Bladder infections are common among women. They usually are characterized by the classical symptoms of urinary urgency, frequent urination of very small amounts of urine, dysuria, and sometimes hematuria.

Urinary frequency means more frequent urination than normal. Of course, normal frequency varies from person to person, and from time to time. It mostly depends the volume of liquid recently consumed, and the amount of insensible loss of sweat and water vapor during breathing. That said, most women with bladder infections have no difficulty in identifying urinary frequency, complaining that they have to urinate every 15 to 30 minutes.

Urgency means the sensation that you must empty your bladder immediately or risk involuntary loss of urine.

Normally, as urine fills the bladder, a threshold is reached at a certain volume that provokes the muscles of the bladder wall to contract. This contraction of the detrusser muscles of the bladder provoke the sensation of needing to urinate. For normal women, if they resist that urge to urinate, the sensation will disappear as the bladder relaxes and allows more urine to collect.

Eventually, another threshold will be reached and again the detrusser muscles of the bladder will contract, provoking a sensation that the women needs to urinate. This cycle continues until eventually, the bladder will begin involuntarily emptying.

Among women with bladder infections, the symptom of urgency occurs because the bladder itself is inflamed from the presence of infection. This inflammation lowers the threshold at which the bladder detrusser muscles contract, and sometimes increases the intensity of the contraction. With very little urine accumulation, the woman may feel the overwhelming urge to urinate.

Similarly, urinary frequency, every 15 to 30 minutes, is merely a reflection of this same process. When she does urinate, she empties only very small amounts of urine because that’s all that’s there.

The symptom of painful urination, or dysuria, occurs because of the inflammation of the bladder. One common variation of this is called terminal dysuria, in which the pain occurs mostly at the end of voiding.

Hematuria, or blood in the urine, is not always noticed by women with bladder infections, but sometimes it can be quite dramatic. It is due to the inflamed bladder contracting and shearing some of the lining in such a way that there is some oozing of blood from the lining. It’s not, by itself, dangerous as there isn’t very much actual blood loss, but it can be very disquieting to the patient.

Most bladder infections seen outside of a hospital setting are due to sexual activity.

During intercourse, with the pushing and pulling of the genital tissues, bacteria that are normally present around the vaginal opening get nudged up through the urethra and into the bladder. Virtually all women who have just had intercourse will demonstrate some bacteria in their bladder. So why don’t women constantly get bladder infections? It’s because there are a number of protective factors present.

First, the bladder lining is relatively resistant to bacteria. The lining produces a thin mucous that protects it, to some extent, against bacteria.

Second, there is always a fresh supply of sterile urine coming down from the kidneys, through the ureters, and into the bladder, so whatever bacteria might be present are being constantly diluted with this sterile urine.

Third, there usually aren’t large numbers of bacteria nudged into the bladder during intercourse, so the bladder defenses are not usually overwhelmed.

That said, the bladder is not invulnerable to infection, particularly if there are other factors present that predispose toward infection, such as dehydration, repeated exposure, or trauma.

The amount of fresh, sterile urine that is delivered to the bladder depends on the woman’s hydration status. If

she has not recently consumed very much liquid, then her urine production will be modest and not provide much dilutional protection. Or if she has been quite active physically before intercourse, she may have lost enough body fluid through sweating and heavy breathing that her kidneys are working to conserve fluids. In this situation, her risk of acquiring a bladder infection following intercourse will be increased.

While the number of bacteria introduced into the bladder during intercourse is usually small, it may be increased significantly if intercourse is prolonged, or multiple episodes of intercourse occur in a relatively short amount of time. This can predispose her towards acquiring a bladder infection.

Finally, trauma can set her up for a bladder infection in a couple different ways.

Intercourse is inherently a little bit physically traumatic to the genital tissues. There is pulling and tugging, thrusting, deep penetration, and shearing forces applied to the tissues. If an episode of intercourse is unusually vigorous, then more than average numbers of bacteria may be introduced into the bladder. The bladder itself may be struck or sheared by the deeply thrusting penis, disrupting, at least on a microscopic scale, some of the protective mucous layer of the bladder lining.

But intercourse need not be unusually vigorous or prolonged for some minor trauma to occur. In an ideal world, prior to intercourse, a woman would be thoroughly aroused, with the pelvic musculature very relaxed and the tissues well-lubricated. In real life, that high degree of arousal is sometimes the case, but at other times, for a variety of reasons, she may be sub optimally relaxed and sub optimally lubricated. Normal intercourse or even brief intercourse during this time will carry more than the usual amount of trauma because of increased tension of the muscular pelvic floor, and increased shearing forces because of the lack of satisfactory lubrication. Both of these predispose her towards acquiring a post-coital bladder infection.

Understanding the physiology of bladder infections allows us to make good choices among techniques to avoid these annoying problems. I have five recommendations:

Number 1. Lubrication.

Try to achieve good lubrication during intercourse. Some women have no difficulty at all with this, while others find they need to add additional lubrication prior to lovemaking. There are many commercial products available without prescription to facilitate lubrication. In this context, the simpler products will usually give the best results. Keep a supply of lubricant close by and don’t hesitate to apply it and reapply it to both the male and female partner, particularly if intercourse is prolonged.

Number 2. Empty your bladder before intercourse.

If your bladder is even somewhat full prior to initiating intercourse, it will be more vulnerable to the mild trauma that naturally accompanies the thrusting and deep penetration.

Number 3. Empty your bladder immediately after intercourse.

This is your best chance for flushing out most of the bacteria that have been nudged up into your bladder during sex.

Number 4. Drink glass of water.

While you are emptying your bladder, drink a glass of water to encourage the kidneys to produce more fresh, sterile urine to help flush out the remaining bacteria. If you don’t have water available, almost any drinkable liquid can substitute, although both caffeine and alcohol are bladder irritants, so while increasing urine production, you may be increasing the irritation of the bladder lining.

Number 5. Vitamin C.

While drinking your glass of water, swallow a single Vitamin C pill. After ingesting Vitamin C, a tiny amount is absorbed and retained by you, but the vast majority of it is rapidly excreted into your urine. Vitamin C is also called ascorbic acid, and when it appears in the urine, it turns your urine mildly acidic.

That’s good for preventing bladder infections because the commonly found bacteria in the bladder hate acidic environments. The acid inhibits their growth, and holds them in a sort of suspended animation long enough for you to flush them out with the fresh urine coming down from the kidneys.

A single Vitamin C pill won’t hurt you, is widely available without a prescription, and has an astonishingly long shelf life without refrigeration. One small bottle could last you a very long time.

So that’s it…

• Lubricate,
• Void before and after intercourse,
• Drink a glass of water, and
• take a Vitamin C pill right after

And that’s how you can help to avoid bladder infections.