What are the most common misconceptions about urinary tract infections. How can you distinguish between UTI myths and facts. What are the best practices for managing and preventing UTIs.

Understanding Urinary Tract Infections: Debunking Common Myths

Urinary tract infections (UTIs) are a prevalent health concern, particularly among women. With a wealth of information available online, it’s crucial to separate fact from fiction. This comprehensive guide aims to clarify misconceptions and provide evidence-based insights into UTIs, their diagnosis, and treatment options.

Myth 1: UTIs Only Affect Women

While it’s true that women are more susceptible to UTIs, men are not immune. The anatomical difference in urethra length between genders plays a significant role in infection risk. Women’s shorter urethras make it easier for bacteria to reach the bladder. However, men can and do experience UTIs, especially as they age or if they have underlying health conditions.

Myth 2: All UTIs Cause Symptoms

Contrary to popular belief, not all UTIs manifest with noticeable symptoms. Asymptomatic bacteriuria, a condition where bacteria are present in the urinary tract without causing discomfort, is more common than many realize. This phenomenon is particularly prevalent among older adults and individuals who use catheters.

The Truth About UTI Symptoms and Diagnosis

When symptoms do occur, they can include:

• A strong, persistent urge to urinate
• A burning sensation during urination
• Frequent urination
• Cloudy or strong-smelling urine
• Pelvic pain (in women)
• Blood in the urine

In some cases, more severe symptoms may indicate that the infection has spread beyond the bladder. These can include:

• Fever and chills
• Nausea and vomiting
• Back pain
• Fatigue

Diagnosing UTIs: Beyond Symptoms

Diagnosis of a UTI typically involves a urine culture to identify the presence of bacteria. However, the mere presence of bacteria doesn’t always necessitate treatment, especially in asymptomatic cases.

Treatment Approaches: When Are Antibiotics Necessary?

One of the most persistent myths about UTIs is that all infections require antibiotic treatment. In reality, the approach to treatment depends on various factors, including the presence of symptoms and the patient’s overall health status.

Myth 3: All UTIs Require Antibiotic Treatment

Asymptomatic bacteriuria often doesn’t require treatment, especially in otherwise healthy individuals. However, certain groups may benefit from antibiotic therapy even in the absence of symptoms:

• Pregnant women
• Individuals scheduled for urologic surgery
• People with weakened immune systems

For symptomatic UTIs, antibiotics remain the primary treatment option. The choice of antibiotic and duration of treatment depend on the severity of the infection and the patient’s medical history.

Natural Remedies and Prevention Strategies for UTIs

While antibiotics are often necessary for treating active infections, there are several natural remedies and preventive measures that can support urinary tract health:

1. Stay hydrated: Drinking plenty of water helps flush out bacteria from the urinary system.
2. Urinate frequently: Don’t hold it in when you need to go, as this can allow bacteria to multiply.
3. Wipe from front to back: This prevents bacteria from the anal area from entering the urethra.
4. Avoid irritating feminine products: Some hygiene sprays and douches can irritate the urethra.
5. Consider cranberry products: While evidence is mixed, some studies suggest cranberry may help prevent UTIs.

Can UTIs Resolve on Their Own?

Another common misconception is that UTIs will always clear up without intervention. While asymptomatic bacteriuria may resolve without treatment, symptomatic UTIs rarely do. Ignoring symptoms can lead to more serious complications, including kidney infections.

The Connection Between Sexual Activity and UTIs

Sexual activity is often associated with an increased risk of UTIs, leading to some misconceptions about their nature and transmission.

Myth 4: UTIs Are Sexually Transmitted Infections

UTIs are not classified as sexually transmitted infections (STIs). However, sexual activity can increase the risk of developing a UTI. During intercourse, bacteria can be pushed into the urethra, potentially leading to infection. This is why urinating after sex is often recommended as a preventive measure.

Myth 5: UTIs Can Be Passed to Sexual Partners

Unlike STIs, UTIs are not contagious and cannot be passed between partners through sexual contact. The bacteria causing UTIs are typically already present in a person’s own body or environment.

Special Considerations for Different Age Groups

The risk and management of UTIs can vary significantly across different age groups:

UTIs in Children

Children, especially young girls, can develop UTIs. Symptoms may be less specific in children and can include:

• Bedwetting in toilet-trained children
• Unexplained fever
• Abdominal pain
• Vomiting

Prompt treatment is crucial in children to prevent kidney damage.

UTIs in Older Adults

Older adults are more susceptible to UTIs due to various factors, including:

• Weakened immune systems
• Incomplete bladder emptying
• Use of catheters
• Hormonal changes (in women)

In older adults, UTIs can sometimes present with atypical symptoms such as confusion or behavioral changes, making diagnosis challenging.

