The best therapy options

The symptoms pointing to a cystitis are acute pain and burning when urinating as well as a frequent and/or sudden urge to urinate which can trigger involuntary loss of urine. Another classic symptom are pains above the pubic bone. The urine can be opaque and smell strong. If pain occurs in the area of the kidneys (flank pains), a temperature develops or there is blood in the urine, the patient needs to consult a doctor urgently. In such a case it is possible that a kidney is involved and this should always be treated with antibiotics very quickly.

The doctor mostly arrives at the diagnosis of a cystitis on the basis of the symptoms described by the patient and the result of a test using a urine test strip. If the urine test strip shows white blood cells, protein and nitrite, this indicates a bacterial inflammation. Further examinations are normally not necessary.

A urine culture, that is the cultivation of the germs on a breeding ground in an incubator, is only prepared by the physician in the case of recurring infections, if a woman is pregnant or in the case of pre-existing conditions. In such cases it is important to know the type and number of the bacteria so as to direct the therapy specifically.

Many doctors are still quick at prescribing antibiotics for cystitis as these are fast-acting und shorten the duration of the illness. They are indispensable in the case of complicated bladder infections but mostly not necessary for uncomplicated cystitis. In most cases it is enough to relieve the pain and to wait for the self-healing. This, at any rate, is the result of a study of the University of Göttingen in the year 2016 promoted and sponsored by the Federal Ministry of Education and Research (BMBF). Half of the patients with uncomplicated urinary tract infection received an antibiotic, the other half Ibuprofen. All patients were closely controlled. The group treated with Ibuprofen had somewhat stronger complaints, but two thirds recovered again without any antibiotics. If PTA and pharmacists, in a consultation, recommend Ibuprofen for an uncomplicated cystitis, they should point out to patients that they need to see a doctor if there is no improvement after three days.

Heat – for example a hot-water bottle – and up to two litres fluid a day support the healing process. Whether herbal extracts, for example from birch, stinging nettle, goldenrod or restharrow, or the so-called »bladder and kidney tees«, will accelerate the healing process has not been substantiated by controlled studies. However, many patients have positive experiences with this. In the case of cardiac or renal insufficiency, the therapy by means of flushing is, however, due to its large quantity of fluid, contraindicated.

Doctors speak of recurrent urinary tract infections if these occur at least twice within six months or at least three times within a year. Affected women should have themselves medically examined to clarify any possible anatomic causes.

There are various strategies to fight recurrent bladder infections effectively – for example the antibiotic prophylaxis. The women affected take a low-dosed antibiotic over three to six months. The antibiotic chosen should be in accordance with the proven bacteria species.

Another prevention strategy concerns women who repeatedly contract bladder infections through sexual intercourse. It may be helpful to them to take a dose of an antibiotic after each intercourse.

PTA and pharmacists can recommend herbal preparations or mannose as an alternative. The fixed combination of nasturtium and horseradish has proven effective in the prevention of recurring cystitis as well as in the treatment of the acute cystitis. The effect is due to the mustard seed oils contained therein.

According to the current S3 guideline for uncomplicated urinary tract infections, D-mannose is also suitable as prophylaxis of recurring cystitis in women. For this purpose two grams of the sugar need to be taken per day.

Often cranberries are recommended for the prevention of cystitis in public media. Here too the effect is based on an inhibition of the bacteria adhesion. Active agents are anthocyanidins and proanthocyanidins. There were contradictory results of studies with different cranberry preparations concerning their effect, which may be due to the different dosages. Presumably a daily proanthocyanidin dose of 100 milligrams is needed to be effective. This can only be achieved with extracts, but not with the consumption of the berries or with cranberry juice.

Changing the contraceptive method is advisable if so far spermicides and diaphragms have been used. In the case of women after the menopause, a local oestrogen treatment can reduce the frequency of infections. Exaggerated intimate hygiene harms the protective bacteria in the genital area.