What is a bladder infection?
A bladder infection, medically also known as cystitis or bladder catarrh, is an infection of the bladder that is predominantly caused by bacteria. Other pathogens are less commonly the cause of this disease. It is classified as a "lower urinary tract infection," which includes the urethra and bladder, as opposed to the "upper urinary tract," which consists of the kidneys and ureters.
Typically, the germs enter the urethra from outside and then advance into the bladder, where they cause inflammation. An inflamed bladder can cause cramping pain as well as pain during urination. This often also leads to increased urgency to urinate, although the amount of expelled urine may remain small.
What causes a bladder infection?
The development of bladder infections can have various causes, which are explained in more detail in this article.
How do bladder infections develop?
Bladder infections are very often caused by pathogens such as bacteria, fungi, or viruses. However, there are also bladder infections that can arise as side effects of medications or medical therapies.
Bacteria as a cause of a bladder infection
Bacteria are the most common cause of bladder infections. In most cases, the pathogens enter the bladder from the intestine via the urethra and cause an infection there. A reverse course, where the inflammation starts from the kidneys and the germs descend to the bladder via the ureters, is very rare.
Most bladder infections are caused by the bacterial species Escherichia coli (E. coli), which naturally occurs in the intestine. When these bacteria enter the urinary tract, they can cause inflammation. Other bacteria such as Proteus or staphylococci can also cause cystitis.
Fungi, viruses, and other pathogens as triggers of a bladder infection
There are also cases of bladder infections that are not caused by bacteria. Here, fungi such as Candida albicans, parasites, and viruses like adenoviruses or polyomaviruses can be responsible. After tropical travel, schistosomiasis (bilharzia) can also trigger a bladder infection, where the fluke infects the urinary tract. If a bladder infection is suspected, a medical examination should be carried out.
Medications and medical treatments as a cause of a bladder infection
Cystitis can also occur as a side effect of certain medications, such as cyclophosphamide used in tumor treatment, or as a result of radiation in the pelvic area (radiation cystitis).
What happens during a bladder infection?
In a bladder infection, the mucous membrane of the bladder is affected, which often leads to pain, itching, and increased urge to urinate. The affected bladder mucosa reacts more sensitively to stretching stimuli and triggers the urge to empty more quickly. Blood in the urine can also occur but is a rarer symptom.
Read more here about the causes of a bladder infection.
What are the risk factors for a bladder infection?
Bladder infections often occur in women. This is mainly due to the shorter urethra in women, which is about 4 centimeters long, compared to 20 to 25 centimeters in men, as well as the proximity of the urethral opening to the anus.
What factors increase the risk of a bladder infection?
Other factors can increase the risk of a bladder infection as well as a complicated course:
Frequent sexual intercourse (honeymoon cystitis):
Mechanical friction facilitates the entry of intestinal germs into the urinary tract, which can lead to a bladder infection. This is especially common among couples in the first days or weeks of their relationship, which is why it is often called "honeymoon cystitis." Read more here about bladder infection after sexual intercourse.
Certain contraceptive methods:
The use of contraceptive methods such as diaphragms or spermicides can increase the risk of a bladder infection. These methods can alter the natural balance of bacteria in the vagina and promote the growth of harmful bacteria.
Bladder catheter:
In people who need a bladder catheter for medical reasons and have to wear it for a long time, there is an increased risk of bladder infections. The catheter can introduce bacteria into the bladder and obstruct the natural flow of urine.
Bladder dysfunction:
Problems with bladder function, such as obstructed urine flow, provide ideal conditions for bacteria to multiply. Stagnant urine allows bacteria to multiply in the bladder and cause an infection.
Diabetes mellitus: People with diabetes mellitus often have elevated sugar levels in their urine, which promotes bacterial growth. The high sugar content provides bacteria with a rich food source and encourages their multiplication in the urinary tract.
Weakened immune system:
A weakened immune system, which can be impaired by factors such as cold exposure or stress, increases the risk of bladder infections. An intact immune system is crucial for defending against infections in the urinary tract.
Urine flow disorders:
Narrowing of the urethra or a faulty urine reflux mechanism can obstruct normal urine flow and thus increase the risk of bladder infections.