Advanced Treatment Options and Recurrent UTIs

For individuals experiencing recurrent UTIs (defined as three or more UTIs within a year), additional treatment strategies may be considered:

Prophylactic Antibiotics

In some cases, low-dose antibiotics taken regularly may be prescribed to prevent recurrent infections. This approach requires careful consideration due to the risk of antibiotic resistance.

Vaginal Estrogen Therapy

For postmenopausal women, vaginal estrogen therapy can help restore the natural balance of bacteria in the urinary tract, potentially reducing the risk of UTIs.

Immunotherapy

Some studies have explored the use of vaccines or immunostimulants to boost the body’s natural defenses against UTI-causing bacteria. While promising, these approaches are still under investigation.

The Role of Diet and Lifestyle in UTI Prevention

Beyond basic hygiene practices, certain dietary and lifestyle choices can influence UTI risk:

Dietary Considerations

• Probiotics: Some evidence suggests that probiotics may help maintain a healthy balance of bacteria in the urinary tract.
• Vitamin C: This nutrient may help make urine more acidic, creating a less hospitable environment for bacteria.
• Avoiding irritants: Some individuals find that certain foods or drinks (e.g., caffeine, alcohol, spicy foods) can irritate the bladder and potentially increase UTI risk.

Lifestyle Factors

Several lifestyle habits can contribute to UTI prevention:

• Proper hygiene: Regularly cleaning the genital area and avoiding harsh soaps or douches.
• Clothing choices: Wearing breathable, cotton underwear and avoiding tight-fitting pants.
• Stress management: Chronic stress can weaken the immune system, potentially increasing susceptibility to infections.

By adopting these preventive measures and understanding the true nature of UTIs, individuals can take proactive steps to maintain urinary tract health and reduce their risk of infections.

Emerging Research and Future Directions in UTI Management

The field of UTI research is continuously evolving, with new insights and potential treatment approaches on the horizon:

Antibiotic Alternatives

As concerns about antibiotic resistance grow, researchers are exploring alternative treatments for UTIs. Some promising areas include:

• Bacteriophage therapy: Using viruses that specifically target harmful bacteria.
• Probiotics: Developing probiotic strains that can compete with UTI-causing bacteria.
• Natural compounds: Investigating plant-based substances with antimicrobial properties.

Personalized Medicine Approaches

Advances in genetic testing and microbiome analysis may lead to more tailored UTI prevention and treatment strategies. This could involve:

• Identifying genetic factors that increase UTI susceptibility.
• Analyzing an individual’s urinary microbiome to develop targeted interventions.
• Customizing antibiotic regimens based on personal and bacterial genetic profiles.

As research progresses, our understanding of UTIs and how to manage them effectively will continue to improve, offering hope for better outcomes and reduced recurrence rates.

In conclusion, urinary tract infections remain a significant health concern, but with accurate information and appropriate management strategies, their impact can be minimized. By dispelling common myths, embracing evidence-based practices, and staying informed about emerging research, individuals can take control of their urinary health and reduce the burden of UTIs on their lives.

Mayo Clinic Q and A: 6 UTI myths and facts

• By

  Cynthia Weiss

  February 2, 2023

DEAR MAYO CLINIC: As a woman in my mid-60s, I have been diagnosed with a urinary tract infection for the first time ever. I was surprised to find out that I don’t need antibiotics because I don’t have any symptoms. There’s a lot of conflicting information online about UTIs, like whether every infection needs to be treated and if sex causes an infection. Can you help me distinguish between UTI myth and fact?

ANSWER: Urinary tract infections, also called UTIs, are the most common infection for women in the U.S., so you are not alone. About 40% of women will have at least one UTI in their lifetime, and 1 in 10 postmenopausal women had a UTI in the last year.

A UTI is an infection that occurs in the urinary system, such as the bladder, ureters and kidneys. Most infections involve the bladder, which is known as the lower urinary tract.

Similar to your experience, UTIs don’t always cause symptoms. But when they do, the symptoms may include a strong urge to urinate, a burning feeling while urinating, urinating more often, red or bright pink urine, or pelvic pain. Some patients experience chills, marked fatigue, fever or flank pain along the side of the torso below the ribs. These symptoms indicate that the infection has extended beyond the bladder, possibly to the kidney or into the bloodstream.

Here’s the truth about six UTI myths you should know in case you develop another infection:

Myth: Only women can get a urinary tract infection.
Fact: UTIs can affect both men and women. Women are at greater risk for a UTI because the urethra is shorter than in men, so it’s easier for bacteria to travel to the bladder. UTIs also are more common in postmenopausal women because changes in vaginal and urethral tissue due to low estrogen levels increases the risk of infection.

