Recognizing and treating cystitis in men

Even if women are affected by bladder infections much more frequently than men, inflammation of the urinary bladder (urocystitis or cystitis) can also cause problems for men. A bladder infection in men is often even more severe than in women since the prostate can also be affected. It is all the more important to know the symptoms of cystitis in men to treat them correctly and in good time. Here, you can read everything you need to know about cystitis in men.

What is cystitis?

Bladder infection is one of the urinary tract infections (UTIs). This is a – usually bacterial – infection of the urinary tract. The urinary tract extends from the kidneys through the ureters (upper urinary tract) to the bladder and urethra (lower urinary tract).

A bladder infection only affects the urinary bladder and is usually caused by bacteria from the intestinal flora that ascend through the urethra. In addition to the bladder, the urethra ( urethritis or urethritis) or the kidneys ( pyelonephritis or pyelonephritis) can also be affected by inflammation.

 

What types of urinary tract infections are there?

There are three forms of urinary tract infections, more precisely, bladder infections:

• Uncomplicated cystitis: This is an inflammation of the urinary bladder without any functional or anatomical peculiarities. This means that the kidneys and urinary tract’s function and form must be completely normal. In addition, there must be no renal dysfunction or other concomitant diseases that could promote a urinary tract infection.
• Complicated cystitis: Any urinary tract infection that does not meet the requirements of an uncomplicated urinary tract infection is considered complicated. In the case of complicated cystitis, there are physical accompanying circumstances.
• Recurrent (recurrent) cystitis:  One speaks of recurrent urinary tract infections when there are two or more infections per six months or three or more per year.

Cystitis in men – a particular case

Bladder infections in men have a special place in these categories. Even if he is entirely healthy, every bladder infection in a man is considered complicated.

This is for two reasons. On the one hand, men are less likely to be affected by urinary tract infections due to their long urethra – in women, the urethra is only a few centimetres long so pathogens can more easily ascend into the bladder. It should, therefore, always be clarified in men whether malformations or diseases could have promoted cystitis. On the other hand, there is a risk that the prostate will also be affected by the inflammation.

 

Causes: How does a man get a bladder infection?

Intestinal bacteria are the most common cause of bladder infections. The bacteria rise through the urethra and can lead to urinary bladder infections. 

Escherichia coli (E. coli), Proteus mirabilis, Klebsiella, or enterococci are the bacteria responsible for this. They sometimes also occur in the intestines of healthy people but can cause bladder infections if carried into the urinary tract. The pathogens do not differ in men and women.

In rare cases, cystitis can also be caused by viruses, parasites or fungi. Theoretically, infection with the pathogens that can trigger cystitis can occur. Strictly speaking, however, a bladder infection is not contagious.

Risk factors for cystitis in men

The risk factors for a urinary tract infection are primarily sexual intercourse, anatomical changes in the urinary tract, urinary catheter and previous illnesses such as diabetes : 

• Unprotected sex can lead to infection with various bacteria, fungi and viruses. Some of these pathogens can ascend through the urethra and cause cystitis.
• Anatomical changes, such as a narrowing of the urethra, can make it difficult for urine to drain. Urine that stays in the bladder too long is a good breeding ground for bacteria, which can multiply and cause cystitis.
• Foreign bodies in the urethra or urinary bladder, such as a urinary catheter, also promote urinary tract infections since bacteria can attach themselves to the plastic surface.
• In addition, systemic diseases,  such as diabetes mellitus, can contribute to the development of cystitis. If the blood sugar level is too high, sugar is excreted in the urine. Bacteria can multiply very well in this “sweet” urine.

Hypothermia of the urinary tract is rarely the cause of infection. However, cold can encourage bacteria to rise through the urethra. 

Symptoms of cystitis in men

Dysuria, Alguria, Stranguria, Pollakiuria and Haematuria: These foreign words describe the typical symptoms of cystitis in men and women, although these signs do not necessarily have to appear. 

• Dysuria describes difficult urination. For example, urination does not start as usual, or the stream is weakened or interrupted.
• Algeria is in pain when urinating. Pain or a burning sensation when urinating are typical bladder infection symptoms.
• Stranguria describes the feeling of a constant, painful urge to urinate without being able to urinate.
• The symptom of pollakiuria goes in a similar direction. Those affected must go to the toilet often but can only urinate tiny amounts at once. This frequent urge to urinate is also characteristic of the inflammation of the urinary bladder.
• Inflammation of the urinary bladder can also lead to the excretion of blood in the urine, known as hematuria.

More precisely, the blood in the urine is a secretion of red blood cells (erythrocytes). Typically, urine should not contain more than five erythrocytes per microliter. If this is the case, one speaks of microhematuria. Micro because you can’t see the blood in the urine; you can only detect it in the laboratory. The urine does not turn red. Red-colored blood discharge would be called gross hematuria, which is not typical of cystitis.

So-called suprapubic pain, i.e. pain over the pubic area, can also occur,  which can also be triggered by pressure. General symptoms such as fever, chills and malaise are rare. Symptoms are usually limited to the urinary tract.

 

When is a doctor’s visit necessary for a bladder infection?

