Still recovering from a cold or flu? Could it be contributing to cystitis?

Why is the immune system so important when it comes to cystitis?

Even with winter finally drawing to a close, the recent cold snap in the weather has left many of us struggling to fight off the last of the cold and flu outbreaks that have plagued us over the last few months.

When we think of the cold and flu season – the immune system is often top of mind, but why are we less quick to consider our immune functions when it comes to other conditions, such as cystitis?

Just like colds and flu which are often causes by viral or bacterial infections, more often than not, cystitis is caused by a bacterial infection too. So, just like when we feel a scratchy throat or a runny nose coming on, if you feel a niggle down below, you are also relying on our immune system firing up, stopping the invaders in their tracks, and helping to keep those symptoms under control!

This is even more so if our tissues have become vulnerable as a result of previous damage (in the case of recurrent cystitis, for example) as then our immune system has to work that little bit harder. Damaged tissues mean that the initial physical barrier is compromised (our immune system’s armour if you like) and so our immune cells need to be extra vigilant in order to be on the lookout for potential pathogens.

What signs suggest your immune system may be under pressure?

If you suffer from recurrent cold and flu infections, then it could be a sign that your immune system needs some additional support. But when it comes to cystitis, what are some of the warning signs to look out for?

  • The repeated need for antibiotics –Antibiotics aren’t always necessarily the answer when it comes to cystitis. Although in some cases they are most definitely required for example, to help protect your kidneys from infection, they shouldn’t always be the go-to. In many cases, with some suitable precautions your immune system should be capable of fighting off a minor UTI or a bout of cystitis within a few days. However, if you need to repeatedly step in with antibiotics, then it could suggest that your immune system is flagging. This comes with a whole host of other issues including the implications antibiotics can have for our gut bacteria which we know are important for supporting our immune functions. Plus, there’s the threat of antibiotic resistance which doesn’t bear thinking about if your immune functions are already compromised
  • Recurrent cystitis –If you suffer from recurrent cystitis it could be a sign your immune system is struggling to keep things under control. There may be some structural issue which is making infections more likely, such as a prolapse, for example, but it may also be a good idea to consider supporting the immune system
  • Interstitial cystitis – Cases of interstitial cystitis are often a little more complicated. With no obvious infection, one might assume that the immune system is working away fine and needn’t be very involved! However, the underlying cause is generally somewhat unknown, and one theory is that the immune system is overreacting, giving rise to symptoms when there is no infection underlying. Autoimmune conditions should be treated by a practitioner, but if interstitial cystitis is a problem, this might just be something to consider.

What factors could be affecting your immune system?

If you suspect that your immune system is struggling to keep up with the demands, it might be time to consider implementing some dietary and lifestyle factor that could help:

  • A limited diet – If you live on convenience foods then it’s not likely to be giving your immune system the support it needs. Processed foods will not only lack in the nutrients you need to support your immune system such as zinc or vitamin C, but they will also contain pro-inflammatory ingredients that won’t help to create a supportive internal environment. Aim to eat fresh and avoid excess sugar, alcohol and caffeine
  • Poor sleep or stress – Insufficient sleep and excess stress will only put your immune system under more pressure. Aim to rest, relax and get enough shut eye in order to help support those immune functions
  • Age – Unfortunately as you get older your immune system can struggle to keep up with the demands. For a number of reasons, from changing diets to physical changes, issues such as cystitis can become more common. So, it might be time to take some extra precautions and don’t risk falling victim to those recurrent infections
  • Exercise habits – Whether it’s too much or too little, the amount of exercise you do is an important consideration. Leading a sedentary lifestyle means that you risk having poor circulation which means your immune cells aren’t going to be patrolling as meticulously as we would like. On the other hand, with over-exercise, you risk throwing your body into a state of stress and your immune functions could become compromised as a result. Aim for a happy medium for optimal support.

What can be done to help?

So, if cystitis is getting you down and you suspect your immune functions could be at the root of the problem, here are my top tips to help get you back on track:

  • Employ an immune-boosting diet – If your immune system needs a boost there’s nothing better than employing some fresh foods. Avoid processed meals and snacks and cook from scratch using lots of fresh ingredients. Fresh fruit and vegetables will be rich in vitamins, minerals and antioxidants to help give your immune system the resources it needs. Be sure to limit alcohol as much as possible too as this can make your immune cells sluggish
  • Vitamin C – As much as fresh fruit and veg is a good source of vitamin C, if recurrent cystitis is an issue for you then some extra vitamin C will come in handy. A good quality vitamin C derived from natural sources will not only help support the immune system, but will also help with the repair of any previously damaged tissues within the urinary tract
  • Uva-ursi – At the first sign of an infection, start taking our Uva-ursi complex. The herb Uva-ursi has astringent and anti-inflammatory properties and together with Echinacea, this remedy also helps to support your immune system – ideal!
  • Echinacea – Whilst Uva-ursi is the remedy to go for at the time of a cystitis infection, longer term, Echinaforce can be used to help support the immune system, plus help ward off that lingering cold or flu. This can come in especially useful during high risk times, for example in the winter months
  • Cranberry – To help support the urinary tract in the long-term, Cranberry is a good option. Research has shown that cranberry supplements can help prevent bacteria to adhering to the urinary tract and reduce the incidence of subsequent infections

1. Caljouw, MA et al. Effectiveness of cranberry capsules to prevent urinary tract infections in vulnerable older persons: a double-blind randomized placebo-controlled trial in long-term care facilities. J Am Geriar Soc. 2014, 62(1), p103-110

Signs & Symptoms

Bladder Infection

  1. •Constant urge to urinate; urinating more often than usual; feeling like your bladder is still full after you pass urine.

  2. •Burning or pain when you pass urine.

  3. •Cloudy urine or blood in the urine.

Acute Kidney Infection

  1. •Pain in one or both sides of your mid-back.

  2. •Fever and shaking chills.

  3. •Nausea and vomiting.

{Note: Bladder infections are much more common than kidney infections. You can also have a UTI without symptoms.}

Causes & Risk Factors

UTIs result when bacteria infect any part of the urinary tract. The bladder is the most common site. The risk for getting a UTI is greater for:

  1. •Sexually active females.

  2. •Females who use a diaphragm.

  3. •Males and females who have had UTIs in the past.

  4. •Anyone with a condition that doesn’t allow urine to pass freely. Kidney stones is an example.


  1. •Drink plenty of water and other fluids everyday. Cranberry juice may help prevent bladder infections.

  2. •Empty your bladder as soon as you feel the urge.

  3. •Drink a glass of water before you have sex. Go to the bathroom as soon as you can after sex.

  4. •If you’re prone to UTIs, don’t take bubble baths.

  5. •If you’re female, wipe from front to back after using the toilet. This helps keep bacteria away from the opening of the urethra.

  6. •If you use a diaphragm, clean it after each use. Have your health care provider check it periodically to make sure it still fits right.


An antibiotic to treat the specific infection and pain relievers (if necessary) are the usual treatment. If you get UTIs often, your health care provider may order certain medical tests to diagnose the cause.

You might think that urinary tract infections (UTIs) are a worry only for adult women. But they are a concern for babies and young children, too.

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About 3% of girls and 1% of boys will develop a UTI by the time they’re 11 years old, according to the American Academy of Pediatrics (AAP). Uncircumcised boys have slightly more UTIs than those who have been circumcised.

UTIs happen when bacteria get into the urinary system through the urethra (that’s the passageway by which urine travels from the bladder to the outside of the body). Bacteria can get into the urinary tract from the skin around the rectum and genitals. “Holding” urine, improper hygiene or constipation are common causes of UTIs in children, says pediatric urologist Jeffrey Donohoe, MD.

In children, UTIs may go untreated because often the symptoms aren’t obvious to the child or to parents. But UTIs in children need treatment right away to get rid of the infection, prevent the spread of the infection and to reduce the chances of kidney damage.