Myth: All UTIs cause symptoms.
Fact: Most UTIs cause symptoms, like pain or a burning sensation when urinating, or a feeling like you need to urinate often. As you discovered, though, it is possible to have bacteria in the urinary tract but not have any UTI symptoms. This is called asymptomatic bacteriuria, and it is more common in older adults or people who use a catheter to empty their bladders.

Myth: All UTIs must be treated with antibiotics.
Fact: Not all UTIs require antibiotics. Some people can have bacteria in their bladders but not experience any symptoms. This is called asymptomatic bacteriuria. In most cases, no treatment is necessary as the bacteria is not causing issues. This is probably why your health care team didn’t recommend treatment for your recent UTI.

There are a few groups of people that may require treatment, including people who are pregnant, people with planned urologic surgery and people with weakened immune systems. Antibiotics are used to treat UTIs when the person is experiencing painful or bothersome symptoms and there is bacteria present in the urine.

Myth: A UTI will go away on its own.
Fact: Asymptomatic bacteriuria, which is a UTI without symptoms, could go away without treatment. However, UTIs with symptoms rarely resolve on their own. If you begin experiencing UTI symptoms, like burning, pain or frequency, talk with your health care team about obtaining a urine culture and the right treatment for you.

Myth: UTIs can be passed to your partner.
Fact: UTIs are not contagious or passed between partners by sexual or casual physical contact.

Myth: UTIs are sexually transmitted infections.
Fact: Sexual activity can increase the risk for UTIs, but it does not cause them. Therefore, UTIs are not classified as sexually transmitted infections. The act of intercourse can cause bacteria to get close to or into the urethra, the small tube that empties your bladder. Lower your risk by urinating after intercourse to remove some of the bacteria before it can cause an infection.

Talk with your health care team if you start to experience UTI symptoms, like painful or burning urination, pelvic pain, a strong urge to urinate, fever, chills, disorientation, or back or side pain. — Dr. Ross Avant, Urology, Mayo Clinic Health System, Albert Lea, Austin and Rochester, Minnesota

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• 5 tips to prevent a urinary tract infection published 7/12/22

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9 Best Remedies for Bladder Infections

Bladder infections can cause a range of uncomfortable symptoms. Using a combination of medical treatments and home remedies may provide relief.

Bladder infections are the most common type of urinary tract infection (UTI). They can develop when bacteria enter the urethra and travel into the bladder.

The urethra is the tube that takes urine out of the body. Once bacteria go into the urethra, they can attach to the walls of the bladder and multiply quickly.

The resulting infection can cause uncomfortable symptoms, such as the sudden urge to urinate. It may also cause pain while urinating and abdominal cramping.

A combination of medical and home treatments may ease these symptoms, but treatment from a healthcare professional is also necessary. If left untreated, bladder infections can spread to the kidneys or blood and become life-threatening.

Here are 9 effective bladder infection remedies.

Water flushes out the bacteria in your bladder, which helps get rid of the infection faster. It also dilutes your urine, so urinating may be less painful.

Urine is made of waste products from your body. Concentrated, dark urine may be more irritating and painful to pass when you have a bladder infection. Meanwhile, diluted urine is lighter in color and usually doesn’t irritate as much.

Try this

Drink at least eight glasses of water per day. Limit caffeinated drinks, including coffee, tea, and soda. Caffeine can irritate your bladder even more when you don’t have an infection.

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Frequent urination helps eliminate the infection by moving bacteria out of the bladder. “Holding it,” or not going to the bathroom when you need to, allows time for the bacteria to continue multiplying in the bladder.

It may also be helpful to urinate after having sex. Sexual activity can push bacteria deeper into the urethra in both men and women.

Urinating after sex may help flush bacteria away from your urinary tract. This prevents germs from settling and causing an infection.

Try this

Drink plenty of fluids so you can urinate and go to the bathroom as soon as you can.

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Antibiotics kill the bacteria causing the bladder infection. If you have a UTI, you usually need medication to get rid of the germ causing the infection. Experts recommend treating UTIs with antibiotics.

If you have symptoms of a UTI, see your doctor. Sexually transmitted infections (STIs), vaginal infections, and certain vaginal conditions can mimic symptoms of a UTI. For this reason, it’s essential to get the right treatment for your condition.

Try this

• Call a doctor if your symptoms last longer than 2 days or become worse. You’ll likely need antibiotics to treat your bladder infection.
• If you’re older, pregnant, or have other serious health conditions, like diabetes, call a doctor right away.
• The length of treatment might vary, depending on the drug your doctor prescribes and your overall health.
• It’s important to take your medication for the full course, even if you feel better before it’s done. Taking the full dose will make sure all the harmful bacteria are out of your system.

