latter case, a contrast medium is injected through the urethra into the bladder and the emptying is documented with an X-ray. A cystoscopy can also be useful under certain circumstances.
How to prevent urinary tract infections?
Some people are more prone to getting bladder infections than others. That depends on various factors. However, you are not completely at the mercy of the infection, certain measures should help to keep the urinary tract healthy:
- Drink a lot (min. 1-1.5 liters per day) : preferably water and unsweetened herbal or fruit tea. When consumed regularly, cranberry juice is said to have a positive effect against recurring bladder infections. However, this is not scientifically proven.
- Go to the bathroom often : If you have to, don’t wait. If the urethra is flushed more frequently, it is more difficult for bacteria to ascend there. Even after intercourse (within 10 to 15 minutes), women should try to urinate to flush out any bacteria that the act may push into the urethra.
- Antibiotics : In special cases, a preventive administration of antibiotics can be useful. Long-term use of antibiotics can be considered in the case of recurring or chronic cystitis.
- Wipe correctly : Wiping from front to back after going to the toilet does not rub the bacteria from the anus into the urethra.
- Keep warm : Especially the feet and abdomen. Cooling down weakens the immune system, bacteria have an easy time of it.
- Fresh, comfortable underwear : Avoid tight panties as they can irritate the pubic area and can carry germs to the vagina. Better: well-fitting cotton underpants.
- Intimate hygiene : regularly but not excessively. It is best to wash the intimate area with warm water only. Soap, intimate sprays or disinfectants can irritate the sensitive mucous membrane.
- Bladder-friendly prevention : Condoms protect against pathogens while vaginal suppositories and diaphragms tend to encourage infection.
Cystitis: course of the disease and prognosis
The vast majority of urinary tract infections are harmless and heal after a few days with antibiotic therapy. Some women experience cystitis at regular intervals, and the risk increases with age.
More serious complications arise only rarely and mostly due to special accompanying circumstances. Particular care should be taken if the kidneys are involved as a result of a bladder infection, since in unfavorable cases blood poisoning (urosepsis) can develop.