Mechanical procedures:
Procedures such as cystoscopies can disrupt the natural protective barrier of the bladder and increase the risk of infection.
Pregnancy and postpartum period:
Hormonal changes during pregnancy can widen the urinary tract and facilitate the entry of germs. This, along with the physical changes during the postpartum period, can increase the risk of bladder infections.
Incorrect wiping technique after bowel movements:
In women, incorrect wiping technique after bowel movements can lead to intestinal bacteria being transferred to the urethra, increasing the risk of infection. It is important to wipe from front to back to avoid this.
What symptoms are there and how can I recognize a bladder infection?
The symptoms of a bladder infection are varied, but increased urge to urinate, pain, and burning during urination are very common. The symptoms can also vary in women and men, as the spread of the infection to different organs such as the vagina, the prostate, or the epididymis is possible.
Signs and Symptoms of a Bladder Infection
What are the symptoms of a bladder infection? The typical signs of an uncomplicated bladder infection include pain when urinating, often felt as burning, as well as a strong and frequent urge to urinate, usually with only small amounts of urine passed.
Although these symptoms are often the only complaints, other signs can indicate a bladder infection. The intensity of these symptoms can depend on various factors, such as comorbidities or the type of pathogens. The most common symptoms are pain when urinating, often perceived as burning, which is typical for a bladder infection. Additionally, urination may be difficult, and those affected suffer from frequent and nighttime urination, known as nocturia. Pain in the lower abdomen, medically referred to as suprapubic pain, also occurs frequently. Furthermore, cramp-like pain in the bladder along with a strong urge to urinate, a condition known as tenesmus, can significantly impair the quality of life of those affected.
Additional signs such as itching can indicate a bladder infection. Cloudy and unpleasant-smelling urine can be a sign of a bladder infection. In women, increased discharge may also occur, especially if the infection spreads to the vagina (Vaginitis). Read more about this in the blog post on bladder infection or vaginal infection. Back pain occurs when the infection spreads to the kidneys or affects the prostate in men. Although fever is rare in a simple bladder infection, it is still possible. Urge incontinence, characterized by such a sudden and strong urge to urinate that those affected cannot reach the toilet in time, can also occur. In addition, in rare cases, visible discoloration of the urine may occur, which can be brown or red due to blood admixtures (macrohematuria); invisible blood admixtures (microhematuria) are more common.
Early detection and beginning cystitis
Pregnant women are particularly susceptible to bladder infections, which can have serious consequences for both mother and child. Therefore, urine is routinely tested for signs of bladder infection during pregnancy. During the Check-up 35, a dipstick test is performed to analyze the urine for signs of inflammation. Statutory health insurance holders are entitled to this examination every three years from the age of 35 and once between 18 and 35 years.
After a thorough interview, the doctor creates an anamnesis before conducting a physical examination and, if necessary, measuring body temperature. Usually, the patient is asked to provide a urine sample. It is recommended to clean the intimate area thoroughly beforehand and then collect the midstream urine in a sterile container.
The urine dipstick test shows color changes and tests for certain substances in the urine, including white blood cells (leukocytes) and nitrite, a metabolic product of bacteria. With clear symptoms of an uncomplicated urinary tract infection, the dipstick test is sufficient to make the diagnosis and start appropriate therapy.
For a more detailed analysis of bacteria in the urine, a laboratory test is necessary, especially in cases of recurrent or complicated bladder infections as well as during pregnancy. The analysis allows the doctor to tailor the therapy precisely and avoid complications.
How is the diagnosis of a bladder infection made?
The diagnosis of a bladder infection is made by the doctor.
How is cystitis diagnosed?
At the beginning, the doctor will ask about your medical history (anamnesis) to identify symptoms and possible risk factors for a bladder infection. Depending on which group you belong to as a patient—whether young, pregnant, male, or with other underlying conditions—the significance of a bladder infection and the subsequent examinations vary.
In young, otherwise healthy women, the doctor can often diagnose an uncomplicated bladder infection based on typical symptoms and prescribe a standardized therapy without needing further tests. For other patient groups, such as pregnant women, children, or young men, additional examinations are required.