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Severe bladder infections can cause pain in the pelvic region, even when you’re not urinating. Antibiotics will treat the infection.

Keep in mind it may take a day or two before the drugs start to help. Taking pain medications may relieve abdominal cramps, back pain, and any discomfort you may feel.

Try this

Ask a doctor if it’s safe to take over-the-counter pain relievers. Taking acetaminophen (Tylenol), ibuprofen (Advil, Motrin IB), or phenazopyridine (Pyridium) can ease pain while you wait for the antibiotics to start working.

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Putting low heat across your abdominal region or back may soothe the dull ache that sometimes occurs during bladder infections. This can be especially helpful when used together with your medications.

Try this

You can buy a heating pad at a local drugstore or online. Make sure to follow the directions on the package carefully to avoid burning yourself.

You can also make a warm, moist compress at home by soaking a small towel in warm water and placing it over your bladder or abdomen.

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Bacteria thrive in warm and moist environments. For women, tight jeans and other tight clothes can trap moisture in delicate areas. This creates a breeding ground for vaginal bacteria.

Try this

Wear cotton underwear, loose pants, or skirts to promote air circulation and reduce bacterial growth.

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Cranberry has been used as a natural treatment for preventing bladder infections for generations. According to a 2021 review, cranberry juice and cranberry tablets show some promise as a remedy for women who frequently get bladder infections when used alongside medical treatment.

However, more research is needed to determine whether cranberry juice really works for preventing bladder infections in the larger population.

Try this

Talk to a doctor about cranberry juice as a way to prevent bladder infections.

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Some research suggests that probiotic supplements could help improve the concentration of beneficial bacteria in the urinary tract and genitals to protect against recurrent bladder infections.

Lactobacilli, in particular, can help block the adherence and growth of harmful bacteria that cause infection.

Furthermore, taking probiotics may also prevent certain side effects commonly associated with antibiotics, such as diarrhea.

Try this

Consult with a doctor to determine whether taking probiotics may be a good option for you.

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Vitamin C can help increase the acidity of urine to prevent the growth of harmful bacteria, which may aid in the prevention of recurrent bladder infections.

Additionally, vitamin C possesses antimicrobial and antioxidant properties, which could be beneficial for preventing infection.

However, more research is needed to understand how vitamin C foods or supplements may impact bladder infections.

Try this

Try adding more foods rich in vitamin C to your diet, such as fruits or vegetables, to increase your intake of vitamin C. If you’re interested in trying supplementation, be sure to consult with a medical professional first.

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The following lifestyle changes may help reduce the occurrence of bladder infections:

• Drink six to eight glasses of water per day.
• Urinate as soon as you feel the need. No
• Take showers instead of baths.
• Wear cotton underwear.
• Change your underwear daily.
• Urinate before and after sexual activity.
• Avoid using a diaphragm or spermicide, and change to an alternate form of birth control.
• Use nonspermicidal lubricated male condoms.
• Be sure to wipe from front to back after urinating.
• Avoid using douches or vaginal sprays.

Your doctor may recommend preventive treatment if you’ve been experiencing recurrent bladder infections. This can consist of taking antibiotics in small daily doses to prevent or control future bladder infections.

Diet, along with the acidity of the urine, may also impact how individuals are affected by these infections.

Researchers at Washington University School of Medicine in St. Louis found that those whose intestinal tract produced certain substances, called urinary aryl metabolites, had less bacterial activity in their urine.

The production of these substances seems to be related to the types of healthy bacteria people carry in their intestinal tract. Also, urine that was low in acid had fewer bacteria, so medications that can make the urine less acidic may have a role in preventing these infections.

Bladder infections, including recurring infections, require medical attention. When treated promptly and effectively, the risk of serious complications is low.

Numerous researchers are also working on developing vaccines to protect against the most common types of bacteria that cause bladder infections. Until then, home remedies combined with medications are important steps to feeling better.

Acute and recurrent cystitis. Difficult patient | Tsareva A.V.

Introduction

Urinary tract infections (UTIs) are among the most common infectious diseases that affect both sexes and all age groups [1]. The most frequently reported form of uncomplicated UTI is acute cystitis, which develops more often in women and accounts for 0.5–0.7 episodes per woman per year [2]. In Russia, at least 26–36 million cases of acute bacterial cystitis are registered annually [3].

The term “cystitis” is used to describe the inflammatory process in the wall of the bladder, localized mainly in the mucous membrane [4]. The inflammatory reaction occurs in various clinical situations and can be both infectious and non-infectious in nature.