Two kinds of UTIs

UTI symptoms include:

  • Fever.
  • Pain or burning during urination.
  • Need to urinate more often, or difficulty urinating.
  • Wetting of underwear or bedding by a child who knows how to use the toilet.
  • Vomiting, refusal to eat.
  • Abdominal pain.
  • Side or back pain.
  • Foul-smelling urine.
  • Cloudy or bloody urine.
  • Unexplained and persistent irritability in an infant.
  • Poor growth in an infant.

It’s important to distinguish between UTIs with fever and those without, Dr. Donohoe says. A young child with a high fever and no other symptoms has a 1 in 20 chance of having a UTI, the AAP says.

“Typically, urinary tract infections with a fever happen when the infection travels to the kidneys or when they are severe bladder infections,” Dr. Donohoe says.

Doctors treat UTIs with fever or UTIs in children younger than age 2 more aggressively, Dr. Donohoe says. That’s because frequent or untreated UTIs can scar a child’s kidneys and cause permanent damage.

How you can help your child getting a repeat UTI

Once a UTI clears, it’s helpful to get kids in the habit of using the bathroom every two hours to prevent future infections, Dr. Donohoe says.

Teach your daughters to wipe front to back after going to the bathroom. Also, taking regular baths, drinking plenty of water and even consuming watered-down cranberry juice can help your child avoid a UTI. Drinking fluids helps to flush the infection out of the body.

Cranberry juice has a reputation for curing UTIs. However, traditional, consumer-friendly cranberry juices — which are often a blend of various juices — have not been shown to be particularly effective, Dr. Donohoe says. The purer cranberry preparations can be unpalatable to children because they are tart.

“Cranberry, however, has been proven an effective treatment for preventing urinary tract infections,” Dr. Donohoe says. “It can reduce the likelihood of urinary tract infections in people who are at risk.” Kid-friendly probiotics in chewable form also can help avoid UTIs.

What to do if you think your child has a UTI

If you think your child may have a UTI, call your pediatrician. A simple test can diagnose if your child has a UTI. To get rid of the infection, your child will need to take antibiotics.

It’s important to continue giving your child the medicine until your pediatrician says the treatment is finished, even if your child feels better. UTIs can return if not fully treated.



BPS/IC is a clinical diagnosis based primarily on chronic symptoms of pain perceived by the patient to emanate from the bladder or pelvis associated with urinary urgency and frequency in the absence of other identified causes of the symptoms . The prevalence of chronic pain due to benign causes, including BPS/IC, is reported to be at least 10% in the general population . Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or an experience described in terms of such damage. Pain can be categorized as physiologic pain of the normal state and pathophysiologic pain of the abnormal state. Physiologic pain represents nociceptive pain that disappears as soon as the nociception input disappears. Pathophysiologic pain continuously occurs, even after the nociception input disappears or the tissue damage is repaired. Pathophysiologic pain can be further divided into nociceptive pain, neuropathic pain, and psychogenic pain; pathophysiologic pain causes spontaneous pain, evoked pain, etc. Pathophysiologic pain is not a warning sign, but is a pathological condition that harms the body, particularly if inflammation or damage occurs around or in the nerve tissues .

Continual or repetitive trauma, toxins, infection, or inflammation affecting the pelvis or bladder in BPS/IC patients can lead to peripheral nerve stimulation or damage, which is well known as pathophysiologic nociceptive pain. Neuropathic pain refers to pain arising as a result of damage to any part of the sensory system. Neuromas, regenerating sprouts, and demyelination are thought to be responsible for the ectopic discharge of injured nerves. In contrast with nociceptive pain, the quality of pain associated with neuropathic lesions is often entirely new and different to the patient. Specific emotional factors such as anxiety and depression are known to enhance the experience of pain, which can be categorized as psychogenic pain. Adrenaline and carbon dioxide during anxiety and stressful periods increase the activities of the reticular activating system in the midbrain and rostral pons and the transmission of nociceptive input to the thalamus and the cerebral cortex. Depression can enhance nociception by reducing the activity of the powerful descending inhibitory pathways from the brainstem. Anxiety or depression can strengthen the pain, whereas chronic pain induces even more stress in the depressed patient, leading to aggravation of the condition .

Peripheral sensitization of primary afferent sensory fibers by mediators of the pain response results in greater and more frequent transmission of action potentials to nociceptive neurons than in “normal” pain responses, and central sensitization can also cause an individual to perceive greater and more prolonged pain owing to increased central neuronal responsiveness. Pathophysiologic pain has characteristic features including hyperexcitation, receptive field expansion, hyperalgesia, allodynia caused by long-term changes in nociceptive neurons, peripheral or central sensitization, and wind-up. Thus, BPS/IC patients have simple bladder pain as well as symptoms like hyperalgesia and allodynia in their complicated or amplified form. This “pain memory” in the central nervous system may be why IC patients become refractory to different therapies .

In the treatment of BPS/IC, patient education and empowerment, dietary manipulation, pelvic floor relaxation, pain killers including narcotic analgesics, intravesical therapy, intramural botulinum toxin injection, neuromodulation, and surgical intervention have been adopted with variable success . Despite the diversity of treatment, BPS/IC is a chronic disease, and no current treatment has a significant impact on symptoms over time in the majority of patients. If bladder inflammation by a progressive defect in epithelial permeability were suspected as the cause of the bladder pain in BPS/IC patients, the epithelial defect, bladder inflammation, and bladder pain should be selected as targets of treatment. However, if bladder inflammation by epithelial defect does not currently exist but was the cause of the current pain owing to its existence at a specific time in the past, BPS/IC must be considered as a chronic pain syndrome. In such a case, treatment must be focused on effective, quick, and long-term removal of pain.

The basic principles of pain treatment are as follows. First, pain must be quickly treated before peripheral or central sensitization; prognosis can be improved by faster treatment. Second, if pain remains after various treatment modalities, treatment must be continued for a longer period to reduce or remove the pain. Third, all parts of the pain development mechanism, from direct injury or inflammation to the nerves in the peripheral or central nervous system and peripheral nociception to central sensitization, must be targets of pain treatment by use of diverse drugs.

We performed low-dose triple therapy until bladder pain was relieved in BPS/IC patients. However, despite such continued treatment, we observed breakthrough, exacerbation, or periodic flare-up symptoms with transient, fluctuating, worsening characteristics in 7 patients. These patients were prescribed PDS 10 mg, once a day for 1 to 3 months. Once the flare-up symptoms disappeared, PDS was slowly stopped after tapering the dose, and only triple therapy was continued.

Our triple therapy comprised minimal doses of each drug, including tricyclic antidepressants (amitriptyline, duloxetine), anticonvulsants (gabapentin, pregabalin), and analgesics (NSAIDs), and we then compared the scores before and after low-dose triple therapy. The ICSI and ICPI scores at 1, 3, and 6 months after low-dose triple therapy showed a 60 to 70% improvement, and the VAS score showed an improvement of more than 70%. These improvements were statistically significant. When pain disappears, the drug treatment should be stopped and the patient should be monitored carefully .

In patients in whom bladder pain is not improved by low-dose triple therapy, treatment with opioids, neuroleptics, and α2-agonists affecting the central nervous system such as the brain and the spinal cord have been attempted. Such methods have not shown satisfactory effects, however, and are accompanied by many side effects. Most opioids are µ-opioid receptor agonists or drugs with direct affinity for µ-opioid receptors. Short-term opioid therapy can relieve the breakthrough or exacerbated pain or show relapse of pain with an average decrease of approximately 30%. However, the frequent occurrence of significant adverse events such as tolerance, dependence, withdrawal phenomenon, individual variability in response, opioid-induced hyperalgesia, and deleterious effects on quality of life, including mood, disability, activities, and sex, limit the use of these drugs. Also, neuroleptics (haloperidol, chlorpromazine) block dopaminergic receptors at mesolimbic sites, and α2-agonists (clonidine, Catapres) are known to function through activation of the descending inhibitory pathway in the dorsal horn .

