Painful, frequent urination, or blood in urine – women

The best known symptoms of bladder infection are: a) pain or burning on urination, b) frequent, urgent urination and sometimes c) blood in the urine.

These symptoms are not always caused by infection due to bacteria. They can be due to a viral infection or even to excessive use of caffeine- containing beverages such as tea or coffee. Sometimes there may be no obvious cause for pain on urination. Excessive frequency may be due to ‘nerves’. When the cause is not bacteria, then antibiotics will do no good.

Bladder infection or ‘cystitis’ occurs much more frequently in women and girls than in men and boys. Most women have it at one time or another. This is because the female urethra, the tube leading from the bladder to the outside of the body, is only about one inch long – a short distance for bacteria to travel to reach the bladder. Sometimes bladder infection is related to sexual activity. The urethra is situated alongside the vaginal wall; stretching of the vagina during intercourse may encourage bacteria to enter the bladder. Bruising of the urethra during intercourse which can occur more readily if there is insufficient vaginal lubrication may cause similar symptoms, without infection being present.

Infection in the kidney may cause symptoms similar to bladder infection, but is often accompanied by back pain or pain in the sides, and fever. This requires more vigorous treatment and investigation. A stone in the kidney can cause pain in the side which is often severe and passage of blood in the urine, but does not usually cause pain on urination. If there is ever severe pain in the side, consult a doctor quickly.

Passing blood in the urine is never normal and should be investigated by a doctor. If it is accompanied by painful urination then it is very likely to be the result of an infection, but if blood is passed without pain, the likely causes are potentially more serious, e.g. a stone or growth in the kidney or bladder.

Bladder infections are common during pregnancy and may be more difficult to treat. Treatment must, of course, take the pregnancy into account.

Vaginal infections such as thrush or trichomonas and sometimes VD can cause pain on urination.

It is quite possible that many bacterial bladder infections will respond to home treatment alone. Still it makes good sense to use antibiotics when appropriate and this has become standard medical pratice. Antibiotics may be especially important in bladder infections which keep on recurring. Even if you are inclined towards doing without drugs, you should see the doctor unless the symptoms respond quickly and completely to home treatment.

Home Treatment

Treatment of a urinary infection often does require an antibiotic, but this may not alter the symptoms for 24 hours. Quicker relief is afforded by home treatment which should be started immediately any symptoms appear, even if it is the middle of the night:

• Drink a lot of fluid. At the first sign of symptoms drink half a pint of fluid every twenty minutes for at least three hours. The bacteria are literally washed away from the body during the resulting copious urination.

• Take bicarbonate of soda. One teaspoonful in a glass of water three times a day (adults only, and not for anyone with heart disease). This will help to neutralise the very acid urine produced by the infection, and so relieve discomfort.

Prompt home treatment may at times cure sufficient use KY Jelly (obtainable from the pharmacist). After intercourse, empty the bladder about 15 minutes later. This will help to wash out any germs that may have got into the bladder.

There are a number of simple preventive measures which may help women with recurrent cystitis:

• Wipe toilet tissue from front to back (to avoid spreading germs from the anus).

• Wear cotton pants and avoid tights and tight trousers.

• Wash down below with plain soap and water twice a day and never use vaginal deodorants or bubble baths.

• Ensure that there is adequate vaginal lubrication before attempting to have sexual intercourse. If natural secretions seem in-

What the Doctor Will Do

Ask about the symptoms; possibly examine the abdomen and back, and perform a vaginal examination if there is any discharge. A urine specimen may be examined under the microscope and possibly also sent to the hospital laboratory for bacteria to be isolated. For the occasional urinary infection it is not essential for a urine culture to be taken before therapy is started, although usually a follow- up specimen will be tested after the course of antibiotics has finished, to ensure that the infection has cleared. Further investigation may include special X- rays of the kidneys, and sometimes referral to a urologist (specialist surgeon for kidney and bladder problems) or gynaecologist.