Cystitis is characterized by frequent recurrence. After the first transferred acute uncomplicated cystitis for 6 months. a repeated episode develops in 27% of women [5], within a year — in 50% [6], while in 75% of patients relapses occur more than 4 times a year [7].

The prevalence of acute cystitis, the severity and intensity of dysuric disorders, a significant decrease in the quality of life in the acute period of the disease explain the high interest of potential patients in this diagnosis, methods of treatment and prevention. This often leads to an unusual dialogue at the appointment, when the doctor’s question: “What is bothering you?” – the patient answers: “I have cystitis …”. Patients make their own diagnosis, self-medicate, not always resorting to the help of specialists. In such cases, almost any symptom associated with urination is mistakenly considered as inflammation of the bladder mucosa. This leads to excessive therapy, including antibiotics, thus making a significant negative contribution to the global problem of antibiotic resistance [8].

Unfortunately, general practitioners, gynecologists and even urologists also neglect the rules for detailed clinical and laboratory diagnosis of cystitis, mistaking completely different diseases for cystitis. This predetermines many tactical errors in the treatment of dysuria, contributing to a significant increase in patients with recurrent and chronic course of this pathological process.

Clinical manifestations of acute bacterial cystitis are characterized by sudden onset and development of frequent urination in small portions, pain and pain during urination, imperative urge to micturition with pain over the womb or its absence, sometimes with blood in the urine (especially in the last portion). At the same time, hyperthermia (over 38 °C), pain in the lumbar region, itching and discomfort in the area of ​​the vestibule of the vagina and the external opening of the urethra outside the urination, and abundant vaginal discharge are not typical for acute cystitis [9]. ].

For an objective assessment of the symptoms of the disease, a quantitative assessment of the Acute Cystitis Symptom Scale (ACSS) was proposed, consisting of 18 questions reflecting the main clinical signs of cystitis and differential symptoms, to which the patient responds independently. This research method has a sensitivity of 91.2% and a specificity of 86.5% in relation to the prediction of acute cystitis [10]. It is recommended that all patients with cystitis complete a urination diary for two days for an objective assessment of the frequency and volume of urination [11].

Laboratory diagnosis of acute and recurrent cystitis involves a urinalysis using test strips, as an alternative to a general urinalysis, a positive test for nitrites and leukocyte esterase. In acute uncomplicated cystitis, urinalysis does not have a high diagnostic value. In complicated or recurrent (chronic) cystitis, a general (clinical) urinalysis is recommended to detect signs of urinary tract inflammation [12]. Microbiological (cultural) examination of urine is not recommended for patients with acute uncomplicated cystitis during primary diagnosis due to the duration of the study and, at the same time, a slight increase in diagnostic accuracy.

According to the 2020 federal clinical guidelines of the Ministry of Health of Russia, the use of routine instrumental diagnosis of acute cystitis using ultrasound examination of the bladder, cystoscopy is not recommended for female patients under 40 years of age without risk factors for urolithiasis, urinary tract obstruction, interstitial cystitis, or urothelial cancer [13]. In patients with suspected acute cystitis, with relapses of the disease, as well as in the absence of the effect of the treatment, it is recommended to measure the rate of urine flow (uroflowmetry) with the determination of the volume of residual urine to clarify the diagnosis and determine further tactics of management [14].

These easy-to-use clinical and diagnostic tools can allow physicians of various specialties to correctly diagnose acute and recurrent cystitis and exclude neurological diseases that present with symptoms of dysuria. Failure to comply with the above algorithm leads to many clinical errors, which is fraught with the development of complications.

Case #1

Patient B., 32 years old. She complained of burning and cramps in the urethra during urination, increased urgent urge to urinate, up to 3 episodes of urination during a night’s sleep, moderate discomfort in the suprapubic region, temperature rise to 37.2 °C.

When collecting an anamnesis, it was found that the symptoms of dysuria appeared 3 days ago, their intensity increased over the next day. Urological history is not burdened. No hypothermia factor was detected, there was no sexual contact within 5 days before the onset of symptoms of the disease. The patient was in contact with a patient with COVID-19 (sick spouse).

Taking into account the peculiarity of complaints, the speed of development of the pathological process, the doctor made a preliminary diagnosis of “acute cystitis”. According to the federal clinical guidelines of the Ministry of Health of Russia “Bacterial cystitis”, a survey was carried out: the score according to the questionnaire of symptoms of acute cystitis (ACSS) was 15 points, including the severity of typical symptoms of acute cystitis – 6 points; urinalysis (test strip): nitrite test and leukocyte esterase test are negative, microhematuria.

