Bladder Infection Treatment
What is a Bladder Infection?
Urinary tract infection typically represents bacterial infection of the bladder or kidneys. The condition is more common in women than men because the urethra is shorter and in closer proximity to the anus in women. A common mode of infection in women is translocation of bacteria from the anal area to the vaginal and urethral location.
Patients with bladder infection (cystitis) typically develop suprapubic discomfort, burning on urination (dysuria), cloudy urine, abnormal smelling urine, and fever. Some patients develop blood in the urine. If the infection ascends up the urinary tract into the kidneys, individuals may develop back pain, nausea, and vomiting. Mild cases of kidney infection (pyelonephritis) can be managed as an outpatient but severe cases often require hospitalization for intravenous fluids and antibiotics.
What Causes a Bladder Infection?
Urinary tract infection is caused by bacterial infection of the urinary tract – kidneys, ureters, bladder, prostate (in men), and urethra. The most common organisms that cause urinary tract infections include Escherichia coli, Klebsiella, Proteus, and Group B streptococcus. Most of these bacteria originate from the colorectal area and translocate to the urethra – this is more common in women due to their anatomy. Woman are usually encouraged to wipe backwards after a bowel movement, avoiding forward motion toward the vagina and urethra.
Certain conditions increase the risk of developing urinary tract infections:
- Female gender
- Recent sexual intercourse
- Advanced age
- Urinary retention – due to medications, spinal cord injury, diabetes
- Benign prostatic hyperplasia
- Prior urologic surgery
- Foley catheter placement
- Urinary stent placement
- Kidney stones
Stagnant urine in the bladder (caused by enlarged prostate or stones) allows bacteria to flourish and replicate – producing symptoms such as fever, suprapubic pain, urinary frequency, and dysuria. If the infection advances up the urinary tract into the kidneys it is called pyelonephritis. This tends to be a more severe infection that causes back pain, fever, nausea, and vomiting. Pyelonephritis can lead to acute kidney injury, bacteremia, sepsis, and potentially shock. These serious conditions may ultimately lead to death if not caught early and treated with appropriate antimicrobial therapy.
How Common is a Bladder Infection?
Urinary tract infection is exceedingly common in the United States and responsible for frequent primary care and emergency department visits. Complicated forms of the condition may require referral to a urology and infectious disease specialist.
The incidence of urinary tract infection in sexually active young women is high – one study showed the incidence to be 0.5 to 0.7 urinary tract infections per person-year. Urinary tract infections also frequently affect postmenopausal women, with an approximate incidence of 0.07 episodes per person per year. The incidence of pyelonephritis is approximately 13 cases per 10,000 women per year.
Signs and Symptoms
Symptoms of urinary tract infection depend on the location of infection. Cystitis is infection of the bladder – this typically leads to the following symptoms:
- Dysuria – burning on urination
- Urinary frequency
- Urinary incontinence
- Suprapubic abdominal pain
- Changes in the smell or appearance of urine
If the infection spreads up the urinary tract to the kidneys (pyelonephritis), patients are more likely to have these additional findings:
- Back pain
- Nausea & vomiting
- Systemic toxicity
Bladder infection (cystitis) often results in tenderness when the doctor presses in the suprapubic area. Patients with pyelonephritis typically have pain when the doctor taps on their back near the kidneys – this is referred to as costovertebral angle tenderness. Men with prostatitis – infection of the prostate gland – typically have pain on palpation of the prostate during rectal examination.
The diagnosis of urinary tract infection is suggested based on symptoms and physical examination, but typically confirmed with laboratory studies.
Your doctor will also usually order a urine dipstick. This test provides a quick yet non-specific evaluation of your urine in terms of the presence of protein, blood, or infection. If this test is positive your doctor will likely treat you empirically with antibiotics. Your doctor may have your urine examined with a urinalysis sediment and microscopy. This is a more accurate study to determine the cause of your urinary symptoms. Your doctor will typically send the urine for culture to obtain bacterial speciation and antimicrobial sensitivities.
If more severe forms of urinary tract infection, your doctor may obtain blood tests such as a CMP (comprehensive metabolic panel) and CBC (complete blood cell count). If you have signs of sepsis they will also likely order blood cultures. Occasionally, they will obtain an ultrasound or CT scan of the abdomen to determine the precise source of infection and whether kidney stones are present.
Bladder Infection Medication and Treatment
Simple urinary tract infections in women can be treated with antibiotics for 3-7 days, depending on the type of prescription. The most commonly prescribed antibiotics for urinary infections include:
- Macrobid (nitrofurantoin)
- Bactrim (trimethoprim-sulfamethoxazole)
- Cipro (ciprofloxacin)
- Levaquin (levofloxacin)
Enterococcus usually requires therapy with ampicillin or vancomycin. However, there has been an emergence of vancomycin-resistant enterococcus (VRE), which requires treatment with Zyvox (linezolid).
Extended spectrum beta-lactamase (ESBL) organisms are a type of resistant bacteria that may require intravenous therapy with a carbapenem:
- Primaxin (imipenem/cilastatin)
- Merrem (meropenem)
- Invanz (ertapenem)
- Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011; 52:e103. - http://www.uphs.upenn.edu/bugdrug/antibiotic_manual/idsa-cystitispyelo-2010.pdf
- Czaja CA, Scholes D, Hooton TM, Stamm WE. Population-based epidemiologic analysis of acute pyelonephritis. Clin Infect Dis 2007; 45:273. - https://www.ncbi.nlm.nih.gov/pubmed/17599303
The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.