Bladder infection: risk factors

An infection of the urinary bladder, also known as cystitis, is an inflammation of the mucous membrane (urocystitis) or the entire wall (pancystitis). As a result, specialists also call cystitis bladder catarrh (Greek: catarrh = inflammation of the mucous membranes) or, more broadly, a urinary tract infection. Inflamed urethras and bladders are common; in the worst case, the infection may spread to the kidneys and ureters.

The urinary bladder is part of the urinary tract along with the urethra, ureters, and kidneys . form in the process

• urethra and bladder the lower urinary tract and
• ureters and kidneys the upper urinary tract.

Bladder inflammation is therefore – just like urethritis (urethritis) – a lower urinary tract infection.

Urinary tract infections affect women much more frequently than they do men. About 10 out of 100 women will experience a bladder infection at least once per year; of those, half will experience another infection within the following 12 months. The urethra in women is significantly shorter than in men, which is due to differences in female anatomy. Therefore, bacteria must travel less distance to settle in the urinary tract and trigger inflammation. Additionally, compared to men, the urethral opening is situated nearer to the anus.

Uncomplicated or complicated cystitis

Experts divide cystitis into uncomplicated and complicated forms. In uncomplicated cystitis:

• only the lower urinary tract is affected
• there is no risk of severe disease or complications
• bacteria are usually the cause of the inflammation

Furthermore, the simple form is simple to treat and usually heals quickly. However, there is a risk of a complicated course in the case of complicated cystitis. Functional disorders or anatomical peculiarities of the urinary tract, as well as accompanying diseases such as diabetes mellitus or an immune deficiency, are the causes here. Bladder infections are considered complicated in men, children, and pregnant women. Experts also mention the complicated form in the case of renal pelvic inflammation. They are frequently more difficult to identify and treat.

Interstitial cystitis and other special forms of cystitis

Neither viruses nor bacteria can cause interstitial cystitis, a chronic bladder pain syndrome. Symptoms are similar to those of normal cystitis, but more pronounced and severe pelvic pain is in the foreground. Only specialists diagnose bladder pain syndrome.

Hemorrhagic cystitis is caused by Enterobacter viruses and has similar symptoms to normal cystitis. Emphysematous cystitis is associated with gas formation in the bladder and has a high mortality rate, so rapid therapy should be taken.

Bladder infection: symptoms

The typical symptoms of an acute bladder infection are:

• Burning when urinating
• Pain in the lower abdomen when going to the toilet
• constant urge to urinate and frequent urination (pollakisuria)
• increased urge to urinate at night (nocturia)

The bladder infection causes the sensation of having to push against resistance when urinating. When urinating, the bladder contracts spasmodically, causing pain. Cystitis patients also typically excrete small amounts of urine each time they go to the toilet.

In addition, an acute bladder infection can cause other symptoms that affect the urine:

• For one, cystitis can be associated with blood in the urine  (hematuria), which may not always be visible to the eye.
• On the other hand, the urine often looks cloudy and smells strange.

Symptoms of cystitis are typically limited to the lower urinary tract. If the inflammation spreads from the urinary bladder to the kidneys or the prostate, it can cause fever, back pain, or flank pain. Those who are affected frequently describe a general feeling of illness, have poor sleep, and are easily irritable.

Bladder infection: causes

A bladder infection can be caused by various pathogens. Bacteria are usually the cause of the inflammation, but  viruses , fungi and worms  can also be behind it. A constantly occurring or chronic cystitis can turn

• caused by new infections or
• represent an inflammation that has not yet completely healed and flares up again.

Bladder infection: bacteria as the cause

Escherichia coli is the most common cause of bacterial bladder infections, as it migrates from the intestinal flora and causes cystitis in the urinary tract. It is responsible for 80 percent of all bacterial bladder infections.

But other bacteria can also cause cystitis, such as staphylococci, Klebsiella, Proteus and enterococci.