The results obtained ruled out the diagnosis of acute bacterial cystitis and required further examination in a planned manner in the scope: ultrasound of the bladder, ultrasound of the kidneys, urethrocystoscopy, determination of SARS-CoV-2 coronavirus RNA in the discharge from the mucous membrane of the oropharynx and nasopharynx by PCR.

For the period of additional examination, it is recommended to take a biologically active additive (BAA) Uronext (LLC NPO Petrovax Pharm) in the dosage regimen of 1 sachet 1 r / day for 7 days.

As a result of additional examination, calculi of the bladder, upper urinary tract were excluded according to ultrasound of the kidneys, bladder; according to urethrocystoscopy, signs of epithelial bladder cancer were excluded, hyperemia and edema of the bladder mucosa in the region of the cervix and Lieto’s triangle were revealed. Test for SARS-CoV-2 is positive.

As a result, the diagnosis was established: COVID-19, a positive test result for the virus. Acute viral cystitis.

Started in the monotherapy regimen, the treatment of dietary supplement Uronext contributed to the improvement of the condition due to a significant reduction in burning and pain in the urethra during urination. Against the background of complementary treatment for COVID-19, the patient noted the disappearance of urgent frequent urge to urinate.

With the development of the COVID-19 pandemic in the world, descriptions of clinical observations began to appear, characterized by an increase in the frequency of urination, urgent urge to urinate, pain and discomfort during urination in patients with COVID-19[15]. At the same time, there were no laboratory signs of an acute inflammatory process localized in the bladder mucosa — leukocyturia and bacteriuria. Patients were diagnosed with viral cystitis associated with COVID-19.

It is assumed that against the background of a systemic inflammatory response, the concentration of inflammatory cytokines increases, which are released into the urine or are secreted on the bladder mucosa. Researchers look at cystitis associated with COVID-19, as a manifestation of a long-term systemic inflammatory response of the body, in particular from the bladder [16].

Uronext is a dietary supplement consisting of three active ingredients in the optimal dosage: D-mannose 2000 mg (the effectiveness of this dose was confirmed in randomized clinical trials with daily intake for the prevention of UTIs) [17], Cran-Max 500 mg (equivalent to 36 mg of proanthocyanidins) – a patented extract of North American cranberry with increased efficiency due to a patented form of release of cranberry molecules that prevents the destruction of active components in the acidic environment of the stomach and allows to increase bioavailability by 2 times, as well as vitamin D ₃ 1 µg.

Cran-Max and D-Mannose are anti-inflammatory and diuretic. Due to these effects, Uronext relieves symptoms and accelerates recovery, which makes it possible to use it in acute cystitis and recommend it for the prevention of UTIs. Uronext has a good safety profile and can be recommended for pregnant women and people with diabetes.

Case #2

Patient M., 34 years old. Complaints of intermittent intense cramps and pain in the urethra during urination, increased urge to urinate, blood in the urine, nagging pain in the lower abdomen, turbidity and an unpleasant smell of urine. At the time of the examination, there were no active complaints, she noted moderate discomfort in the vestibule of the vagina outside of urination, which intensifies at the end and after micturition.

Such episodes occur on average 1 time in 2 months. last 4 years. Associates exacerbation with sexual intercourse with a spouse without the use of barrier methods of contraception after a period of forced sexual abstinence (due to the spouse’s rotational work method).

Addressed with complaints to the urologist. A study of the general analysis of urine was carried out, where an increased level of leukocytes was determined, a diagnosis of “acute cystitis” was made. Treatment with oral and injectable antibacterial drugs was recommended: protected aminopenicillins, third-generation cephalosporins, fosfomycin, nitrofurantoin, furazidin. This therapy led to the disappearance of symptoms for a short period without the formation of persistent periods of remission.

Taking into account the peculiarity of the patient’s history, the incidence of acute dysuria, confirmed leukocyte-uria in each episode, the attending physician made a provisional diagnosis of “recurrent cystitis”.

According to the federal clinical guidelines of the Ministry of Health of Russia “Bacterial cystitis”, the following examination was carried out: laboratory analysis of urine (general urinalysis, urinalysis according to Nechiporenko) – without signs of inflammatory changes; bacteriological examination of urine – the total microbial count is less than 10 ² cfu/ml. According to uroflowmetry, there were no signs of urination disorders, the volume of residual urine was within the normal range.

When conducting a bacteriological study of vaginal discharge, scraping from the vagina by PCR real-time “Femoflor 16” revealed signs of bacterial vaginosis with a decrease in the concentration of lactobacilli, an increase in the number of anaerobic microorganisms ( Gardnerella vaginalis more than 10 ⁶ and Enterobacteriaceae 10 ⁵ ). During an additional examination by a gynecologist, a diagnosis of bacterial vaginosis was established, and treatment was carried out aimed at normalizing the vaginal microflora. As a result of the treatment, the symptoms of discomfort in the vestibule of the vagina outside of urination disappeared.

