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Cystitis and thrush can become more common as women approach the menopause. So what do you need to know about their symptoms and treatments?

This article was included in issue 72 (spring 2017) of The Menopause Exchange newsletter.

The medical term ‘cystitis’ refers to a variety of symptoms you may experience when you have a ‘bladder infection’ or urinary tract infection. You may be aware of pain when passing urine (called ‘dysuria’) or of low abdominal (tummy) pain afterwards. Your urine is unusually smelly and cloudy. You may also have an urge to pass urine frequently and with little warning (‘urgency’), often passing only small amounts at a time, and then feeling almost immediately that you need to go again. Often, women with cystitis must get up at night to pass urine (‘nocturia’) and, if the infection is severe, they pass blood in their urine (‘haematuria’).

Your urine is naturally sterile, but the passage of bacteria from your outside skin up your urethra (tube from your vagina to your bladder) can occur, allowing bacteria to multiply in your urine. Your bladder is essentially a bag of muscle. Urinary tract infections cause inflammation and irritation of the lining of your bladder. This causes your bladder muscles to spasm, which is why you feel the frequency and urgency, and sometimes incontinence, with a urinary tract infection. If your bladder lining is very inflamed, the tiny blood vessels break, giving rise to blood-stained urine.

Diagnosing a urinary tract infection is usually relatively easy for a GP or nurse, based on you having at least three of the six symptoms mentioned in the section above. Dipping your urine with a special stick designed to pick up the presence of white blood cells (which indicate an infection) can help to confirm the diagnosis. However, dipstick tests aren’t accurate in older women, especially those over 75, when bacteria in the bladder is a common finding without the urine being infected. In older women, it’s much better to send a sample off to be looked at under the microscope and for ‘culture’, which means trying to grow a sample of bacteria in the lab, to check precisely which bacteria are causing the infection, if there is one.

Preventing urinary tract infections can be a straightforward process. Drink plenty of fluids (NOT fizzy drinks or caffeinated tea/coffee) during the day and always wipe yourself from front to back after going to the toilet – the most common bacteria causing urine infections are from the E. coli group, which live in your bowel. Lots of sex can irritate your urethra, hence the term ‘honeymoon cystitis’; it can help to empty your bladder before and after intercourse. During and after the menopause, you produce less vaginal lubrication, which acts as a natural antibacterial. This means that the tissues surrounding your urethra become less elastic, allowing for more damage to your skin during sex. Using an oestrogen cream or pessary (e.g. ‘Vagifem’, which is available on prescription), or non-hormonal lubricants (such as ‘Replens’, which is available over the counter from pharmacies AND on prescription) can help prevent cystitis. Avoid wearing scented panty liners or using bubble baths as this helps to maintain your body’s natural pH (acid) balance.

If your cystitis symptoms persist for more than three days, or are recurrent, please see your nurse or doctor. Blood in your urine should always be reported as very rarely this can be a sign of bladder cancer.

Thrush is a common fungal infection that affects both men and women but mainly women. The fungus, called Candida albicans, also causes athlete’s foot and skin rashes.

Typically, the symptoms of a vaginal infection are intense itching, soreness and a thick, white vaginal discharge. The lips of your vulva (genital area) look red and sore. These symptoms are considered so distinctive that an examination is often not needed, and GPs and nurses can prescribe treatments without doing one. However, in older women, the symptoms may not be so clear cut, with only a small amount of discharge, and soreness when passing urine, rather like that of cystitis. As there are other skin conditions that can cause vaginal soreness, including eczema, it’s often better to be examined to ensure correct treatment. Although vaginal swabs are often taken in GP surgeries, they aren’t very good at picking up thrush, which is found quite naturally in small quantities in the vagina, and is often noted on routine smear tests without causing any infection at all.

Causes of vaginal thrush during and after the menopause are similar to those of urinary tract infections, such as a lack of natural lubrication and reduced resistance of your tissues to infection from the thrush fungus living on your skin. Thrush is also more common in women suffering from diabetes, taking antibiotics and having a poor immune system (e.g. undergoing chemotherapy). Penicillin-type antibiotics are those most likely to cause vaginal thrush. Thrush is sometimes the first sign of diabetes.

Women can prevent thrush by avoiding scented bubble baths and panty liners (as with cystitis). Using a lubricant before sex can help, as dryness during sex can cause damage to your vaginal tissues, and allows the thrush fungus to enter your skin. Also, wearing loose fitting underwear and trousers is a good idea, as the thrush fungus loves warm, damp environments.

Treatment is usually with an anti-fungal cream, such as clotrimazole (‘Canesten’), or anti-fungal medicine, such as fluconazole (‘Diflucan’). However, clotrimazole is not now available over the counter if you’re over 60 and fluconazole can interact with other medicine, so it’s best to speak to your doctor or nurse if your symptoms persist for longer than two weeks despite self-help measures.

About the author

Dr Jeni Worden is a GP with a special interest in women’s health and with a background in complementary medicine. She lives and practises in Dorset.

Created spring 2017

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