We chose to use corticosteroids in our patients with BPS/IC for the following reasons. Firstly, corticosteroids have antiinflammatory, immune-modifying, and pain-modulating properties that target the immunity, inflammatory, and neurological cascades. IC has many features of an autoimmune disease-chronicity, exacerbation, remission, high prevalence of antinuclear antibodies, and association with other autoimmune syndromes . There have been several reports of patients with lupus cystitis who improved with immunosuppressant therapy including corticosteroids . The most striking effect of glucocorticoids is inhibition of the endoneurial expression of proinflammatory cytokines (cytokines, enzymes, receptors, and adhesion molecules). There are ample evidences that an increase in the level of endoneurial tumor necrosis factor-alpha (TNF-α) contributes to neuropathic pain following nerve injury. Neuroinflammation is supposed to play a crucial role in the pathology of neuropathic pain . It is conceivable that glucocorticoids might modulate this neuroimmune interaction. Therefore, antiinflammatory and immunosuppressive effects of corticosteroids are indicated to improve pain by inhibiting the production of inflammatory mediators, reducing prostaglandin synthesis, and suppressing ectopic neural discharges from the injured or inflamed fibers .

Secondly, corticosteroids can work as a mast cell stabilizer to prevent symptoms and the progression of BPS/IC. Mast cells contain vasoactive and inflammatory mediators (e.g., histamine, leukotrienes, prostaglandins, and tryptases) and play a central role in the pathogenesis of neuroinflammatory conditions, including IC. Degranulation occurs in response to immunoglobulin E, substance P, cytokines, bacterial toxins, allergens, toxins, and stress. Mastocytosis occurs in 30 to 65% of IC patients. Increased levels of histamine, histamine metabolites, and tryptase occur in IC patients. The therapeutic response to treatment with antihistamines (e.g., hydroxyzine) and leukotriene inhibitors speaks to the role of mast cells in IC pathogenesis . TNF may act directly on mast cells or indirectly by inducing the secretion of mast cell chemokines in neurogenic cystitis. Mast cell activation could then stimulate C-fibers and result in pain. Thus, blockage of mast cell migration to the lamina propria as well as blockage of mast cell activation would minimize mast cell activation of C-fibers. Endoneurial mast cells have a key role in the pain syndromes seen after nerve injury via their release of TNF-α and other mediators, including factors that recruit leukocytes to the site of injury. Glucocorticoid therapy for neuropathic pain may work via the reduced expression of TNF-α in endoneurial mast cells .

On the basis of this knowledge, we administered oral PDS when the flare-up phenomenon appeared, and successful results were achieved in 7 patients. To the best of our knowledge, this is the first trial to assess such an approach to treatment. Compared with the values before PDS treatment, the ICSI, ICPI, and VAS scores improved after PDS treatment by 70.7%, 68.6%, and 69.9%, respectively. Low-dose triple therapy with PDS caused no significant adverse effects including mood change.

Instead of using a double-blind placebo-controlled trial, we used a research model in which the pretreatment pain level of the patient was set as the control. This was done because, first, the use of placebo in patients with severe pain is unethical and patient agreement cannot be obtained easily. Especially with the existence of effective treatment, delay in treatment may cause progression of the disease. Second, the necessity of placebo-controlled trials has been questioned by easy unblinding caused by the side effect profile and drug efficacy in the active arm of the study. The results of the present study are believed to have greater reliability with a higher value compared to 35%, the maximum effect generally anticipated with placebo. In patients with BPS/IC who showed transient, fluctuating, worsening pain as a flare-up symptom despite undergoing low-dose triple therapy, a short course of oral PDS therapy was sufficiently effective. However, large-scale studies should be performed to verify our findings.

Anabolic Steroid Abuse

Original Editors – Adam Fischer & Nancy Marshall from Bellarmine University’s Pathophysiology of Complex Patient Problems project.

Top Contributors – Nancy Marshall, Adam Fischer, Wanda van Niekerk, Elaine Lonnemann and Wendy Walker


Anabolic-androgenic steroids, commonly called “anabolic steroids”, are synthetic substances that resemble male sex hormones (e.g., testosterone). Anabolic steroids promote the growth of skeletal muscle and cause increased production of red blood cells (anabolic effects), and the development of male characteristics (androgenic effects) in both males and females. Anabolic steroids are also responsible for muscle and bone cell proliferation, while androgenic is responsible for both primary and secondary sex characteristics. Further benefits of anabolic steroids is the anti-catobolic properties, preventing tissue breakdown commonly associated with greater and greater intensity activities (i.e. greater distances, weights, times, etc.).

Common medical uses of anabolic steroids include replacement therapy to treat delayed puberty in adolescent boys, hypogonadism and impotence in men, breast cancer in women, anemia, osteoporosis, weight loss and other conditions with hormonal imbalance.

Anabolic steroids can be injected, taken orally, or applied externally as a gel or cream. Due to the possibility of serious adverse effects and a high potential for abuse, they are classified as Schedule III Controlled Substances in the U.S. Doses taken by abusers can be 10 to 100 times higher than doses used for medical conditions.

Some commonly abused anabolic steroids are listed in the table below.


Prevalence of anabolic steroid use is poorly researched, particularly in longevity. Individuals using AAS range from adolescent weight trainers to high level professional athletes and olympians. Most research data collected is acquired through direct survey methods. Due to the nature of self reporting surveys, AAS is likely to be under reported. As social attitude towards the acceptance of anabolic androgenic steroid use changes, better profiling of this patient population may be seen. Current research suggest prevalence among adolescence at 1-5%.

The 2005 Monitoring the Future study, a NIDA-funded survey of drug use among adolescents in middle and high schools across the United States, reported that past year use of steroids decreased among 8th- and 10th-graders since peak use in 2000. Among 12th-graders, there was a different trend—from 2000 to 2004, past year steroid use increased, but in 2005 there was a significant decrease, from 2.5 percent to 1.5 percent.

Characteristics/Clinical Presentation

Clinical signs and symptoms of anabolic steroid use include:

Severe depression leading to suicide can occur with anabolic steroid withdrawal.

In the pediatric population, there is a risk of decreased of delayed bone growth. Tendon or muscle strains are common and take longer than normal to heal.

Diagnostic Tests/Lab Tests/Lab Values

A urinalysis is the most common screening method with the use of GC-MS, known as gas chromatography and mass spectrometry, which identifies a specific substance in a certain provided sample. Traditionally, gas chromatography (GC) coupled with mass spectrometry (MS) has been used for confirmation of anabolic steroids and their metabolites in human urine.


One of the main reasons people give for abusing steroids is to improve their athletic performance. Another is to increase their muscle size or to reduce their body fat. This group includes people suffering from the behavioral syndrome called muscle dysmorphia. In one series of interviews with male weightlifters, 25% who abused steroids reported memories of childhood physical or sexual abuse. Similarly, female weightlifters who had been raped were found to be twice as likely to report use of anabolic steroids or another purported muscle building drug, compared with those who had not been raped. Also, some adolescents abuse steroids as part of a pattern of high-risk behaviors.