According to the results obtained, at the time of the examination, there were no signs of an active infectious and inflammatory disease in the organs of the urinary system. The main direction of the patient’s management was the selection of an adequate anti-relapse prevention scheme for recurrent infections of the lower urinary tract.

General recommendations are given: drinking large amounts of fluid (more than 1.5 l/day), forced urination immediately after intercourse, refusing to use spermicides and the diaphragm as contraceptive methods, careful proper toileting of the external genital organs, limiting sexual contacts during the pre-examination and treatment by a gynecologist. As a drug regimen for anti-relapse therapy, immunoactive prophylaxis with OM-89 for 3 months was chosen.

A certain recent trend has been the use of non-antimicrobial agents for anti-relapse prevention of recurrent infections of the urinary system. In this case, Uronext was recommended in the mode of taking 1 sachet within 6 hours after sexual contact.

Clinical observation by a urologist and gynecologist was carried out for 5 months. During the observation period, there were no recurrences of acute cystitis with the resumption of sexual contacts with the spouse in the previous mode of activity.

Recently, due to the growing problem of antibiotic resistance of uropathogens to the main classes of antibiotics used, the use of long-term antimicrobial prophylaxis regimens has been sharply limited. On the example of this patient, the antibacterial load was significant – up to 6 courses per year for 4 years in a row. This factor is currently considered as a predictor of worsening intestinal and vaginal dysbiosis, which only increases the risk of another recurrence of acute cystitis [18].

A feature of the presented observation of recurrent UTI was the association with sexual intercourse after a period of abstinence. This circumstance suggested the choice of postcoital prophylaxis as the most preferable one. The use of antibacterial drugs was undesirable.

In patients with recurrent UTIs, the use of Uronext helps to increase the relapse-free period. D-Mannose and Cran-Max directly affect the main uropathogen, E. coli ( E. coli ), preventing it from attaching to the urothelium and triggering an inflammatory response. The antiadhesive effect of D-mannose (blocking type 1 fimbriae) in cystitis and other UTIs is effectively complemented by cranberry proanthocyanins, since E. coli have P-pilus (37.2%) and type 1 fimbriae (62.8 %) [19]. Vitamin D ₃ is required to maintain an adequate immune response to a uropathogen. It has been shown that the active components of dietary supplement Uronext can help reduce the frequency of exacerbations of cystitis by 4 times [20].

Conclusion

Acute cystitis and recurrent cystitis are widespread and socially significant diseases detected in women of active reproductive age and menopause. These clinical conditions cause significant social and sexual maladjustment of patients, significantly reducing the quality of life. Symptoms of acute cystitis due to low specificity require careful differential diagnosis, primarily with infectious and inflammatory diseases of the vagina and non-infectious urological diseases. This allows rationalizing the antibiotic therapy of acute cystitis, using it only in cases where it is really necessary. It is important to expand the use of non-antibacterial agents for the treatment and prevention of acute and recurrent cystitis. All this will reduce the chronicity of the disease and reduce the incidence of recurrent inflammatory processes in the urinary tract.

Thanks

The editors would like to thank Petrovax Pharm LLC for their assistance in the technical editing of this publication.

Acknowledgment

Editorial Board is grateful to LLC “NGO Petrovax Pharm” for the assistance in technical edition of this publication.

Information about the author:

Tsareva Anna Viktorovna – Candidate of Medical Sciences, urologist, head of the urological group of MMC Multi Clinic Tomsk LLC; 634029, Russia, Tomsk, st. Sibirskaya, 9/1.

Contact information: Tsareva Anna Viktorovna, e-mail: [email protected]. Transparency of financial activities: the author has no financial interest in the presented materials or methods. There is no conflict of interest. Article received on March 4, 2021, received after review on March 30, 2021, accepted for publication on April 22, 2021.

About the author:

Anna V. Tsareva – Cand. of Sci. (Med.), urologist, Head of the Urology Group, International Medical Center “Multi Clinic”; 9/1, Sibirskaya str., Tomsk, 634029, Russian Federation.

Contact information: Anna V. Tsareva, e-mail: [email protected]. Financial Disclosure: the author has no a financial or property interest in any material or method mentioned. There is no conflict of interest. Received 03/04/2021, revised 03/30/2021, accepted 04/22/2021.

Pelvic Floor (Kegel) Exercises for Women

This information will help you learn what pelvic floor (Kegel) exercises are and how to do them.