Urine diagnostics play an important role when a bladder infection is suspected. The doctor orders tests for bacteria and blood admixtures, including the urine test strip, microscopic urine examination, and urine culture. In severe cases or recurrent infections, an antibiogram can be performed to determine the most effective antibiotics.
The urine test strip is a simple but useful tool to detect the presence of bacteria in the urine. Especially in pregnant women, asymptomatic bacteriuria can lead to complications and therefore requires treatment.
For the urine sample, the so-called "midstream urine" is required to avoid contamination with external bacteria. For women, it is important to thoroughly clean the genital area before urinating and to spread the labia.
In cases where complications such as kidney inflammation are suspected, an ultrasound examination (sonography) can be performed. Occasionally, further tests such as a urine flow measurement (uroflowmetry) or a voiding cystourethrogram may be necessary to check bladder emptying and any outflow obstructions.
How is a diagnosis made in complicated cystitis?
A urinary tract infection occurs when inflammation arises in various parts of the urinary system, including the urethra, bladder, ureters, and renal pelvis. A distinction is made between a lower urinary tract infection, which affects the urethra and bladder, and an upper urinary tract infection, which affects the renal pelvis and ureters.
A urinary tract infection is considered complicated if there are anatomical abnormalities, functional disorders of the urinary tract, or certain accompanying diseases such as diabetes mellitus, impaired kidney function, or a weakened immune system. This also includes kidney pelvis infections as well as urinary tract infections in men, children, and pregnant women, as the risk of complications is higher in these cases.
Especially in recurring or complicated urinary tract infections, an additional ultrasound examination of the urinary tract is advisable. The ultrasound device can detect anatomical changes in the kidneys and urinary tract. This allows the doctor to determine, for example, whether the prostate is enlarged, whether there are changes or stones in the bladder, and whether the kidneys are affected by the inflammation.
Furthermore, a post-void residual urine measurement provides information on whether urine remains in the bladder after urination. For this, the patient must first completely empty the bladder on the toilet. Then the doctor uses an ultrasound device to check if and how much urine remains in the bladder. If this value exceeds a certain volume, it indicates a possible emptying disorder.
If necessary, the urologist may request special and more complex examinations. These include X-rays or a urine flow measurement (uroflowmetry) to assess bladder emptying and possible backflow of urine into the ureter.
In a voiding cystourethrogram, contrast medium is injected into the bladder through the urethra, and a series of X-rays document how the bladder empties. Alternatively, the contrast medium can be administered intravenously to assess not only the bladder but also the kidneys and ureters.
In rare cases, a cystoscopy may also be necessary. In this procedure, the urologist inserts an endoscope through the urethra into the bladder to directly examine it from the inside and detect changes such as inflammation or tumors. However, these elaborate examinations are only indicated for recurrent urinary tract infections or when there is a justified suspicion of such changes.
The vast majority of urinary tract infections occur in young, healthy women and are usually uncomplicated, primarily known as bladder infections.
Distinguishing between complicated and uncomplicated urinary tract infections is crucial, as it significantly influences the scope of diagnostic tests and treatment strategies.
Special types of bladder infections
Special types of bladder infections occur less frequently, including:
Hemorrhagic cystitis:
This form is characterized by larger amounts of blood in the urine. Common causes are viruses or certain bacteria such as Enterobacter. The symptoms resemble those of a typical bladder infection and include pain during urination.
Interstitial Cystitis:
This form of bladder infection is chronic and has no bacterial or viral cause. It is described in more detail in the chapter on chronic bladder infections.
Emphysematous cystitis:
Gas forms in the bladder in this condition, which often occurs in diabetics.
How is bladder infection treatment carried out?
The treatment of bladder infections by a doctor follows a clear treatment plan depending on symptoms and risk group and can be individually adjusted. There are also self-help remedies that can be used for a bladder infection.
What treatment options are available for a bladder infection?
Uncomplicated bladder infections often resolve on their own. However, treatment can help speed recovery and relieve symptoms. Read more here about treatment of bladder infections.