Systemic Involvement

Systemic involvement resulting from anabolic-androgenic steroid abuse varies among individuals related to length of use and dosage. Systems involved include, but are not limited to: endocrine, urogenital, integumentary, cardiovascular, hepatic, skeletal muscle, psychological, pulmonary. For a detailed description of the influence of anabolic steroids on physiological processes and exercise see this Physiopedia Page:

  • The influence of anabolic steroids on physiologic processes and exercise

Possible health consequences of anabolic steroid abuse:

Hormonal system

  • Men
    • Infertility
    • Breast development
    • Shrinking of the testicles
    • Male-pattern baldness
  • Women
    • Enlargement of the clitoris
    • Excessive growth of body hair
    • Male-pattern baldness

Musculoskeletal system

  • Short stature (if taken by adolescents)
  • Tendon rupture

Cardiovascular system

  • Increases in LDL; decreases in HDL
  • High blood pressure
  • Heart attacks
  • Enlargement of the heart’s left ventricle


  • Cancer
  • Peliosis hepatitis
  • Tumors


  • Severe acne and cysts
  • Oily scalp
  • Jaundice
  • Fluid retention


  • Hepatitis

Psychiatric effects

  • Rage, aggression
  • Mania
  • Delusions

Medical Management

Pharmacological management of androgenic anaboloic steroid abuse is not always indicated, with supportive behavioral psychotherapy and patient education of withdrawal signs and symptoms being sufficient plans of care. Psycho-pharmacological intervention may include prescription of anti-anxiety or anti depressants in combination with cognitive behavioral therapy. Pharmacological management of AAS abuse addresses hormonal imbalances as a result of chronic use or addresses specific signs and symptoms of withdrawal including;

  • weakness
  • fatigue
  • decreased appetite
  • weight loss
  • nausea
  • vomiting
  • diarrhea
  • abdominal pain

Physical Therapy Management

Very little information is available providing suggested physical therapy management of patient populations abusing AAS. Professional healthcare providers are faced with ethical considerations when treating those using or recovering from anabolic-androgenic steroid use and associated conditions. The American Medical Association called for a formal ban on over the counter anabolic steroids and associated hormonal derivatives. Physical Therapists may be treating associated symptoms related to systemic involvement of prolonged AAS abuse.

Psychological Management

There is limited literature available for forms of cognitive psycho therapy aimed at treating clinical depression and associated detrimental behavioral patterns.

Differential Diagnosis

Any young adult with chest pain of unknown cause, possibly accompanied by dyspnea and elevated blood pressure and without clinical evidence of neuromusculoskeletal involvement, may have a history of anabolic steroid use. Consider anabolic steroid use as a possibility in men and women presenting with chest pain in their early 20’s who have used this type of steroid since age 11 or 12.

Case Reports/ Case Studies


Urinary tract infections are uncomfortable and can lead to serious complications, even organ damage. Commonly referred to as UTI’s, the infection primarily targets the bladder and kidneys and has a nasty tendency to recur. Women, teens, and young children are most often afflicted but men can suffer from them as well. While UTI’s may seem like a straightforward infection for which antibiotics are the clear solution, they are anything but, and the following 10 facts will make that clear.

Facts About Urinary Tract Infections

1. Antibiotics are not the Answer

Many of the bacteria which cause UTI’s have developed resistance to antibiotics and the impact is alarming! Multi-drug resistant pathogens, or MDRs, scoff at typical antibiotics and need to be addressed with a more aggressive, heavy-duty profile. Enterococci bacteria are especially resistance to standard antibiotics. Those who suffer from recurring UTI’s face the concern of increased infection by antibiotic resistant bugs. Clearly, prevention is best measure in the battle against UTI’s.

2. Bacteria are not the Only Culprit

Have you ever heard of schistosomiasis? It’s a disease caused by a harmful organism (a flatworm, specifically) and may cause UTI’s. There are four types of schistosomiasis all can lead to kidney disease and bladder cancer. Worldwide, 200 million people are infected every year and 100,000 die. Although it’s most common to Africa and the Middle East, it’s on the move; even to as far away as Fiji.

3. Urinary Tract Infections Complicate Diabetes

A recent study found that patients with diabetes are more likely to have drug resistant bacteria that cause urinary tract infections – especially if their diabetes is poorly regulated. Another study found that both men and women with diabetes have a greater risk of developing urinary tract infections than others. The most startling revelation is that urinary tract infections may even cause life threatening complications for diabetics.

4. Pregnant Women Have Added Risks

Unfortunately, the incidence of urinary tract infection increases for women during pregnancy. One study suggested an association between UTI’s and serious concerns such as preterm birth and smaller than normal gestational age infants. To counteract recurring UTI’s during pregnancy, many women use natural remedies like cranberry juice, probiotics, or acupuncture.

5. Obesity Increases Risk of UTI’s in Men

A 2013 study examined how obesity affects the chances of developing a UTI and found that obese men are two times more likely to develop the UTI than obese women. Obese men and women are also more likely to develop UTI’s than the non-obese and have added chance of developing serious complications.

6. Eye Damage May be a UTI Complication

A urinary tract infection can lead to bladder and kidney damage; but it can also affect the eye. Although rare, when both kidneys are infected and untreated, eyesight damage can occur.

7. Rheumatoid Arthritis Linked to Higher Chance of Infection

Persons with rheumatoid arthritis visit the emergency room twice as often for UTI’s than persons without. For those visits, a recurring UTI, which required hospitalization, usually occurs within a year. One possible cause is that the use of oral steroids taken for rheumatoid arthritis may increase the occurrence of the UTI and recurring infection.

8. UTI’s Can be a Common Concern for Kids

One in five children who have one UTI will have more. Unfortunately, long-term studies have demonstrated little success with antibiotics. Based on the research, prevention appears the best approach with a focus on education and proper care. For those children who do suffer from a UTI, cranberry juice may be effective.

9. Cranberry is an Excellent Remedy

Cranberry has long been used to address UTI’s and is recommended by many doctors. Multiple studies have found that cranberry was as effective as antibiotics, and produced no side effects. One randomized, placebo-controlled study reported that, over a 24-week period, women who consumed cranberry juice did not experience a recurrence of infection. Cranberry juice with high concentrations of antioxidants, specifically proanthocyanidins, appears to be a helpful defense for UTI’s in children.

10. Probiotics are a Great Defense

With the ineffectiveness of antibiotics, research has turned to probiotics as a means to address urinary tract infections. Lactobacillus probiotic strains have demonstrated the best results. In one study, women who took this strain experienced significant improvements. This particular probiotic bacteria also stimulates immune function, lowers acidity levels in the urinary tract, and discourages the growth of UTI causing organisms.

What’s your preferred remedy for urinary tract infections? Leave a comment below and share it with us!

References (20)

†Results may vary. Information and statements made are for education purposes and are not intended to replace the advice of your doctor. If you have a severe medical condition or health concern, see your physician.


7 Surprising Risk Factors for Urinary Tract Infections

RELATED: 7 Tips to Help You Stay Hydrated

3. Taking certain drugs: As previously mentioned, whenever your bladder holds on to urine, rather than emptying completely when you pee, bacteria have more of a chance to grow and your risk of getting a UTI increases. Some medication — including antihistamines, antipsychotic drugs, decongestants, and anticholinergic drugs — can cause you to retain urine. That doesn’t mean you should stop taking them, Dr. Rabin says. Just be aware of the extra risk, drink lots of water, and try to void completely when you visit the restroom.

4. Wiping the wrong way: There’s a reason your mother taught you to wipe from front to back after you pee or have a bowel movement. (If she didn’t, she should have.): Going in the opposite direction can help bacteria travel from your anus to your urethra and into your bladder, Rabin says. In fact, when researchers evaluated the behavior patterns of premenopausal women who are susceptible to recurrent urinary tract infections, they found that wiping from back to front increased the risk by 64 percent and that the vast majority of infections (66 percent) were due to E. coli (a bacteria that normally lives in the intestines), according to a study in a 2018 issue of the journal Urologia Internationalis.

RELATED: Excessive Sitting May Harm Your Urinary Tract, Study Finds

5. Going through perimenopause or menopause: As estrogen levels start to drop with age, midlife women may experience some thinning of the tissues in the vagina and bladder, and the nerves and muscles may not function as well, which can cause difficulty emptying the bladder fully, Rabin explains. These changes can in turn foster bacterial growth, increasing the risk of UTIs.

