Recurrent cystitis in women: myths and realities


By Dra. Vanda Daniela López Gunther

Urinary tract infections are related to poor hygiene: Myth

There is no evidence that frequent urogenital cleaning prevents recurrent urinary tract infections. In fact, thorough and frequent cleaning of the genital area, douching or showers and frequent use of soap helps remove part of the normal flora and germs that maintains vaginal acidity, thus permitting the growth of other bacteria or fungus that can cause illness.

Similarly, the use of condoms containing spermicide increases the likelihood of urinary tract infections.

However, correct urogenital cleaning should be carried out, taking care to wipe from front to back in order to avoid bringing germs from the anal area into the vagina and urethra.

Urinary tract infections can be picked up from public baths: Myth

While it is true that most women experience discomfort when using public bathrooms and avoid sitting on the toilet for hygienic reasons, the transmission of bacteria from toilet seats  has not been demonstrated. In fact, most germs survive only for a short time in an inert atmosphere. In any case the bacterial inoculum is scarce and a person with a competent immune system should be able to defend herself.

Nor has the transmission of STDs (HPV: Human Papilloma Virus – genital warts or HIV: the virus that causes AIDS) from sitting on public toilets been demonstrated. However, cleaning the toilet seat with a cloth or using disposable paper covers is recommended.

It may also be useful to urinate in disposable cone type devices which allow  the woman to urinate in a standing position and avoid having to sit on the toilet seat.

Sex predisposes to cystitis: FACT

Many women suffer from what was formerly known as cystitis of the “honeymoon”. The reason that urinary infections occur frequently after intercourse is because the female urethra is shorter, its diameter is thicker than a man’s urethra and it is closer to the vagina, so that bacteria in the genital area can be passed quickly to the urethra and then ascend to the bladder.

Moreover, the penis serves as a facilitator mechanism for the passage of these bacteria.

Constipation is a risk factor for recurrent cystitis: Fact

Fecal  impaction affects the proper emptying of the bladder. In patients suffering from chronic constipation, it has been shown to increase the bladder volume and activate the evacuation which tends to be incomplete.

Cranberry prevents the appearance of recurrent urinary tract infections: Fact

Some components of cranberry  (proantocinidinas) inhibit the phenomenon of adhesion of the P factor of E. coli  fimbriae to the urinary tract (fimbria is a type of hair which allows the bacteria to bind to the inner wall of the bladder) and thereby prevents biofilm formation (a kind of protective layer for bacteria in the urinary tract which confers resistance to being eradicated by antibiotics). Clinical studies suggest that there are other mechanisms not fully known which explain why cranberry may help prevent cystitis, since it is proven that the consumption of natural juices is better than tablets. However, the downside is that the juices are loaded with sugar and care must be taken with the glucose load.

Diabetes causes cystitis: Fact.

The incidence of cystitis is more common in diabetics. This is because the metabolic chaos and incompetence of the immune system may favour excess growth of bacteria in diabetic patients. Moreover, in the last stages of diabetes, diabetic neuropathy, there may be neurological damage in the control mechanisms of the bladder (neurogenic bladder) and in these cases there is a decrease in the perception of bladder filling and incomplete emptying (flaccid bladder), with the consequent appearance of urinary tract infections.

Pregnancy causes cystitis: Fact.

Pregnancy is a condition of immune suppression per se. The woman is under the influence of progesterone, a hormone that causes relaxation of smooth muscle (smooth muscle is present in the urinary tract: urethra, ureters and bladder). Inhibiting the natural peristalsis of the ureters and relaxing the urethra favour bacterial ascent from the urethra to the bladder and eventual passage of bacteria into the kidneys. In addition, during pregnancy, especially in the first trimester, the immune system is physiologically suppressed. It is important that pregnant women with symptoms of cystitis be evaluated by the gynaecologist, since urinary tract infections are the leading cause of abortions in the first trimester of pregnancy and of preterm delivery in the third trimester.