Our Bodies, Ourselves (137 page)

Medication treatment is usually either metronidazole or clindamycin, taken orally or vaginally for five to seven days. Single-dose oral metronidazole may also be effective but less so (cure rates range from 40 to 60 percent). Metronidazole is sometimes used first, because it spares the lactobacilli in your vagina and is less likely to trigger a yeast infection. Vaginal treatment avoids systemic side effects but is more expensive than the five-to-seven-day pill regimens.

Some women will have another BV outbreak within nine months of initial treatment. Long-term condom use may help to prevent recurrent infection. Women with BV have more frequent infections following gynecologic surgery, and some studies suggest that BV increases the risk of giving birth prematurely if you have it during pregnancy.

Self-help treatments include general vaginitis prevention measures and taking extra vitamins B and C. You can help prevent recurrences by minimizing the use of tampons, avoiding douching, and using condoms (to offset the alkaline effect of semen). Alternative treatments may provide temporary relief but not an actual cure. Vaginal and oral use of yogurt doesn't help with BV.

The urinary bladder is an expandable muscular organ that stores our liquid waste (urine) so we can excrete it intermittently. This organ is obviously not exclusively female, but because it sits so close to the other organs that are unique to women, gender-specific issues exist.

Urinary tract infections (UTIs) are so common that most of us get at least one at some point in our lives. They are usually caused by bacteria, such as E. coli, that get into the urethra and bladder (and occasionally the kidneys) from the gastrointestinal system. Trichomoniasis, chlamydia, and viruses can also cause UTIs. Low resistance, poor diet, stress, and trauma to the urethra from childbirth, surgery, and catheterization can predispose you to getting them. A sudden increase in sexual activity can be a trigger (hence the term “honeymoon cystitis”).
Pregnant women are especially susceptible, as pressure from the growing fetus keeps some urine in the bladder and ureters (the tubes carrying urine from the kidneys to the bladder), allowing bacteria to grow.

Postmenopausal women are also susceptible because of the effect of hormonal changes on the bladder and urethra. Occasionally, UTIs are caused by a congenital anatomical abnormality or, mostly in older women or women who have had many children, a prolapsed (fallen) urethra or bladder.

Cystitis (inflammation or infection of the bladder) is by far the most common UTI in women. While the symptoms can be frightening, cystitis in itself is not usually serious. If you suddenly have to urinate every few minutes and it burns like crazy even though almost nothing comes out, you probably have cystitis. There may also be blood and/or pus in the urine. You may have pain just above your pubic bone, and sometimes there is a peculiar, heavy odor when you first urinate in the morning.

It's also possible to get mild temporary symptoms (such as peeing frequently) without actually having an infection, simply because of drinking too much coffee or tea (both are diuretics), premenstrual difficulties, food allergies, vaginitis, anxiety, or irritation to the area from bubble baths, soaps, or douches. As long as you are in good health and not pregnant, you can usually treat mild symptoms yourself for twenty-four hours before consulting a practitioner.

Cystitis often disappears without treatment. If symptoms persist beyond forty-eight hours, recur frequently, or are accompanied by chills, fever, vomiting, and/or pain in the kidneys (near the middle of the back), see a doctor. These symptoms suggest that infection has spread to the kidneys, resulting in pyelonephritis, a serious problem that requires medical treatment. Also see your provider if you have blood or pus in the urine, pain on urination during pregnancy, diabetes or chronic illness, or a history of kidney infection or diseases or abnormalities of the urinary tract. Untreated chronic infections can lead to serious complications, such as high blood pressure or premature births (if occurring during pregnancy).

© Nina Reimer

When cystitis does not respond to self-help treatments within twenty-four hours, or it recurs frequently, get a urine test. Make sure your provider asks for a clean voided specimen
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and does a pelvic exam to rule out other infections. Your urine should be examined for evidence of blood and pus, then cultured. Sometimes, even when you have symptoms, the culture may come back negative (not show any infection). False-negative cultures may be due to mishandling or too-dilute urine; you may also get a false-negative report if your cystitis is caused by something other than bacterial infection. White blood cells in the urine plus a negative culture (acute urethral syndrome) may indicate a
chlamydia infection
. Some women have bacteria in the urine without symptoms; especially in pregnant women, this should be treated with antibiotics to prevent kidney infection and other complications.

For symptoms that are severe or indicate a kidney infection, medications are usually started immediately. For milder infections, many health care providers prefer to wait for culture results before prescribing a drug. Most UTIs respond rapidly to a variety of antibiotics. Drugs commonly used include ampicillin, nitrofurantoin, tetracycline, ciprofloxacin, a sulfamethoxazole and trimethoprim combination (Bactrim/Septra), and sulfonamides (Gantrisin). (Women who have a deficiency of glucose-6-phosphate dehydrogenase should not take sulfonamides.) You may get a single large dose or several doses spread out over three to ten days.

If symptoms persist longer than two days after you start taking drugs, contact your health care provider again. The organisms may be resistant to the antibiotics you are using. Eating plain, unsweetened live-culture yogurt or taking acidophilus in capsule, liquid, or granule form may help to prevent diarrhea or yeast infection by replacing the normal bacteria in your intestines that can be destroyed by the drugs.

Acetaminophen may relieve pain from UTIs. Some practitioners recommend a drug called Pyridium, an anesthetic that relieves pain but does not treat the infection itself. (Pyridium dyes the urine a bright orange, which will permanently stain clothing. It also can cause nausea, dizziness, and possibly allergic reactions.)

Surgical treatment for UTIs should be limited to specific situations in which a woman's anotomy is clearly causative. Pelvic exercises
known as Kegels
can forestall the need for this operation and help prevent future infections.

Even with drugs and/or surgery, many women continue to have recurrent urinary tract infections. Sometimes it helps to treat chronic infections with long-term, low-dose medications.

Urinary incontinence is a condition where women lose urine unintentionally. It often first appears during pregnancy as a result of pressure from the growing fetus on the bladder. Damage
related to birth traumas may cause ongoing urinary incontinence, as can pelvic surgery. Some women will develop incontinence with advanced age, even without any specific traumas. If the condition is mild, simply using menstrual pads to collect leaking urine may be an adequate solution. A thorough evaluation can help determine what treatment approaches might be most effective. These include bladder training, pelvic flow exercises, medication, and surgery.

Painful bladder syndrome/interstitial cystitis (PBS/IC) was for many years thought to be an inflammatory condition of the bladder wall, but recently it has been recognized as poorly understood chronic pain syndromes that develop for multiple reasons. A clinical diagnosis is based primarily on symptoms of urgency/frequency of urinating and pain in the bladder and/or pelvis.
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Standard treatments of many decades are no longer routinely considered effective. One large urological study from 2000 concluded that “no current treatments have a significant impact on symptoms with time.”
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PBS/IC is at least five times more common in women than men, affecting close to 500,000 females in the United States, with an average age of onset of about forty years; 25 percent of those affected are under age thirty.

PBS/IC has symptoms similar to those of the common urinary tract infection known as cystitis. However, with PBS/IC, routine urine cultures are negative, and there is usually no response to antibiotics. You may feel pelvic pain and pressure and an urgent need to urinate, sometimes as often as sixty to eighty times a day. You may also have vaginal and rectal pain. Pain during sexual intercourse is common. The symptoms can vary from mild to severe.