RELATED: Bladder Symptoms Can Hamper Your Sex Life, Study Suggests

6. Having diabetes: Believe it or not, having diabetes can increase your chances of suffering from UTIs. In fact, research has found that the frequency of UTIs increases in women with type 1 diabetes who have poor blood sugar control. And people, especially older women, with type 2 diabetes who have high levels of hemoglobin A1C (a marker of average blood sugar levels over the previous three months) have a higher risk of UTIs, research has found. Adding insult to misery, UTIs tend to be more common, more severe, and harder to treat in people with type 2 diabetes, partly because higher levels of sugar in the urine can promote the growth of bacteria, experts note.

7. Wearing little lingerie: Wearing a thong, a teddy, or string-bikini underwear may make you feel sexy, but it can trap bacteria in the vaginal area and compress the sensitive tissue down there, making you more susceptible to vaginal infections and UTIs. “There are only a couple of inches of space between the openings to the urethra, the vagina, and the rectum,” Rabin notes. “Tight underwear can act as a superhighway for bacteria from the anus to travel to the vaginal area.”

What Is a Urinary Tract Infection?

US Pharm. 2017;9(42):4-7.

Urinary tract infections (UTIs) are the most commonly occurring infections, affecting approximately 150 million people worldwide each year.1 In the United States alone, the societal costs of UTIs are estimated to be $3.5 billion annually.1 UTIs can affect both men and women, but they are especially common in women of childbearing age.2 Most women will experience at least one episode during their lifetime; by 32 years of age, more than half of all women will have reported having at least one urinary tract infection.2,3 Almost 25% of women will have a recurrent infection within a year.2

A UTI is an infection of the urinary system. UTIs are classified as uncomplicated and complicated.4 Uncomplicated UTIs are those occurring in healthy, premenopausal women with no urinary tract abnormalities.3 Complicated UTIs are caused by abnormalities that compromise the urinary tract, such as urinary obstruction, urinary retention, immunosuppression, renal failure, renal transplantation, and presence of foreign objects; pregnancy is another cause.1 Indwelling catheters account for one million cases, or 70% to 80%, of complicated UTIs in the U.S. per year.1 Complicated UTIs occur in both sexes and often affect the upper and lower urinary tracts. UTIs are further categorized based on location: lower UTIs (cystitis) and upper UTIs (pyelonephritis). Pharmacists will frequently encounter patients inquiring about relief from UTI-related symptoms, so it is important that they understand the various OTC products marketed for the management of UTIs.

Etiology and Risk Factors

Urine is generally sterile, and the causative agents for most UTIs originate in bowel flora that enter the periurethral area. Most UTIs are caused by one organism; UTIs caused by multiple organisms may indicate contamination. The causative agents are gram-positive and gram-negative organisms, as well as some fungi.1 The gram-negative bacterium Escherichia coli accounts for almost 90% of all episodes.3,5 Other common causative agents include Staphylococcus saprophyticus, Klebsiella pneumoniae, Enterococcus faecalis, group B streptococcus, Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus aureus, and Candida species.

Women are more likely to develop a UTI because their urethras are shorter than men’s.5 Other risk factors include previous episodes of UTI, sexual intercourse, spermicide use, new sexual partner, reduced mobility, changes in vaginal flora, pregnancy, menopause, diabetes, urinary incontinence, kidney stones, prostate enlargement, and history of UTI in a first-degree relative.2,4,5 In the elderly population, other risk factors to consider are age-related changes in immune function, increased exposure to nosocomial pathogens, and an increased number of comorbidities.6 Certain behaviors are thought to contribute to the development of UTIs, such as frequency of urination and delayed voiding, not voiding pre- and postcoitally, consumption of certain beverages, hot tub usage, douching, wiping patterns, and choice of clothing; BMI may also be a factor. A case-control study found no increased risk of UTI development with these practices.7

Clinical Presentation and Diagnosis

Patients with cystitis often present with a frequent, persistent urge to urinate despite passing a small amount, dysuria or a burning sensation during urination, or suprapubic heaviness.7 Patients with pyelonephritis often experience flank pain or tenderness, a low fever (<101 F), chills, nausea, vomiting, and malaise with or without symptoms of cystitis.2 Patients with a lower or upper UTI may experience hematuria or notice that their urine is cloudy or has a strong odor. Elderly patients tend to present with nonspecific symptoms including altered mental status, change in eating habits, lower abdominal pain, and gastrointestinal symptoms such as constipation.6

In most patients who present with signs and symptoms of UTIs, a history of illness is the most important diagnostic tool, especially when symptom onset is sudden or severe and when vaginal discharge and irritation are not present.2,3 Sometimes, however, UTI diagnosis cannot rely solely on patient symptoms because some patients are asymptomatic; this is more common in older adults than in younger adults.6 Laboratory tests, urine-sample tests, and pelvic examinations should be performed in patients with urinary tract symptoms to properly diagnose UTIs.2,3 Laboratory tests for UTIs include assessments for the presence of bacteriuria and pyuria, nitrite, leukocyte esterase, and antibody-coated bacteria.2

Commercially available dipsticks may be used to detect the presence of a UTI. The pharmacist can recommend an OTC UTI home test kit to determine whether causative agents of UTI are present. After use, the patient should call the physician with the results for evaluation and treatment. The available test kits detect leukocyte esterase and nitrite. Testing for these substances increases overall sensitivity and specificity and reduces the risk of false-negative results.8 Self-testing for UTIs has been proven accurate with proper use, but to avoid inaccurate or false results, patients should be advised to obtain a clean-catch urine specimen and to avoid consuming more than 250 mg of vitamin C within 24 hours of testing; women should not test during their menses.8,9 A strict vegetarian diet, tetracycline, and phenazopyridine may cause inaccurate results.9

Preventive Measures

Almost 25% of women experience recurrent episodes of UTI.10 This is defined as either two uncomplicated UTIs in 6 months or three or more positive cultures within the preceding 12 months.10 UTIs can occur even when precautions are taken, but pharmacists can recommend preventive measures to reduce a patient’s risk for recurrent infections. If a woman is using spermicide-containing contraceptives, she should be counseled about the possible connection between her contraceptive method and recurrent infections, and an alternative form of contraception should be considered. Although studies have not indicated a correlation, behavioral modifications such as staying hydrated, urinating before and after sexual activity, urinating regularly, using tampons instead of sanitary pads and changing them every 3 hours, wiping from front to back, wearing clean cotton underwear and loose-fitting, breathable clothing, and taking showers instead of baths may be helpful. Topical estrogen therapy in postmenopausal women may help prevent UTI recurrences by altering the vaginal flora.6,11 Evidence for use of acupuncture and immunoprophylactic regimens is limited.12

There is little evidence of the efficacy of natural supplements in the prevention of UTIs. Research suggests that the antioxidant proanthocyanidin and the fructose in cranberries can help prevent bacteria, particularly E coli, from clinging to the walls of the urinary tract.13 Cranberry products are available in an array of dosage forms: juice, syrup, capsules, and tablets. Data on the efficacy of cranberry juice in preventing recurrent UTIs are conflicting. A recent Cochrane review determined that cranberry products do not significantly reduce the risk of recurrences compared with placebo.13 Similarly, the use of probiotics has also been considered for the prevention of UTIs. Probiotics support the body’s normal flora, and it is theorized that probiotics form a barrier against pathogens ascending the urinary tract, preventing the adherence, growth, and colonization of the urogenital epithelium by uropathogenic bacteria.14,15 To date, data regarding a protective effect of probiotics against future UTIs have been inconsistent, and additional large, well-designed studies are needed to determine the effectiveness of probiotics.14

Management: Nonprescription Products

Active ingredients found in OTC urinary tract analgesics include phenazopyridine hydrochloride, methenamine, and sodium salicylate (TABLE 1). Phenazopyridine, which provides relief from the pain, burning, itching, and urgency of UTIs, is available in both prescription (100-mg and 200-mg tablets) and OTC form (95-mg and 97.5-mg tablets). The recommended OTC dosage is two tablets three times daily during or after meals with a full glass of water for up to 2 days. Patients with kidney disease or an allergy to dyes should not take this medication. Patients should be advised that their urine may become reddish-orange in color, which is not harmful but can stain clothing. Common adverse effects (AEs) include headache, dizziness, and upset stomach.

