Disorders of the kidneys, bladder, and prostate

Bladder infection

Bladder infection (cystitis, sometimes called urinary tract infection [UTI]) occurs more frequently in females than in males, because the shorter female urethra does not protect the bladder from bacteria as efficiently as does the male organ. A person with a bladder infection complains of discomfort (sharp pain, cramping, or burning) on urination, urge to urinate (“urgency”), frequent urination, difficulty initiating urination, lower abdominal cramping, and sometimes bloody urine, which can be as severe as small clots. Similar symptoms might be suffered by males who harbor infections in the prostate gland.

Treatment involves administration of an antibiotic and increased (1 to 1.5 L of water above usual intake) oral fluid intake. Because many antibiotics are well concentrated in the urine, there are several acceptable treatment regimens. For the sake of simplicity, the female victim can be treated (in order of preference) with nitrofurantoin monohydrate/macrocrystals (Macrobid) 100 mg capsule twice a day for 5 days (safe in pregnancy) with meals; trimethoprim–sulfamethoxazole (Bactrim or Septra) in one double-strength tablet twice a day for 3 days, or two double-strength tablets in one dose; fosfomycin trometamol (Monurol) 3 g sachet single dose; levofloxacin 250 or 500 mg once a day for 3 days; ofloxacin 200 mg twice a day for 3 days, or 400 mg in one dose; norfloxacin 400 mg twice a day for 3 days; lomefloxacin 400 mg; trovafloxacin 100 mg; cefpodoxime 100 mg twice a day for 3 days; cefdinir 100 mg twice a day for 5 days; or amoxicillin–clavulanate 500 mg/125 mg twice a day for 7 days. (See fluoroquinolone antibacterial drugs precaution on page 498.) If the victim is diabetic or older than 65 years of age, or if the symptoms do not completely resolve or they recur within a few days of therapy, use the same or a different drug for 7 to 10 days. If the victim is pregnant, use nitrofurantoin, amoxicillin, ampicillin, cephalexin, cefadroxil, or trimethoprim–sulfamethoxazole. However, do not use trimethoprim in the first trimester.

Older males are more likely than younger males to suffer from UTIs, usually attributed to prostate gland enlargement, which impairs normal urination. Chronic prostatitis might be the culprit. Because a urine culture is generally recommended prior to starting antibiotics, any male (particularly elder) with a suspected UTI should seek medical care. If that is not possible, the same antibiotics as recommended for women above can be selected and administered for 7 days. If the prostate is infected, then different antibiotics will be selected and used for 30 days. In the absence of professional medical care, trimethoprim–sulfamethoxazole is a good choice. A reasonable second choice is doxycycline or amoxicillin–clavulanate.

Chlamydia are bacteria that are a very common cause of reproductive tract infections in women and genitourinary tract infections in men. Because the penicillin family (such as ampicillin) are not effective against Chlamydia, any male with a bladder infection should be treated with tetracycline (500 mg four times a day), doxycycline (100 mg twice a day), or trimethoprim–sulfamethoxazole (one double-strength tablet twice a day) for 10 days, or with azithromycin 1 g in a single dose. Any male who develops a bladder or prostate infection (see page 154) should be seen by a physician when he returns from his journey.

Some persons believe that the incidence of bladder infections in women might be decreased by a daily 8 oz (237 mL) glass of cranberry juice, or by ingesting cranberry juice capsules or tablets. This has never been scientifically proved; emerging data suggest that it is not true.

It might not be convenient for a woman to squat in order to urinate outdoors. There are devices available to facilitate a woman’s urinating while standing or squatting. The Whiz Freedom is advertised as a hydrophobic (repels water), antibacterial, and ecofriendly urine director. This device fits over the pudendal region so that urination can be accomplished when standing or sitting outdoors (or indoors) in such a manner that the urine stream is captured and directed away from the body. Another product intended for the same purpose is the “Lady J.”