Medical treatment:
Antibiotics help quickly and effectively combat symptoms in bacterial bladder infections. The choice of the appropriate antibiotic depends on the type of infection and is determined by a doctor. Commonly prescribed active ingredients include fosfomycin or nitrofurantoin. The treatment usually lasts three to ten days, but there are also preparations that can be taken as a single dose.
It is important to take the antibiotic for the entire duration prescribed by the doctor. Premature discontinuation can cause the infection to recur. Symptoms should improve after one day of antibiotic therapy, and the urine test should return to normal after three to five days. For recurring infections, it is important to perform an antibiogram to determine bacterial resistance and find a suitable antibiotic.
Fungi are less often the cause of bladder infections; in this case, antifungal medications are prescribed. For severe pain, antispasmodic drugs like butylscopolamine can also help relax the bladder muscles.
Self-help with home remedies:
If you suffer from a bladder infection and your health allows, you should drink two to three liters of fluids daily and regularly empty your bladder. This helps flush out the germs. Suitable drinks include kidney and bladder teas, which are available in pharmacies and often contain bearberry leaves, believed to have antibacterial properties. Be sure to follow the preparation instructions on the package insert. Additionally, a hot water bottle, warm sitz baths, or moist warm compresses in the bladder area can relieve discomfort by relaxing the smooth muscles and thus reducing pain. Read more about nutrition during bladder infection here.
What helps with an acute bladder infection?
With appropriate therapy for bladder infections, the doctor can speed up the healing process and keep potential risk factors in mind. Typically, they prescribe both general treatment approaches and, if necessary, specific medications such as antibiotics.
General therapy approaches include adequate fluid intake. During a bladder infection, it is advisable to drink at least two to ideally three to four liters of water or tea per day, provided there are no medical restrictions. Local heat, for example through a hot water bottle to relieve lower abdominal pain, can also contribute to recovery.
For recurring bladder infections, herbal alternatives can also be considered. These include preparations with bearberry leaves, nasturtium, or horseradish root. More on this in the chapter on chronic bladder infections.
Avoiding coffee, citrus juices, alcohol, and sugary drinks is advisable during a bladder infection, as they can irritate the urinary tract or, in the case of sugary drinks, promote bacterial growth. Read more about nutrition during bladder infection here.
Antibiotics are usually the treatment of choice for bladder infections caused by bacteria. Doctors often prescribe them in the form of capsules or tablets. In more severe cases, especially if the bladder infection leads to a kidney infection, antibiotics can also be administered directly through an intravenous infusion.
In mild, uncomplicated cases of bladder infection, the doctor may also prescribe symptomatic treatment with painkillers such as ibuprofen, but not for pregnant women. Find more information here about treatment of bladder infections.
What is the course and what complications can cystitis have?
Depending on symptoms and risk group, a bladder infection can heal quickly or have a prolonged course.
How does a bladder infection progress?
The vast majority of bladder infections are usually harmless. A simple cystitis can either resolve on its own or be cured within a few days with appropriate antibiotic treatment. However, some women regularly suffer from recurring bladder infections, with the risk increasing with age. Serious complications are rarer and usually occur under special circumstances. Special caution is advised if the kidneys are affected by the bladder infection, as in unfavorable cases, blood poisoning (urosepsis) can occur.
If you notice the typical symptoms of a bladder infection, it is advisable to seek medical advice as soon as possible. Although a simple bladder infection may seem relatively harmless, the risk of complications increases if patients simply wait. Timely antibiotic therapy can also significantly reduce the risk of chronic bladder infections.
How long does a bladder infection last?
The duration of symptoms of a bladder infection can vary greatly from person to person. However, it can generally be said that an uncomplicated bladder infection usually subsides within a week. Statistically, symptoms last an average of 6.1 days. During this time, affected individuals are bedridden for an average of 0.4 days, unable to work for 1.2 days, and have their activity limited for another 2.4 days.
What complications are possible with a bladder infection?
In some unfavorable cases, a bladder infection can lead to complications, including:
Recurrent Cystitis:
In people who frequently suffer from bladder infections, doctors refer to recurrent cystitis when at least two bladder infections occur within six months or three per year. Atypical pathogens can also be the cause.