Methenamine (an antibacterial) and sodium salicylate (a nonsteroidal inflammatory drug ) work in conjunction with one another; sodium salicylate stabilizes the urine pH, allowing methenamine to slow the growth of bacteria along the urinary tract and control the UTI. The recommended dosage is two tablets three times daily. Patients should be advised not to take this product if they are allergic to salicylates, are on a low-sodium diet or anticoagulant therapy, or have stomach problems.

Patients may also take pain relievers, such as NSAIDs or acetaminophen, for general relief of UTI-associated pain.

Role of the Pharmacist

It is imperative that pharmacists urge patients who present with UTI symptoms to consult with their healthcare provider as soon as possible to receive appropriate care. Pharmacists should counsel patients on nonpharmacologic treatments and present the option of nonprescription products and UTI home test kits. Patients who decide to use UTI home test kits should be advised on how to avoid inaccurate results and to discuss their results with their healthcare provider. Patients who decide to use OTC urinary tract analgesics should be counseled on the recommended maximum dosage and duration and on common AEs. It is imperative to remind patients that these products are intended only to provide relief of pain and other related symptoms until the healthcare provider is seen. These products do not eradicate bacteria or replace the use of antibiotic treatment, and they should not be used as monotherapy.

What Causes UTIs?

The bacterium that causes most UTIs is Escherichia coli. UTIs can affect both men and women, but they are more common in women. Although UTIs can affect anyone, some factors that can increase your chance of contracting a UTI include sexual intercourse, menopause, spermicides, pregnancy, older age, obesity, genetics, and antibiotic use.

How Can I Tell if I Have a UTI?

Not all UTIs have obvious symptoms, but signs and symptoms of a possible UTI include the need to urinate often, pain and burning sensations during urination, low fever, nausea, vomiting, feeling ill, and back or abdominal pain. You may also notice that your urine is bloody, cloudy, or odorous.

See your doctor immediately if you think you have a UTI, or ask your pharmacist about purchasing a UTI test kit. If you decide to use the take-home UTI test strips, follow the instructions carefully and be sure to discuss your test results with your doctor.

What Can I Take to Relieve Pain?

Phenazopyridine hydrochloride may relieve your pain, burning, itching, and urgency to urinate within 20 minutes. Avoid taking it if you have kidney disease or are allergic to dyes. Do not worry if your urine turns reddish-orange when you take this medication. This common effect is not harmful, but it can stain clothing.

Methenamine (an antibacterial agent) and sodium salicylate (a nonsteroidal inflammatory drug ) work together to slow bacterial growth along the urinary tract and to control the UTI. Do not take this medication if you are allergic to aspirin, are on a low-sodium diet or anticoagulant therapy, or have stomach problems.

You can also take other pain relievers, such as NSAIDs (aspirin, ibuprofen, naproxen, celecoxib) or acetaminophen (Tylenol).

What Natural Supplements Can I Take to Prevent Another UTI?

There is little evidence that natural supplements can prevent UTIs, but you can try cranberry supplements or probiotics. Cranberries contain antioxidants that may help prevent bacteria in the urinary tract from sticking to the walls of the urinary tract. Drinking 10 to 30 oz of cranberry juice per day may be beneficial. Probiotics may help prevent UTIs by supporting the body’s natural microorganisms in the flora.

What Steps Can I Take to Prevent Another UTI?

Drink lots of water, urinate before and after sexual activity, change tampons regularly, wipe from front to back, wear cotton underwear and loose-fitting clothing, and take showers instead of baths.

Remember, if you have questions, Consult Your Pharmacist.

To comment on this article, contact [email protected]

4 Surprising Causes of Urinary Tract Infections

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Urinary tract infections are more than annoying-they can be pretty painful, and unfortunately, about 20 percent of women will get one at some point. Even worse: Once you’ve had a UTI, your likelihood of having another one goes up. That’s why we’re interested in anything we can do to suffer from them less frequently! You’ve heard about healthy habits like wiping-ahem-properly (that’s front to back) and peeing after sex. But did you know that these four things could also raise your risk for this common women’s health condition?

1. Cold, flu, and allergy meds. Any time your bladder holds onto urine, rather than completely voiding when you pee, your risk of a UTI goes up. That’s because the longer urine sits in your bladder, the more time bacteria has to grow. Some medications can cause this; for example this month’s Harvard Health Letter warned that antihistamines could lead to UTIs. Decongestants can also have this effect, making your anti-allergy, anti-cold medications a common culprit. (Feeling under the weather? Check out these 5 Yoga Moves to Beat the Flu.)

2. Your birth control. If you use a diaphragm to prevent pregnancy, you could be at a higher risk of getting a UTI, reports the Mayo Clinic. A diaphragm may press against your bladder, which makes it difficult to completely empty it, which is one of the causes of a UTI. Spermicides can throw off the balance of bacteria, putting you at risk as well. If you have recurring UTIs, it might be worth asking your doctor about trying a new form of birth control.

3. Chicken. Yep, you read that right. A study in the journal Emerging Infectious Diseases found a genetic match between the e. coli bacteria that causes UTIs in humans and the e. coli in chicken coops. If you handle contaminated chicken and then go to the bathroom, you could be transmitting the bacteria to your body via your hands. (To minimize the chances of this happening to you, make sure to wash your hands thoroughly before and after preparing food, and cook raw meet well.)

4. Your sex life. UTIs aren’t sexually transmitted, but sex can push bacteria into contact with your urethra, so getting busy more frequently than usual can raise your risk of contracting one. That’s why most infections start within 24 hours of sexual activity. Other sex-related risk factors: a new guy or multiple partners-so don’t forget to have these 7 Conversations for a Healthy Sex Life.

  • By Marnie Soman Schwartz

5 Steps to Break the Cycle of Chronic Urinary Tract Infections

As a child, I had chronic urinary tract infections. I was treated with multiple antibiotics from the age of 5 until age 17. This chronic use of antibiotics impacted my skin and my digestive system. It may have even contributed to the breast cancer I got at age 30. Throughout my training in medical school and functional medicine, I learned the importance of avoiding antibiotics as much as possible. Recurrent use of antibiotics increases your risk of getting another infection and causes the bacteria to become resistant to the antibiotics. But all too often, many people get into the cycle of continual antibiotic use. Common infections that become chronic or frequent include ear infections, sinus infections, and urinary tract infections. In the past, I found chronic urinary tract infections a difficult problem for both myself and my patients. Now, I am excited when a woman comes to see me with chronic urinary tract infections, because I know that I can help her.