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About Kegel Exercises

The main purpose of Kegel exercises is to help you strengthen your pelvic floor muscles. These muscles support your uterus, bladder, and intestines (see Figure 1). They are also called pelvic organs.

Figure 1 Pelvic floor muscles and pelvic organs

How Kegel exercises can help you

Kegel exercises can help you:

• Control or prevent urinary incontinence. Incontinence is the leakage of urine or feces that you cannot control.
• Support the pelvic organs. This will help reduce incontinence and soreness.
• Improve pelvic floor muscle coordination. Exercise helps make muscles stronger and more flexible. This is important if you experience pain or discomfort during intercourse or during a pelvic exam.

Kegel exercises can also be beneficial for sexual health and sexual satisfaction because they:

• improve blood circulation in the vagina and pelvic floor muscles,
• facilitate the achievement of orgasm;
• increase the production of vaginal lubrication (moisturizing the vagina).

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How to Identify Your Pelvic Floor Muscles

When doing Kegel exercises, it is important to identify your pelvic floor muscles to make sure you are working with the correct muscles.

To determine the pelvic floor muscles, do the following:

• imagine you are urinating. Tighten the muscles that you use to interrupt the flow of urine while urinating. These are the pelvic floor muscles.
  • Do not stop the stream of urine while urinating. This may result in incomplete bladder emptying and may also increase the risk of urinary tract infection (UTI).
• Tighten the muscles you use to hold back a bowel movement or gas.
• Insert the tip of a clean finger into the vagina. Tighten your pelvic floor muscles around your finger. You should feel the muscles in your vagina tense up and your pelvic floor move up.

How to tell if you’re using the wrong muscles

Contracting your pelvic floor doesn’t involve your abs, legs, or buttocks.

• To find out if the muscles in your legs or buttocks are also contracting, you can place one hand under your buttocks or on the inside of your upper leg. Tighten your pelvic floor muscles. If you feel movement in your leg or buttocks, then you are using the wrong muscles.
• If you are sitting in a chair, then when doing Kegel exercises, your body should not rise from the chair. If you feel that your body is lifting, then you are using the muscles of the buttocks.

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How to do Kegel exercises

Get into a comfortable position before starting

Get into a comfortable position before starting Kegel exercises so that your body is relaxed. Most people prefer to do Kegel exercises while lying in bed or sitting in a chair. They can be done in any position convenient for you.

Once you are familiar with the exercises, you can do them in any position and anywhere, such as standing somewhere and waiting in line, which can help you do them more often.

Kegel steps

1. Inhale deeply through your nose to contract your abdominal muscles and fill with air. During inhalation, the pelvic floor muscles should be relaxed.
2. Exhale slowly through pursed lips, as if you were blowing through a straw. Do this by slightly tensing your pelvic floor muscles.
3. The pelvic floor muscles should be in a tense state for 3-6 seconds during exhalation. This is called a cut.
4. Inhale again and stop muscle contraction. This will allow the muscles to relax.
5. Relax your pelvic floor muscles completely for 6-10 seconds. It is very important to completely relax the muscles between each contraction.

and do not hold your breath while doing Kegel exercises. If you feel like you are holding your breath, count out loud while doing Kegel exercises.

How often to do Kegel exercises

Do this exercise for 10 repetitions per session. For best results, do 2-3 sessions of Kegel exercises daily. Sessions are best done at regular intervals throughout the day.

When to increase the duration of Kegel exercises

You can increase the duration of Kegel exercises if:

• pelvic floor muscles do not get tired after their contraction for 3-6 seconds;
• pelvic floor muscles do not get tired after doing 10 Kegel exercises in a row.

In this case, try contracting the muscles for 6-10 seconds. Then completely relax the muscles for 10 seconds. Be sure to keep breathing as the muscles contract.

Try to achieve the goal of holding a strong contraction for 10 seconds 10 times in a row.

What to do if you experience pain after Kegel exercises

Kegel exercises should not hurt. If you experience pain during or after Kegel exercises, stop exercising immediately and call your health care provider. You may not be doing the exercises correctly or they are not suitable for you.

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Getting Sexual Health and Intimacy Information at MSK

If you need more information about sexual health and intimate life, talk to your health care provider. You can also enroll in the MSK’s Female Sexual Medicine and Women’s Health Program. For more information or to make an appointment, call 646-888-5076.

Services offered under the Women’s Sexual Medicine and Health Program are available at the following centers:

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When should you contact your healthcare provider?

Call your healthcare provider if:

• concerns about bowel, bladder, or sexual function;
• difficulty concentrating on the pelvic floor muscles;
• pain when doing Kegel exercises;
• difficulty doing Kegel exercises;
• pain in the pelvic area;
• questions requiring referral to a physical therapist who specializes in pelvic health.