Honeymoon Cystitis

By Dr. Robert R. Byrne

First some terms: The urinary tract makes, stores, and then empties urine, a waste product that your body makes all the time. The kidneys make the urine. They are in the upper back, partially protected by the ribs. They drain urine through the ureters, small tubes as big as straws into the bladder, a balloon-like organ low in the belly. The bladder is designed to fill up with urine, and then when full, it lets you know that you should look for a bathroom. Once you are ready, it then contracts to push out the urine through the urethra. In men, the urethra opens at the tip of the penis. In women, the urethra opens into the front of the vagina.

When doctors talk about infections of the urinary tract, we describe them as urinary tract infections or UTIs. Cystitis is a more specific term for a UTI of the bladder. Pyelonephritis is a more serious UTI of the kidneys. “Honeymoon cystitis” is actually an old term, not really used anymore, but it paints a picture. It describes a cystitis that occurs after sexual intercourse. This can, of course, occur during a fabulous trip to wherever, but can also happen at any point to all women. UTIs lead to over 8 million doctor visits each year. Roughly 10 in 25 women will have a UTI in their lifetime. UTIs become more common after women become sexually active.

Normally, urine does not have bacteria in it, and the one-way flow of urine in the system helps to prevent bacteria from getting in. The urethra stays closed when working normally, to keep urine in and to keep bacteria out. The mucosal lining of the urethra seals together like two wet pieces of paper would stick together – keeping urine in and bacteria out. Bacteria live on the skin, and bacteria live in the GI tract, and a special type of bacteria normally live in the vagina. These bacteria in the vagina help to keep other bacteria and yeast from growing, and help to prevent infections. Anything that makes the urethra irritated and not work normally, or makes it more likely for abnormal bacteria to live in the vagina near the urethra can increase the risks of infection. Some people are more at risk for infection for genetic reasons they can’t control – their skin types allow bacteria to stick to the urethra more easily and cause infection. Women who have been on a lot of antibiotics may have more abnormal bacteria in the vagina (because the good bacteria have been killed) and may have more infections. Women approaching or after menopause have a decreased level of estrogen in the urethra and vagina, and this can allow the urethra to be irritated more easily.

Bacteria may get into the bladder occasionally, and if the bladder is working normally it may be urinated out before it becomes a problem. If bacteria gets into the bladder and grows, it makes the mucosal lining of the bladder and urethra become inflamed and red (like the back of the throat gets with a cold). This makes the bladder hurt when it fills up. It can cause pain in the low belly or the vagina. It often leads to frequent or uncontrollable voiding or even leakage (the bladder’s irritated lining doesn’t want to fill up and stretch, so it makes you urinate often with small amounts of urine). It can cause low back discomfort. This is cystitis. This typically responds to antibiotics, and sometimes even can go away on its own. If you think you have a UTI on your honeymoon, you should go to a clinic and get treated. If cystitis is not treated it is certainly uncomfortable and can rarely lead to a more serious infection. Bacteria in the bladder can sometimes crawl backwards up the ureters and lead to a kidney infection, or pyelonephritis, which causes high fevers and back pain and generalized sickness. This requires more or longer treatment with antibiotics, and sometimes even hospitalization. If you have blood in your urine with a UTI, you should make an appointment with your health care provider. If you have repeated UTIs, you should make an appointment. If you are having fevers with a UTI, you should see your doctor.

So, what can you do to avoid cystitis when on your honeymoon (and even when not on your honeymoon)?

First, you should remember the basic precautions listed here:
1. Drink a lot of water to keep your urine dilute and your bladder flushed
2. Urinate often
3. Don’t hold your urine too long if you need to urinate
4. Wipe from “front to back”
5. Urinate before and after sexual intercourse

Second, avoid certain things that can make the urethra more irritated:
1. Condoms are very important, but condoms with spermicidal jelly can be irritating to the urethra
2. Personal lubricants can be helpful to decrease irritation, but watch out for “warming jelly” which can cause urethral irritation in some women and men
3. Diaphragms have been associated with higher risks of UTIs

Finally, if you think you are at increased risk, see your doctor before your trip:
1. If you have gone through menopause or think your estrogen level may be low, ask your healthcare provider – they may be able to prescribe a topical estrogen which is applied directly to the urethra.
2. If you know you get UTIs with intercourse, ask your healthcare provider to help – they may be able to provide antibiotics that you can take with you to treat yourself if you get an infection. Some women who always have UTIs every time they have sex can take a single low dose antibiotic pill after intercourse to help prevent infection.
3. Other things including probiotics (particularly if you have been on antibiotics) or cranberry tablets may help as well.

For more information about UTI or other urological problems, visit our website at www.athensareaurology.com. Information for this article is obtained from the American Urological Association.