These are 5 important instructions I give my patients for preventing urinary tract infections:

  1. Use Probiotics – We have trillions of good bacteria that line our skin, digestive system and also our genital urinary system. These good bacteria have a tremendous influence on our immune system. They are often the first line of defense that prevents unwanted bacteria or viruses from invading the body. When we kill off these good bacteria with antibiotics, we increase our risk of developing a secondary infection, sometimes in a different part of the body. For example, many times people who take an antibiotic for a sinus infection also get a urinary tract infection or vaginal yeast infection. Or they will go on to get a viral upper respiratory infection. This is all too common. When it comes to antibiotics, only take them when necessary. Also, replace the good bacteria that the antibiotics killed through fermented foods and probiotics. Multiple strains of Lactobacillus probiotics taken orally or vaginally have been shown to decrease the risk of getting a bladder infection. Lactobacillus reuteri and Lactobacillus rhamnosus, taken by mouth, have been shown to colonize the vaginal tract and decrease the risk of urinary tract infections. Vaginally applied probiotics can also prevent both urinary tract infections and yeast infections.
  2. Consume Cranberry – Cranberry extract prevents the bacteria that cause bladder infections from being able to bind to the bladder wall. I usually have people avoid cranberry juice because of the excess sugar, so cranberry extract is a great alternative. Cranberry capsules are an excellent supplement that can be used for prevention. Here are some of my favorite cranberry tablets. I often have women take 2 tablets daily for prevention of urinary tract infections and increase if they are having symptoms.
  3. Add in D-Mannose – D-Mannose also prevents the bacteria that often cause urinary tract infections from adhering to your bladder wall.. Studies have shown that 2 grams per day work better than even antibiotics at prevention of urinary tract infections. You can get tablets that have both cranberry and D-Mannose or just D-Mannose as a tablet or powder.
  4. Reduce Sugar – High levels of sugar in the diet can encourage the wrong kinds of bacteria and yeast to grow in your body and increase your risk of multiple infections. Avoid added sugar in your diet. It is important to choose a whole foods diet that is low in processed foods. This will ensure that you get the necessary nutrients to support your immune system and decrease your risk of many infections, including urinary tract infections.
  5. Don’t Forget the Basics – Drink plenty of water, do not hold your urine, use cotton underwear, and urinate right after sexual intercourse. Whenever you urinate, the bacteria that may be in your urinary tract system are flushed out. So keeping your urine dilute and urinating frequently can help decrease your risk of getting urinary tract infections.

If you are experiencing the symptoms of urinary tract infections, like burning while urinating, frequent urination, blood in your urine, fevers, or back pain, make sure to see your doctor immediately and get your urine tested.

I hope these 5 tips decrease your risk of getting a urinary tract infection and break the cycle.

To Your Health,


But, there are some cases where antibiotics are a good idea, so keep reading.

Strep Throat

Symptoms typically include a very sore throat along with a fever of 101 or greater, sore glands (lymph nodes) under your jaw on the side of your neck, tonsils that are bright red or have white patches (exudates). It’s doubtful that it’s Strep throat if you have a cough, runny nose, or congestion along with the other symptoms. Strep throat is actually less likely in adults than in children.


This type of chest infection is not one to mess with–it can be life-threatening, particularly in young babies and older adults. Symptoms typically include a fever of 101 or higher, cough, pain in the chest when inhaling, extreme fatigue, and shortness of breath. If you’ve got these symptoms a trip to urgent care or your PCP (if you can get in the same day) is essential.

Some Ear infections

This one has caveats. Viral and bacterial ear infections can cause ear pain and congestion, fever, and may come with a cough or a runny nose. The only way to know if an antibiotic is needed is to have a doctor actually look inside your ear with an otoscope. If there’s a collection of pus behind the eardrum, then antibiotics are in order. Otherwise, it will usually clear up with Tylenol, ibuprofen, and time. Bacterial ear infections are much more common in children, but they can happen to adults as well.

Some Sinus infections

These pesky infections cause congestion, headaches, facial pain and pressure, and lots of mucus drainage. Most of the time antibiotics are not needed because sinus infections typically start out viral. Some people are unlucky enough to contract a bacteria as a secondary infection. If you have any of the following, it’s more likely to be bacterial and warrant an antibiotic: fever of 101 or higher, severe facial pain that has been present at least 4-5 days, sickness for about a week – where you felt a significant improvement and then got much worse, or symptoms that have persisted for more than 10-14 days.

For most of the other cases of a cough, cold, bronchitis, sore throats, the sniffles, head colds, and upper respiratory infections, it’s a matter of getting rest, taking medications to alleviate symptoms, and riding it out. When in doubt (especially with children, older adults, and those with underlying medical conditions), it’s a good idea to see a doctor.

It was February, and clinic was teeming with respiratory infections of all kinds: mostly the common cold, but also bronchitis, pneumonia, and sinus infections. The patients were coming in usually thinking that they needed antibiotics for their sinus infection, or another respiratory infection.
The first patient on my schedule was a healthcare provider with “sinus infection” written down as her main issue.* She’d had about two weeks of nasal and sinus congestion which she blamed on a viral upper respiratory infection (URI, also known as the common cold). Her two young kids had been sick with colds all winter, so she wasn’t surprised to have these symptoms, along with endless postnasal drip and a cough.

Her congestion had improved a bit at one point, and she thought that she was finally getting better. But then, the day before her appointment, she awoke with throbbing pain between her eyes, completely blocked nasal passages, and, more concerning to her, green pus oozing from her left tear duct. She had body aches, chills, and extreme fatigue. “Do I maybe need antibiotics?” she asked.

Most sinus infections don’t require antibiotics

Ah, sinus infections. The New England Journal of Medicine published a clinical practice review of acute sinus infections in adults, that is, sinus infections of up to four weeks. The need for an updated review was likely spurred by the disconcerting fact that while the vast majority of acute sinus infections will improve or even clear on their own without antibiotics within one to two weeks, most end up being treated with antibiotics.

It is this discrepancy that has clinical researchers and public health folks jumping up and down in alarm, because more unnecessary prescriptions for antibiotics mean more side effects and higher bacterial resistance rates. But on the other hand, while 85% of sinus infections improve or clear on their own, there’s the 15% that do not. Potential complications are rare, but serious, and include brain infections, even abscesses.

But sometimes, antibiotics for sinus infections are needed

So how does one judge when it is appropriate to prescribe antibiotics for a sinus infection? There are several sets of official guidelines, which are all similar. When a patient has thick, colorful nasal discharge and/or facial pressure or pain for at least 10 days, they meet criteria for antibiotic treatment. If a patient has had those symptoms, but the symptoms seemed to start improving and then got worse again, then even if it’s been less than 10 days, they meet criteria for antibiotic treatment. (That’s referred to as a “double-worsening” and is a common scenario in bacterial sinus infections.)

The authors, however, also suggest that doctors discuss “watchful waiting” with patients and explain that most sinus infections clear up on their own in one to two weeks, and it’s a safe option to hold off on antibiotics. The symptoms can then be treated with a cocktail of over-the-counter medications and supportive care, like nasal saline irrigation, nasal steroid sprays, decongestants, and pain medications.

Of course, many patients expect and demand antibiotics for sinus infections, and even those who are open to watchful waiting may hear about the rare but possible complications of things like, oh, brain abscess, and opt to treat.

In the case of my patient above, she met criteria for treatment. She weighed the watchful waiting option against the potential risks of antibiotics for her sinus infection, and chose the prescription. I can tell you from very close follow-up that she improved quickly, though in truth, we will never really know if she would have gotten better anyway.

*This is a real case, details recalled as accurately as possible, based on my own experience as a patient with a sinus infection, originally posted here.

Antibiotics are medicines that can kill bacteria. Doctors often use antibiotics to treat urinary tract infections (UTIs). The main symptoms of UTIs are:

  • A burning feeling when you urinate.
  • A strong urge to urinate often.

However, many older people get UTI treatment even though they do not have these symptoms. This can do more harm than good. Here’s why:

Antibiotics usually don’t help when there are no UTI symptoms.

Older people often have some bacteria in their urine. This does not mean they have a UTI. But doctors may find the bacteria in a routine test and give antibiotics anyway.

The antibiotic does not help these patients.

  • It does not prevent UTIs.
  • It does not help bladder control.
  • It does not help memory problems or balance.

Most older people should not be tested or treated for a UTI unless they have UTI symptoms. And if you do have a UTI and get treated, you usually don’t need another test to find out if you are cured. You should only get tested or treated if UTI symptoms come back.

Antibiotics have side effects.

Antibiotics can have side effects, such as fever, rash, diarrhea, nausea, vomiting, headache, tendon ruptures, and nerve damage.

Antibiotics can cause future problems.

Antibiotics can kill “friendly” germs in the body. This can lead to vaginal yeast infections. It can also lead to other infections, and severe diarrhea, hospitalization, and even death.

