Many of us have experienced an increased urge to urinate and the feeling of constantly having to go to the toilet even though the bladder is empty. This is followed by a burning sensation when urinating and cramp-like pain in the abdomen. These are the typical symptoms of cystitis. In most cases, the cystitis can be cured within a few days by using common home remedies and antibiotics. But what if the cystitis keeps coming back?
When is a bladder infection chronic?
A bladder infection is chronic if it happens three times a year or twice a six-month period. The correct medical term for this phenomenon is “recurrent urinary tract infection” and it means “a recurrent cystitis”.
How do the symptoms differ between acute and chronic cystitis?
The symptoms of a chronic cystitis are usually no different from an acute cystitis. Common symptoms are pain and burning sensation when urinating and a constant need to urinate even though the bladder is empty. In addition, there can be abdominal pain, the smell of urine can be unpleasant and is often cloudy, sometimes bloody.
What causes cystitis?
The most common trigger for cystitis is the so-called Escherichia coli bacteria from the patient’s own intestine. About 80% of urinary tract infections are due to this. Women are affected much more often because they have a shorter urethra than men.
A narrowing or malformation of the urethra, foreign bodies, bladder stones or benign or malignant tumours in the bladder and urethra increase the risk of inflammation. Pregnant women and diabetics are also more at risk because of the higher sugar content in their urine. Other triggers of cystitis can include hypothermia, a weakened immune system, psychological influences such as stress and hormonal changes such as those that occur during the menopause. Bacteria can also get into the urethra during sexual intercourse and cause an inflammation there.
Why do I keep getting cystitis?
The wall of the bladder is protected by a layer of mucus. This protective layer prevents irritating substances in the urine from hitting the sensitive inner wall of the bladder and damaging it. This layer of mucus is often damaged in chronic cystitis. Irritants can thus penetrate unfiltered and cause pain and inflammatory reactions. It becomes problematic if a bladder infection occurs more frequently, because the sensitive mucous membrane becomes increasingly irritated and is therefore even more susceptible to further cystitis. To prevent such a downward spiral in the worst case, it is all the more important to let the cystitis heal properly.
Antibiotic therapy can also trigger a recurring bladder infection, although cystitis can usually be cured with antibiotic therapy. If the antibiotic is stopped too early, for example, previous infections can rekindle. The antibiotic also weakens the immune system: the intestinal flora is stressed when antibiotics are taken, and a weak intestinal flora in turn promotes cystitis. It is therefore important to take the medication as prescribed by your doctor and to take antibiotics during treatment, including a cure if necessary, to strengthen the intestinal flora.
The latest scientific findings suggest a link between additional vaginal infections and frequently recurring bladder infections. It is thought that E. coli bacteria are carried from the bowel into the urinary tract, where some of the microbes implant themselves in the bladder wall and survive there protected from antibiotics and other substances. If a vaginal germ called Gardnerella vaginalis also comes into play, the inactive E. coli bacteria can be reactivated and the urinary tract infection can start again. The vaginal germ often causes no discomfort and a short presence is apparently sufficient to damage cells in the bladder wall and release E. coli. bacteria.
So if you suffer from recurring cystitis without any apparent cause, it is worthwhile to see your gynaecologist and, if necessary, have your vaginal flora examined for pathogenic germs such as Gardnerella vaginalis using a smear test.
What are the treatment options if no cause can be found?
In addition to the already known treatment with antibiotics, immunotherapy or biological drugs can also be used.
Immunotherapy: the immune system is stimulated and is intended to strengthen the body’s natural defences. Our intestine is closely linked to our immune system and a balanced intestinal flora prevents the colonisation of the intestinal mucosa by pathogenic germs. As recurrent urinary tract infections are mostly intestinal bacteria, the immune therapy is intended to strengthen the intestinal flora.
Immunomodulators: are orally taken capsules or tablets that are taken for more than three months and are considered biological drugs. Microorganisms activate the immune cells of the intestinal mucosa and strengthen the body’s natural defences.
Autovaccines: are individually produced therapeutic agents made from inactivated, body-own bacteria of the patient for the prevention and treatment of chronic infectious diseases. This type of therapy takes about six weeks. The active ingredient can be administered orally, as a nasal spray or by injection.
Injection vaccines: If painful recurrent urinary tract infections place a heavy burden on social life and partnership and conventional therapies fail, there is also the possibility of administering a vaccine. Vaccines for the prevention and treatment of cystitis are made from inactive germs, which are most commonly responsible for cystitis.