Awareness Helps Women to Avoid Urinary Infections

Five million times a year women, many of them young, visit doctors for one of the most common of ailments: urinary tract infection. Though easily treated, the infections can still be serious if neglected.

Before modern medicine developed effective treatments, the infections sometimes led to death from kidney failure, even at early ages. That is what happened to Jean Harlow, the “blond bombshell” movie star of the 1930s. Her repeated bouts of infection eventually invaded her kidneys. Antibiotics, dialysis or a kidney transplant that might have saved her today did not then exist, so she died of uremic poisoning at age 26.

Dr. Joseph Corriere Jr., a urologist at the University of Texas Health Sciences Center in Houston, has seen the infections in babies and the elderly; indeed, it is a common cause of death in the aged, even today.

It is also very frequent in young women, particularly those who are sexually active, which may be why it is so often mistakenly thought to be a venereal disease.

Cystitis, as the infections are also called, is not a disease acquired from someone else, but is usually caused by germs from elsewhere in a woman’s own body enter her vagina, then her bladder. Thus, cystitis can be, but is not always, a byproduct of sex--the reason that it is sometimes called “honeymoon cystitis.”

When the infection follows intercourse, it is the the sex act, not the sex partner, that is to blame.

Where do these germs come from? Escherichia coli, the kind most often responsible for cystitis, are normal residents of the intestinal tract, where they do not cause disease.

Men have the infections, but they are far more common in women because of their anatomy. In women, the openings of the vagina and the bladder are very close to each other and to the anus, so germs from the rectum easily pass across the very narrow area--called the perineum--between the rectum and its neighbors.

Women who use diaphragms are especially vulnerable, although no one is sure exactly why. Perhaps these birth control devices tend to trap the offending bacteria in the vagina, from which they can easily move up into the bladder. Or the spermicides used with diaphragms may be to blame. A recent study at the University of Washington found that women who use spermicides are more prone to repeated bladder infections than those who do not.

The classic symptoms of the infections are frequent, urgent and painful urination, and sometimes cloudy or bloody urine. The attacks can recur but, Corriere said, many women can be taught to recognize these recurrences and to treat themselves with one of the common, cheap prescription drugs he uses to treat them the first time.

In fact, he often gives patients unlimited refill prescriptions, provided he can count on them to call him immediately if their symptoms do not clear in a day or two.

“The key to this whole thing is patient education,” Corriere said. “You have to learn about your body, and you have to understand that you don’t have to end up on a kidney machine or with a transplant when you have had a couple of bladder infections. This does not portend serious disease.”

For most of the infections, Corriere relies on Gantrisin, a sulfa drug known generically as sulfisoxazole; Macrodantin (generically, nitrofurantoin), or garden-variety oral penicillin. Unfortunately, many patients are allergic to penicillin, as well as to Gantrisin which, like other sulfa drugs, can cause rashes in some people.

But for those who do not have these sensitivities, Corriere said, both medications are safe and effective, if taken for no more than 3 days at a time. Although some doctors treat uncomplicated cystitis for a week or more, he has found that 3 days will usually do the job.

Are there sure-fire ways to prevent these miserably painful episodes?

The short answer to that question is no. Some people--diabetics, for example--are very susceptible to the infections and tend to have recurrent bouts throughout their lives. Still, precautions are worthwhile.

Heading the list is to drink plenty of fluids, which helps to flush out bacteria that could cause trouble by finding their way from your colon, where they are usually harmless, into your bladder, where they distinctly are not. Some doctors believe that alcohol irritates an infected bladder.

Many people believe that cranberry juice will cure the infections, but it actually contains so little quinolic acid, which makes the urine inhospitable to the germs, that you would have to drink 16 gallons a day to do much good.

Two other common misconceptions, which turned up in a survey by Wang Associates, a New York City medical public-relations firm, are that soapy baths and bubble bath on the one hand, and soft drinks and sweets on the other, can predispose people to bladder infections.

Bubble baths and sudsy water do not cause the infections but do cause, in some people, skin irritations that can mimic cystitis by making urination uncomfortable.

Sweets and soft drinks don’t cause infection, either. As mentioned earlier, however, diabetics as a group are predisposed to the infections and may be particularly vulnerable when their blood sugar fluctuates to overly high levels.

On other folklore, Corriere said, “there’s just no good evidence that a woman’s toilet habits or what she eats, drinks or wears have anything to do with whether she is going to have” the infections.

“These ideas make patients feel needlessly guilty--that they are somehow to blame for their attacks,” he said.

There is, however, no disagreement that women prone to the infections should avoid sex when they are having an attack and take special precautions when they are well and sexually active.

“The emptier the female bladder when its owner is making love the better,” Corriere said. “I tell my patients to void before they have intercourse and--because the bladder is constantly refilling--to get up right away after it and make every effort to void again.

“While in the bathroom that second time, they should drink at least a glass of water. The aim is to minimize the number of bacteria getting into the urine and speed the departure of any that do.”