Pyelonephritis (Kidney Pelvis Infection):
This dangerous complication occurs when the pathogens ascend from the bladder to the kidney pelvis. In addition to a general feeling of illness, symptoms of an upper urinary tract infection appear, but without impairment of kidney function.
Blood poisoning (urosepsis):
In the case of a kidney pelvis infection, the pathogens can enter the bloodstream and cause a life-threatening blood poisoning. Timely antibiotic therapy is essential here.
Epididymitis:
In men, the pathogens can travel through the vas deferens to the epididymis, causing inflammation with swelling and severe pain, and in the worst case, even infertility.
Prostatitis:
In men, the pathogens can also infect the prostate, which can lead to prostatitis with swelling and severe pain.
Shrunken bladder:
A reduced bladder with a rigid bladder wall can develop from an unresolved or chronic bladder infection, as it damages the organ permanently and causes tissue scarring.
Pregnancy complications:
Pregnant women are more frequently affected by bladder infections due to hormonal changes. In particularly unfavorable cases, bladder infections can lead to premature births, reduced birth weight, and preeclampsia.
Therefore, it is important that pregnant women consult a doctor immediately if a bladder infection is suspected, to start appropriate antibiotic therapy in time and minimize the risk of complications.
How can you prevent a bladder infection? Frequency and chronic bladder infections
Chronic bladder infections occur regularly and repeatedly, making them a serious and common health problem. However, there are some things you can do to reduce the risk of recurrent bladder infections.
How common is a bladder infection?
About 3% of women suffer from recurrent bladder infections, defined as more than three infections per year. Although these episodes are unpleasant, they usually have no long-term consequences. It is important that your doctor looks for possible causes that could promote or worsen these inflammations.
Treatment options for frequent bladder infections
There are many measures you can take yourself, which your doctor should discuss with you in detail. If these preventive steps are not effective, experts say there are further treatment options. Immunostimulants are used to strengthen the immune system and support the body's defenses against infections. Mannose is a special sugar that binds bacteria in the bladder, which are then expelled, promoting bladder health. Herbal preparations also offer a therapeutic option by acting directly in the bladder due to their germ-killing properties.
There are various options for preventing recurrent bladder infections:
D-Mannose:
Initial studies suggest that D-mannose may have a preventive effect similar to antibiotics in recurrent urinary tract infections. D-mannose binds to the bacterial fimbriae (pili), preventing their attachment to the bladder mucosa, which reduces the risk of infection.
Herbal preparations (phytotherapeutics):
Certain herbal preparations such as bearberry leaves or a combination of nasturtium herb and horseradish root can reduce the rate of further bladder infections. These preparations contain active ingredients that have anti-inflammatory effects and can inhibit bacterial growth.
Immune stimulation:
Targeted immune stimulation can help strengthen the immune system against bladder infections. This can be achieved by administering killed pathogens to trigger an immune response that prevents or fights off infection.
Estrogen:
In women after menopause, using an estrogen cream can help reduce the frequency of urinary tract infections. Estrogen positively affects the mucous membrane of the urinary tract by increasing its thickness and resilience, making it harder for bacteria to penetrate.
Innovative medical devices:
Innovative medical devices like CANNEFF VAG SUP vaginal suppositories with CBD and hyaluronic acid can help strengthen the mucous membrane in the intimate area and relieve inflammation. Read more here about treatment of bladder infection with suppositories.
Preventive antibiotic administration:
In some cases, doctors prescribe long-term low-dose antibiotics to prevent recurring bladder infections. These antibiotics can be taken regularly or as needed to control bacterial growth in the urinary tract.
Prebiotics and certain lactobacillus strains as well as cranberry products:
These can also help prevent recurring bladder infections, although further research is needed to confirm their effectiveness. Prebiotics and certain lactobacillus strains promote the growth of healthy bacteria in the gut and urinary tract, while cranberry products contain substances that can prevent bacteria from adhering to the bladder wall.
Drink enough:
Drink at least two liters of water or unsweetened herbal or fruit tea daily to flush the urinary tract well. Read more here about nutrition for bladder infection.
Regular toilet visits:
Avoid holding in the urge to urinate, especially after sexual intercourse. Urinate within ten to fifteen minutes after the act to flush out possible pathogens.
