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Cystitis - Flushing Out Trouble

Flushing Out Trouble

Flushing Out Trouble

For some women, the symptoms are all too familiar: burning and stinging during urination and the persistent urge to go, go, go, even when they have just gone. Their urine may be cloudy, smelly and sometimes tinged with blood. The usual problem: a urinary tract infection, caused by bacteria that have worked their way up the urethra into the bladder and settled in for the duration.

Urinary tract infections are second only to colds when it comes to infections in women, whose anatomy sets the stage for trouble. (In men, urinary tract infections are much less common but potentially more serious, because they're often tied to prostate problems.)

Women who get bladder infections, particularly women who don't seem to be able to shake them, may have a problem with the cells lining the bladder, says Robert Moldwin, M.D., assistant professor of urology at Albert Einstein College of Medicine in New York City and an attending physician at Long Island Jewish Medical Center in New Hyde park, New York. Somehow these cells have undergone a change that makes it easier for bacteria to stick to the bladder wall as well as to the vaginal wall. Once the bacteria are on the vaginal wall, it's easy for them to migrate to the bladder.

"Normally, any bacteria that get into the bladder are flushed right back out, but in this case, they're not," Dr. Moldwin says.

Doctors recommend a number of moves to minimize the risk of infection for women who develop recurrent infections. Urinate before and soon after sex, for example. And think twice about using a diaphragm. Women who rely on this birth control method are two to three times more prone to recurrent infections than nonusers, since the diaphragm causes irritation of the vaginal surface, which allows bacteria to adhere, according to Dr. Moldwin.

Spermicidal jellies can also contribute to bladder infections, upsetting the normal balance of "friendly" bacteria in the vagina and the surrounding area. Also, jellies may irritate the vagina, set up inflammation and let bacteria adhere to the vagina, from where they migrate to the bladder, adds Dr. Moldwin.

Most doctors treat urinary tract infections with antibiotics, which usually work just fine. "And we often tell patients with recurrent problems to take one antibiotic pill each time they have sex," Dr. Moldwin adds.

In addition to these measures, some doctors suggest the following nutritional therapy.

Acidify with Vitamin C

Some doctors believe that pushing the urine's pH (acid-alkaline) balance a bit toward the acid side helps treat a bladder infection by slowing the growth of bacteria in the bladder. "Some doctors recommend vitamin C supplements for this," Dr. Moldwin says. It is unclear how this has an effect, and there are no studies to prove it, but it seems to help some women, he adds.

"vitamin C also is likely to be prescribed when a woman is taking a urinary antiseptic drug such as methenamine mandelate (Uroqid-Acid) or methenamine hippurate (Hiprex), which work best when urine is acidified," Dr. Moldwin says. These drugs are most likely to be prescribed as long-term therapy to prevent recurrent or antibiotic-resistant infections.

Doctors who recommend vitamin C to prevent or treat bladder infections usually suggest a daily dose of 1,000 milligrams. You would have to eat about 14 oranges a day to get that much. In fact, oranges and orange juice aren't your best sources of vitamin C in this case, and not only because you would OD on OJ.

"Because of the way your body metabolizes it, orange juice does not acidify your urine as efficiently as supplements," says Kristene Whitmore, M.D., chief of the Department of Urology at Graduate Hospital in philadelphia and co-author of Overcoming Bladder Disorders.

You can check the acidity of your urine with chemically treated nitrazine strips, a sort of litmus paper that's available in many pharmacies. Follow the directions on the package.

Food Factors

Drinking more water is about the only dietary move doctors agree on when it comes to urinary tract infections. Some recommend more acid foods, since acidic urine can inhibit bacterial growth. Others think this is impractical, because the acid balance of urine can change from hour to hour. "Women may need to experiment with foods to see what sort of diet is least bladder-irritating for them," says Robert Moldwin, M.D., assistant professor of urology at Albert Einstein College of Medicine in New York City and an attending physician at Long Island Jewish Medical Center in New Hyde park, New York. Alkaline foods can help in treating symptoms such as urgency and frequency but can't treat specific bacterial infections, he adds.

Here is what's recommended. (Note: These dietary measures won't cure an established infection, but they may help thwart a recurrence or make urinating more comfortable.)

Drink up. perhaps the single most important dietary measure you can take to prevent urinary tract infections (and to speed your recovery from them) is to drink lots of water--about six to eight eight-ounce glasses a day. Keeping yourself well-hydrated helps flush bacteria out of your bladder.

Guzzle cranberry juice. Women have long touted cranberry juice for its ability to prevent bladder infections. Now there's scientific proof for this old wives' tale. But remember, if you have an infection, this won't help much in its treatment, adds Dr. Moldwin.

In a study by Harvard Medical School researchers, 153 older women (average age 78) were divided into two groups. One group was given ten ounces a day of either ordinary cranberry juice sweetened with aspartame; the other got a drink prepared to look and taste exactly like cranberry juice. Urine samples were collected every month for six months. Those who drank the real juice tested positive for infection only 42 percent as often as those who drank the fake juice.

"In the past, the theory was that cranberry juice makes the urine more acidic and discourages the growth of bacteria," explains Jerry Avorn, M.D., associate professor of medicine at Harvard Medical School and the study's main researcher.

"In this study, however, urine did not become more acidic, which lends credence to another theory that something in cranberry juice prevents bacteria from sticking to interior tissues of the bladder, making them easy to flush out and unable to multiply," Dr. Avorn explains.

Blueberry juice has a similar effect, Israeli researchers have found. But other types of juices that were tested--grapefruit, orange, guava, mango and pineapple--do not have the anti-adhesive component.

Stay neutral. Some doctors believe that acid foods slow down resolution of a bladder infection because the acid may irritate an already inflamed bladder. So they recommend neutralizing your urine with a low-acid diet, including antacids or a teaspoon of baking soda mixed in a glass of water two times a day.

Ferret out food foes. If you think something in your diet exacerbates flare-ups, suggests Kristene Whitmore, M.D., chief of the Department of Urology at Graduate Hospital in philadelphia and co-author of Overcoming Bladder Disorders, try eliminating these possible culprits: caffeine-containing foods (coffee, tea, chocolate, cola and some drugs), guava juice, citrus fruits, apples, cantaloupe, grapes, peaches, pineapple, plums, strawberries, tomatoes, spicy foods, alcoholic beverages, carbonated beverages and vinegars. It might also help to eliminate foods that contain the amino acids tyrosine, tyramine, tryptophan and aspartate. They include aspartame, avocados, bananas, beer, cheeses, chicken livers, chocolate, corned beef, lima beans, mayonnaise, nuts, onions, prunes, raisins, rye bread, saccharin, sour cream, soy sauce and yogurt.

prescriptions for Healing

Vitamins aren't the first thing most doctors reach for when it comes to treating or preventing urinary tract infections. But some do recommend vitamin C, especially if you're taking a drug that works better when the urine is acidic. You can split the dose and take half two times a day, according to Kristene Whitmore, M.D., chief of the Department of Urology at Graduate Hospital in philadelphia and co-author of Overcoming Bladder Disorders.

Nutrient Daily Amount

vitamin C 1,000 milligrams

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