Amsterdam Public Health

A bladder infection may seem harmless, but it can lead to serious complications. How does it develop, and how can you prevent it? Suzanne Geerlings, professor of internal medicine, and member of the Infectious Diseases program of the Amsterdam institute for Immunology and Infectious diseases, and Tamara Platteel, general practitioner, epidemiologist, and university lecturer, address these questions.

Over half of all women will experience at least one bladder infection in their lifetime. It is typically caused by intestinal bacteria, such as E. coli, which poses no problem when in the intestines. However, if it enters the urethra and travels to the bladder, it can cause an infection.

Women are much more likely to get bladder infections than men. On average, general practitioners diagnose 124 bladder infections per 1,000 women each year, compared to just 19 in men. ‘This is due to anatomical differences,’ explains Dr. Platteel. ‘In women, the urethral opening is closer to the anus, and the urethra is shorter than in men, allowing bacteria to reach the bladder more easily.’

Women between 15 and 24 years old, and those after menopause, are most at risk. Young women are often sexually active, increasing the likelihood of a bladder infection. This is not usually due to their partner’s bacteria, but because their own intestinal bacteria can be more easily pushed into the urethra during intercourse. For postmenopausal women, lower estrogen levels affect vaginal defenses, making it easier for pathogens like E. coli to colonize. Once they move toward the urethra, they can cause an infection.

A bladder infection typically causes pain or a burning sensation during urination, as well as frequent urges to urinate in small amounts. The urine may change in color or odor, and there may be abdominal or back pain.

Though generally mild, in rare cases, the infection can spread to the kidneys or bloodstream. Suzanne Geerlings, professor of internal medicine at Amsterdam UMC, notes that bladder infections can disrupt daily life, with patients often canceling social plans or missing work. Women with recurring infections may even change their sexual behavior to avoid reinfection.

For women with three or more bladder infections per year, a general practitioner may prescribe preventive medication. "Antibiotics work well, but they have drawbacks," says Prof. Geerlings. "Low-dose antibiotics can lead to antibiotic resistance, reducing treatment options for future infections." Therefore, many doctors prefer to prescribe hormone pills or vaginal hormone creams to postmenopausal women to help prevent bladder infections, rather than antibiotics.

This article is a revised version of an article originally published in Dutch by de Volkskrant written by Kim van der Gouw. Access the original piece here.