How to cure those painful urine infections for good

CySTITIS, or inflammation of the bladder, is one of the most common types of urinary tract infection (UTI) and affects more than 90 per cent of women.

It is typically caused by bacteria invading the bladder wall, explains Con Kelleher, an obstetrician and gynaecologist based at Guy’s and St Thomas’ NHS Foundation Trust. Pain when urinating or passing frequent, small amounts of urine are signs of cystitis. So, too, is blood in the urine, which can make it pink and cloudy — but it can indicate other problems such as bladder cancer, too, so always talk to your GP.

It’s far more common among women than men. ‘The anus is closer to the urethra [the tract that carries urine from the bladder out of the body] in women and the urethra is shorter,’ explains Mr Kelleher. ‘This makes it more likely that bacteria will invade.’

‘UTIs should not be ignored since they can lead to more serious complications such as kidney infection as the bacteria travel up from the bladder,’ says Emma Soos, a nurse with a special interest in urology and director of the Women’s Health Clinic.

For mild cystitis, drinking plenty of water can help flush out bacteria. Although many people believe that cranberry juice can help, recent research found no evidence that the fruit, taken as capsules, made any difference to bacteria in urine.

The antibiotic trimethoprim (Monotrim) is the main treatment and works in 80 per cent of infections. Adults with UTIs which are not responding to treatment should have their urine tested to identify the bacteria causing the problem so they can be targeted with the most effective drugs.

Professor James Malone-Lee, based at University College Hospital, advocates, for some patients, high-dose, long-term treatment with highly-targeted antibiotics, combined with an antiseptic medication called Hiprex, prescribed by a specialist.

To prevent UTIs, wearing clean cotton underwear, avoiding perfumed products and wet wipes, which can be irritating, and wiping front-to-back are effective. Always passing urine at bedtime and after sex — during which bacteria can transfer to the urethra — can also help.

‘MALE CYSTITIS’

ALTHOUGH men can get cystitis, more common is prostatitis — inflammation of the prostate gland which affects half of men and is sometimes called ‘male cystitis’.

Symptoms include pain when urinating, frequent urination and the urgent need to pass water, cloudiness or blood in the urine and pain in the abdomen, groin or lower back. Sometimes it causes sexual problems such as low libido and erectile dysfunction.

Prostatitis is diagnosed by ruling out other conditions that could be causing symptoms, such as cancer. A doctor may give you a physical examination, order urine and blood tests and sometimes a scan of your urinary tract and prostate to check for underlying issues.

In about 10 per cent of cases it can be down to bacterial infection. ‘This type comes on quickly and can cause a high fever, chills, muscle aches and joint pain, as well as pain in the perineum and around the base of the penis and difficulty passing urine,’ says Professor Roger Kirby, from the Prostate Centre.

Treatment is with antibiotics. ‘In severe cases, a man may need antibiotics for four to six weeks, or even longer,’ says Professor Kirby.

Professor Christopher Eden, a urological surgeon at Royal Surrey County Hospital, says the quinolone class of antibiotics are most effective at entering the prostate gland.

‘you often find that GPs prescribe the wrong sort, such as trimethoprim, penicillins and nitrofurantoin which won’t have much effect,’ he says.

The most common type of prosta

titis is not caused by bacteria at all. Chronic prostatitis without bacte-rial infection, also known as chronic pelvic pain syndrome (CPPS) is diagnosed when men complain of pain around their back passage and discomfort passing urine — yet tests reveal no bugs in the urine. ‘Most experts believe this is caused by scar tissue left after a bacterial infection has resolved — this can stimulate nerves which continue to send signals to the brain that there is inflammation,’ says Professor eden.

new evidence suggests it may be down to chronic spasms in the pelvic floor. Treatment for CPPS includes alpha blockers, which can help by relaxing the bladder neck and the muscle fibres within the prostate.

Some patients seem to benefit from Cialis, used to treat erectile dysfunc-tion, in doses of 5 mg per day which can also improve sexual function. Botox injections into the prostate have been used to reduce muscle spasms. And physical therapy to relax the pelvic floor muscles has been shown to help.

Frequent sex and masturbation are sometimes cited as ways to reduce the pain of prostatitis, but Professor eden says that this is probably a myth. ‘But some men do say that it helps.’

‘For some men, surgical removal of the prostate is worth considering as a last resort,’ adds Professor eden.