If the symptoms mentioned above occur, there is an urgent suspicion of a urinary tract infection. Men should always see a doctor with these symptoms as male UTI is always considered a complicated UTI that needs to be treated.

If there is uncertainty as to which doctor is right, men can first contact their family doctor. If necessary, they can refer you to a urologist or andrologist.

Women can do without an immediate visit to the doctor the first time they experience mild to moderate symptoms. Women should also see a doctor if the symptoms last longer or occur repeatedly.

Recognizing a bladder infection in men

Doctors diagnose cystitis with a physical exam and urine tests. During the physical examination, he primarily tests the tenderness over the pubic area.

In addition, the doctor usually performs an ultrasound scan of the bladder, kidneys and prostate. In this way, an accumulation of urine, which in the worst case can damage the kidneys or inflammation of the prostate, can be ruled out.

If necessary, he will also conduct further examinations to determine whether, for example, physical changes such as a narrowing of the urethra or diseases such as diabetes mellitus have caused the cystitis. A thorough search for the causes should be carried out, particularly in the case of recurring, i.e. chronic, cystitis.

Urine tests to diagnose cystitis

So-called urine sticks are available for urine tests. These are test strips that are briefly dipped into a urine sample. The result can be read after a few seconds. This tests for white blood cells, red blood cells and nitrite: 

• White blood cells (leukocytes) indicate inflammation.
• Red blood cells (erythrocytes) can be detected in hematuria.
• Nitrite is a chemical compound produced from nitrate by some bacteria. If nitrite is detected, one speaks of a nitrite-positive urinary tract infection. However, this evidence could be more meaningful since bacteria that cannot produce nitrite can cause cystitis.

The detection using a urine stick is also “qualitative”. This means that the exact amount of leukocytes, erythrocytes, and nitrite cannot be determined; only whether these substances are present in the urine can be determined. However, the advantage of this method is that the examination can be carried out quickly, cheaply and anywhere.

The urine analysis in the laboratory can provide more detailed information. However, this takes longer and is only sometimes necessary. In addition, a so-called urine culture can be created. This characterizes and quantitatively detects the pathogen that causes the urinary tract infection. A bacterial count of 105 CFU (colony-forming units) per millilitre of urine is considered significant bacterial excretion. Any necessary antibiotic therapy can then be adapted to the pathogen.

What to do if you have a bladder infection?

It is essential to distinguish between cystitis with symptoms and bacterial excretion without pain or other symptoms, so-called asymptomatic bacteriuria. Such bacterial excretion without corresponding symptoms should not be treated with antibiotics.

In the case of uncomplicated cystitis, antibiotic treatment can be dispensed with. Drinking enough water (at least three litres a day is recommended) can be enough to get rid of the inflammation. Since bladder infections in men are, by definition, considered complicated bladder infections, antibiotic therapy by a doctor is always necessary.

If anatomical changes in the urinary tract cause cystitis, the doctor will initiate appropriate therapy to eliminate the underlying causes and treat the acute symptoms.

Treating cystitis: antibiotics and duration

The doctor decides which antibiotic will be used to treat the cystitis. Antibiotics from the third-generation cephalosporin group, such as cefotaxime or ceftriaxone, are particularly suitable. Fluoroquinolones such as Ciprofloxacin can also be used, although this group of active ingredients should only be used secondarily due to their side effects. The advantage of these antibiotics is that they also help against possible prostate involvement.

If prostate involvement can be ruled out, the antibiotics pivmecillinam and nitrofurantoin can also be used.

The duration of treatment differs depending on the severity of the infection. Antibiotic therapy lasts about three days if it is a bladder infection without prostate involvement. If prostate involvement is present or cannot be ruled out, the duration of therapy is between seven and 14 days.

What else helps with cystitis?

Various home remedies can be used, especially for mild bladder infections. For men, however, it is always advisable to consult a doctor.

In addition, ensuring sufficient fluid intake (water and tea) and taking it easy physically makes sense.

 Homeopathy can also be used for supportive treatment. Some homoeopathic remedies such as Apis, Nux vomica, Dulcamara and Cantharis are effective against urinary tract infections. However, in the case of severe cystitis, they cannot replace antibiotic therapy.

 

Complications of urinary tract inflammation in men

In men, the prostate is located near the urinary tract. It can be affected by inflammation of the urinary tract. In addition, the inflammation can also spread to the epididymis and trigger epididymitis (inflammation of the epididymis).

The greatest danger is that the inflammation will spread further to the kidneys. The result is pyelonephritis (inflammation of the kidneys). This severe illness usually accompanies general symptoms such as fever and chills. Fast and targeted antibiotic therapy is necessary here.

In addition, in rare cases, a bladder infection can also cause life-threatening Blood poisoning (Urosepsis). To prevent such complications, men should always consult a doctor if they have a bladder infection.

How can men prevent cystitis?

Special measures to prevent bladder infections are unnecessary, as men are generally less affected by urinary tract infections. Good personal hygiene and adequate fluid intake are recommended.

Also, using condoms can protect both sides from sexual transmission of numerous bacteria and STDs. In addition, both sexes should go to the toilet to urinate after intercourse. This protects the urinary tract from ascending infections and, thus, from the development of a bladder infection.