Also, antibiotics may help “drug resistant” bacteria grow. These bacteria are harder to kill. They cause illnesses that are harder to cure and more costly to treat. Your doctor may have to try several antibiot­ics. This increases the risk of complications. The resistant bacteria can also be passed on to others.

Antibiotics can be a waste of money.

Prescription antibiotics can cost from $15 to more than $100. If you get an infection from resistant bacteria, you may need more doctor visits and medicines that cost more.

When should older people take antibiotics for a UTI?

If you have UTI symptoms, antibiotics can help.

  • The most common UTI symptoms are a painful, burning feeling when you urinate and a strong urge to “go” often.
  • Other UTI symptoms in older people may include fever, chills, or confusion. Along with these symptoms, there is usually pain on one side of the back below the ribs or discomfort in the lower abdomen. There may be a change in the way the urine looks or smells.

Some kinds of surgery can cause bleeding in the urinary tract—for example, prostate surgery and some procedures to remove kidney stones or bladder tumors. If you are going to have this surgery, you may need testing and treatment for bacteria in urine.

This report is for you to use when talking with your health-care provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

© 2017 Consumer Reports. Developed in cooperation with the American Geriatric Society.

Urinary Tract Infection

Español: Infección de las vías urinarias

Do you have pain or burning when you urinate? You might have a urinary tract infection (UTI).

Antibiotics are needed to treat UTIs. Your doctor can determine if you have a UTI and what antibiotic is needed.

Urinary Tract Infection

A female urinary tract showing the bladder and urethra, demonstrating how bacteria from the skin or rectum can travel up the urethra.


A female urinary tract showing the bladder and urethra, demonstrating how bacteria from the skin or rectum can travel up the urethra.

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What is a urinary tract infection (UTI)?

UTIs are common infections that happen when bacteria, often from the skin or rectum, enter the urethra, and infect the urinary tract. The infections can affect several parts of the urinary tract, but the most common type is a bladder infection (cystitis).

Kidney infection (pyelonephritis) is another type of UTI. They’re less common, but more serious than bladder infections.

Risk Factors

Some people are at higher risk of getting a UTI. UTIs are more common in women and girls because their urethras are shorter and closer to the rectum, which makes it easier for bacteria to enter the urinary tract.

Other factors that can increase the risk of UTIs:

  • A previous UTI
  • Sexual activity, and especially a new sexual partner
  • Changes in the bacteria that live inside the vagina (vaginal flora), for example caused by menopause or use of spermicides
  • Pregnancy
  • Age (older adults and young children are more likely to get UTIs)
  • Structural problems in the urinary tract, such as prostate enlargement.
  • Poor hygiene, particularly in children who are potty-training


Symptoms of a bladder infection can include:

  • Pain or burning while urinating
  • Frequent urination
  • Feeling the need to urinate despite having an empty bladder
  • Bloody urine
  • Pressure or cramping in the groin or lower abdomen

Symptoms of a kidney infection can include:

  • Fever
  • Chills
  • Lower back pain or pain in the side of your back
  • Nausea or vomiting

Younger children may not be able to tell you about UTI symptoms they are having. While fever is the most common sign of UTI in infants and toddlers, most children with fever do not have a UTI. Talk to a doctor if you are concerned that your child may have a UTI.

baby icon See a doctor right away if your child is younger than 3 months old and has a fever of 100.4 °F (38 °C) or higher.

When to Seek Medical Care

See a doctor if you have symptoms of a UTI. While most cases of UTIs can be treated outside the hospital, some cases may need to be treated in the hospital.

Please see your doctor for any symptom that is severe or concerning.


Your doctor will determine if you have a UTI by asking about symptoms, doing a physical examination, and ordering urine tests, if needed.

UTIs are caused by bacteria and are treated with antibiotics. However, any time you take antibiotics, they can cause side effects. Side effects can range from minor reactions, such as a rash, to very serious health problems, such as antibiotic-resistant infections or C. diff infection, which causes diarrhea that can lead to severe colon damage and death. Call your doctor if you develop any side effects while taking your antibiotic.

Sometimes other illnesses, such as sexually transmitted diseases, have symptoms similar to UTIs. Your doctor can determine if a UTI or different illness is causing your symptoms and determine the best treatment.

How to Feel Better

Antibiotics will usually treat a UTI. If you are prescribed antibiotics:

  • Take them exactly as your doctor tells you.
  • Do not share your antibiotics with others.
  • Do not save them for later. Talk to your pharmacist about safely discarding leftover medicines.

Talk with your doctor and pharmacist if you have any questions about your antibiotics.

Drink plenty of water or other fluids. Your doctor might also recommend medicine to help lessen the pain or discomfort.


You can help prevent UTIs by doing the following:

  • Urinate after sexual activity.
  • Stay well hydrated and urinate regularly.
  • Take showers instead of baths.
  • Minimize douching, sprays, or powders in the genital area.
  • Teach girls when potty training to wipe front to back.

We may not need to rely on antibiotics to treat UTIs

Doctors tend to prescribe antibiotics to treat common bacterial infections, such as those of the urinary tract. However, a new study shows that there may be a new strategy to reduce or potentially even eliminate the need for using antibiotics.

Share on PinterestCould it soon be possible to treat UTIs without using antibiotics?

The new findings were recently published in the Proceedings of the National Academy of Sciences.

The investigators who conducted the study are from Stanford University in California.

They discovered that bacteria found in urinary tract infections (UTIs) require a version of the cellulose molecule to attach successfully to bladder cells.

If this cellulose attachment can be interrupted, there may be another treatment option in the future that does not involve antibiotics.

UTIs and antibiotics

A UTI can occur in any part of the urinary tract, such as in the urethra, bladder, ureters, and kidneys. Symptoms include a burning feeling when you urinate, as well as a frequent need to urinate, even when your bladder isn’t very full. UTIs can lead to dangerous conditions if not promptly treated.

It is vital to see a doctor as soon as possible, because early treatment with antibiotics can clear up a UTI before it travels to the kidneys. Though antibiotics are the first line of defense against UTIs, there is a reason why they may not always work — namely, antibiotic resistance.

Antibiotics are often prescribed for viral illnesses that do not respond to other medication, or when patients do not take that medication properly.

Both scenarios can have the same result: antibiotic resistance. This means that when you become sick with a bacterial infection, the antibiotics that your doctor prescribes might not work properly.

Also, antibiotics can impact the “good” bacteria that make up your gut microbiome, which can lead to further problems.

The results of the new study are very promising. Study co-leader Lynette Cegelski — an associate professor of chemistry at Stanford University’s School of Humanities and Sciences — notes that if we can target the way bacteria adhere to the body, we may be able to fight the infection without worrying about antibiotics at all.

The cellulose key

Plants, algae, and some bacteria produce cellulose. It has several scientific and practical uses, such as in fuel and paper.

The study revealed that there is a chemically unique form of cellulose called phosphoethanolamine in the biofilm of Escherichia coli. These bacteria can cause a number of maladies in the human body, and they are one of the most common causes of UTIs.

Also, the study found that this cellulose is pretty important to the bacteria. “Our experiments,” notes study co-leader Prof. Gerald Fuller, of the School of Engineering, “here reveal a specific function for the cellulose in which it serves a mortar-like role to enhance the adhesion strength of bacteria with bladder epithelial cells.”

In other words, the cellulose found in E. coli acts as sort of a glue between the bacteria themselves and cells found in the bladder.

What the future may hold

The results of this study suggest that in the future, it may be possible to target this cellulose instead of the bacteria themselves.

“Attacking the cellulose could be a great alternative to traditional antibiotics as preventing bacterial adhesion could help break the cycle of infection,” explains Emily Hollenbeck, a former joint-graduate student, adding:

“This type of treatment also avoids the ‘life-or-death’ pressure of traditional antibiotics that lead to drug-resistant mutations.”

Medications that cause uti

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