Bladder-friendly contraception:
Condoms provide protection against pathogens, while improper use of vaginal suppositories and diaphragms can increase the risk of infection.
Proper wiping:
Wipe from front to back after using the toilet to prevent the transfer of bacteria from the anus to the urethra.
Keep warm:
Protect your feet and lower abdomen from getting cold to strengthen the immune system and make it harder for bacteria to enter.
Comfortable underwear:
Wear loose cotton underwear that can be washed at 60 degrees. Tight-fitting panties can irritate the pubic area and transport bacteria to the vagina.
Proper intimate hygiene:
Use warm water or a wash lotion with a pH value that matches the vaginal environment to avoid irritating the sensitive mucous membrane. Soaps, intimate sprays, or disinfectants should be avoided. Use special cleansing products for intimate care such as CANNEFF intimate care foam.
Chronic bladder infection - Interstitial cystitis (IC)
Interstitial cystitis (IC), also known as chronic, non-bacterial bladder inflammation, is a complex disease that mainly affects women over the age of 40. Unlike conventional bladder infections, interstitial cystitis (IC) is not caused by bacteria or viruses. Suspected causes include autoimmune processes, vascular occlusions, hormonal influences, or psychogenic factors. Many affected individuals go through a long suffering period before the correct diagnosis is made.
Symptoms of interstitial cystitis:
The symptoms of interstitial cystitis manifest in various, often intense complaints. Among the most prominent are severe pain in the bladder and lower abdominal region. A characteristic feature of this disease is very frequent and urgent urination, which can be so intense that affected individuals may need to use the toilet up to 60 times a day. This is partly due to the significantly reduced functional bladder volume, meaning the bladder can store considerably less urine than a healthy bladder would.
In addition, affected individuals often suffer from a range of accompanying symptoms that can further complicate daily life. These include rheumatic-like joint pain, which can affect both mobility and overall quality of life. Migraine-like headaches, which are distressing due to their intensity and persistence, are also common. Furthermore, allergies and various gastrointestinal complaints, such as stomach or intestinal problems, may occur, highlighting the complexity and challenge in treating and managing this disease.
Diagnosis of interstitial cystitis:
The diagnosis of interstitial cystitis is established as a diagnosis of exclusion and is based on a thorough evaluation of clinical symptoms, cystoscopy results, and a voiding diary. During cystoscopy, it can be determined that it is not the superficial bladder mucosa but the deeper layers of the bladder wall that are chronically inflamed. These inflammations lead to scarring changes, which in turn reduce the bladder's capacity. Before the final diagnosis is made, diseases causing similar symptoms must be ruled out. These include benign and malignant bladder tumors, ureteral stones, bacterial infections, bladder tuberculosis, and in men, prostate inflammation.
Treatment of interstitial cystitis (IC)
The treatment of interstitial cystitis (IC) primarily aims to regenerate the damaged bladder mucosa. This is usually done by using medications specifically designed to repair defects in the mucosa and thus restore the important protective function of this layer. Here too, CANNEFF VAG SUP vaginal suppositories with CBD and hyaluronic acid help to strengthen the mucous membrane in the intimate area and relieve inflammation. Read more here about the treatment of bladder infection with suppositories.
What advice is there for visiting the doctor with a bladder infection?
It is important to correctly determine when and which doctor to see for a bladder infection. Symptoms can vary greatly, and the severity of the illness is crucial for rapid treatment success. Read more here about the doctor visit for bladder infection.
When to see a doctor at signs of cystitis?
In case of severe symptoms or worsening health condition, a doctor should always be consulted to prevent possible complications. For the diagnosis and treatment of urinary tract complaints, we recommend contacting the following specialists:
- A general practitioner who can treat a wide range of health issues and serves as the first point of contact for the diagnosis and treatment of urinary tract complaints.
- A urologist who specializes in the diagnosis and treatment of diseases of the urinary tract, male reproductive organs, and prostate.
- A gynecologist if the symptoms spread to the vagina.
- A specialist in infectious diseases who has comprehensive knowledge about the diagnosis and treatment of infections, including urinary tract infections.