Viruses, fungi or worms: causes of cystitis

Rarely does a bladder infection have no bacterial causes, but is caused by other pathogens – viruses, fungi or worms. Possible non-bacterial triggers of cystitis include:

• Adenoviruses and polyomas : These pathogens usually cause a bloody bladder infection (hemorrhagic cystitis).
• Candida albicans : This fungus is particularly found in the urinary tract of people whose immune system is weakened or who are taking certain antibiotics . It is also often the trigger for vaginal thrush.
• Causes of  schistosomiasis  (bilharzia) : The worm disease caused by these flukes is widespread in the tropics and subtropics and can result in a special form of chronic cystitis – granulomatous cystitis (granuloma = nodule).

Bladder infection: Other possible causes

Cystitis can also occur as a side effect of certain medications, such as those prescribed to treat tumors. Inflammation of the bladder is also possible as a result of radiation therapy in the pelvic area, which specialists refer to as radiation cystitis. In men, acute prostatitis can lead to cystitis.

Bladder infection: risk factors

In addition to the actual causes – i.e., the pathogens, various risk factors play an important role in the development of a bladder infection. These include:

Urinary retention and residual urine

Urinary retention and residual urine in the bladder can be caused by a number of factors, including bladder or kidney stones, foreign bodies in the urinary tract, an enlarged prostate, anatomical malformations such as a narrowed urinary tract, tumors, or bladder dysfunction (e.g., in the case of paraplegia). As a result, the urine that accumulates in the bladder or urinary tract creates ideal conditions for bacteria, allowing them to settle more easily in the bladder and cause inflammation of the bladder lining.

weakened immune system

When the immune system is weakened, such as from hypothermia, it is more difficult to fight pathogens, and a bladder infection can result. Anyone who uses antibiotics runs the risk of developing a bladder infection because they disrupt the intestinal flora and thus weaken the immune system.

Bladder infections caused by stress

Anyone who suffers from stress often also has a weakened immune system. If germs then nest in the lower urinary tract, it is usually more difficult to fight them – a bladder infection can follow.

Diabetes mellitus

Diabetes patients’ urine often contains a higher percentage of sugar, which is ideal for bacteria because it allows them to settle and multiply more easily. Diabetes patients frequently have bladder dysfunction, resulting in residual urine in the bladder.

Sexual intercourse

People who engage in a lot of sexual activity are more likely to get a bladder infection (so-called honeymoon cystitis). The mechanical friction of the penis irritates the vaginal mucosa. Furthermore, when switching from anal to vaginal intercourse, bacteria can be transported directly into the vagina, making pathogens particularly easy to cause inflammation.

Contraceptive methods 

 Special methods of contraception, such as diaphragms or spermicides (sperm-killing agents), promote the development of cystitis.

Permanent catheter 

Permanent catheters irritate the bladder mucous membranes and can direct bacteria directly into the bladder.

Incorrect wiping technique

Any bacteria in the stool are also transported in the direction of the vagina if the wiping movement with the toilet paper after a bowel movement is carried out from the anus to the vagina. The path to the urethral entrance is usually not difficult.

Excessive intimate hygiene

Anyone who excessively cleans their intimate area, for example, with soap, may cause dry vaginal mucosa and a change in the pH value of the vaginal flora. Cystitis pathogens are more difficult to fight off if the vaginal flora is disturbed and there is a lack of important lactobacilli (lactic acid bacteria), for example.

Hormonal fluctuations 

Hormonal changes occur during menstruation , puberty, menopause or pregnancy. This can also mess up the vaginal flora and make it less effective for its natural protective function against germs. 

Drinking less 

In addition, drinking too little promotes a urinary tract infection, since the urinary tract is less well flushed and fewer germs are transported out of the body with the urine.

Unhealthy Diet

An unhealthy diet high in fat and sugar may also be associated with cystitis. Because this not only has a negative effect on the immune system, but also offers optimal conditions for pathogens.