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BLADDER BALANCE
The Bladder Infection That Wasn't:
Startling Information That All Women Need To Know
By: Ronald E. Wheeler, M.D., Medical Director of the Prostatitis and Prostate Cancer Center
October 11, 2001
Voiding symptoms generate countless office visits, urine culture & sensitivity lab testing, and many, many prescriptions
for antibiotics. The financial tally numbers in the hundreds of millions of dollars. Most troubling is that most women
with voiding symptoms of frequency and urgency do not have bladder infections at all, but rather, have chronic lower
urinary tract inflammation. Inflammation may be associated with yeast, douching, bathing habits, cleansing products or
ingredients including soaps and sexual activity. Inflammation does not require antibiotics, but rather, a program,
process, or product that alters or prevents the level of inflammation.
Patients and doctors alike must improve their awareness and understanding of these disease processes if we expect to keep
women from unintended risk. While symptoms associated with bladder infection (urinary tract infection, UTI) and chronic
bladder inflammation are basically the same, the only way to separate one from the other is to identify bacteria or lack
thereof, and prove it with a culture. Accuracy in this disease understanding and specimen (urine) preparation is critical
to the course of therapy selected and the prospect of disease resolution.
Voiding symptoms pose a significant health risk to women worldwide. The impact of frequency and urgency on women in the
workplace cannot be overstated. It is estimated that as many as 10 million visits are made to physicians every year for
symptoms consistent with a bladder infection or inflammation including frequency and urgency of urination. Additionally,
it is estimated that 50% of all women will experience a validated UTI in their lifetimes while countless additional women
will suffer from inflammatory symptoms alone.
While women are more prone to UTIs or bladder irritability symptoms than men, they are also more prone to misdiagnosis. In
fact, it is estimated that more women are labeled incorrectly with a bladder infection than with any other disease
encountered. The weakness of our present format of urine evaluation in women, lies not in the lack of education or skill,
but rather, in our misjudgment and misapplication of scientific principles.
Additionally, projections may be made that 50% of all bladder infections identified in women are not associated with
bacteria at all, but rather are a misrepresentation of an inappropriate specimen.
How can this happen, you may ask? Easy! Women, who have symptoms of frequency, urgency, and/or burning or stinging on
urination are asked to provide a mid-stream clean catch (mscc) urine for definitive analysis of disease recognition. For
those who are not familiar, the mid-stream clean catch urine specimen brings the expectation for women to produce a urine
specimen with their two hands when in reality, three or four hands would be more appropriate. Women, who know the routine,
know what I am talking about. Those that do not know the process are encouraged to try it sometime.
The concept for the mid-stream clean catch as an appropriate specimen to diagnose disease is pure folly and destined for
failure. When urine flows from the bladder, it commonly washes everything in its path into the urine cup. In essence, the
urine you are asked to provide from your bladder is not representative of the bladder at all, but rather mirrors
everything from the bladder to the outside including contamination from vaginal and urethral secretions (including normal
vaginal bacteria). Clearly, a bladder specimen provided by the mid-stream clean catch urine is a bladder urine plus
contamination and is uncommonly accurate.
Without question, a mid-stream clean catch urine with bacteria has no clinical value at all and should be dismissed as a
practice pattern unacceptable to sound medical practice. To do anything other than this, ignores fundamental medical
principles and invites inappropriate expenditure of funds and further compromises the confidence in our healthcare system
as it relates women's health.
Why is all of this dialogue important, you ask? For starters, women, who have any measure of bacteria identified in the
misguided specimen of all specimens, are regularly prescribed antibiotics. Culture and sensitivity lab testing is
performed at great expense with little benefit except to promote further, academic confusion. To add fuel to the fire of
uncertainty, fewer than 30% of all cultures prove anything at all. To state further, culture and sensitivity of a urine
specimen fails to provide any additional information of clinical value in more than 70% of cases. Even more disturbing is
to culture an inappropriate specimen that adds nothing more than an added cost to the office visit in most cases, at
significant expense to the healthcare system.
In addition to women with frequency and urgency being diagnosed with a urinary tract infection inappropriately, women with
no symptoms at all are frequently added to the bladder infection pool that physicians create. I am reminded of a female
patient, who wanted a complete physical, on her 40th birthday, at the hands of her primary care physician (PCP).
During the course of the evaluation, she was asked to provide a mid-stream clean catch urine for routine analysis. Despite
the absence of voiding symptoms, the presence of bacteria in the specimen, prompted a prescription for antibiotics. The
culture showed a mixture of organisms associated commonly with contamination. On her return to the doctor's office in one
week, she was once again asked to provide a mscc urine.
Again, the urine sample demonstrated the presence of bacteria and a different antibiotic was selected to eradicate the
problem. This process continued until four different antibiotics were prescribed. Feeling the frustration, and the
inability to conquer what appeared to be a simple task, the patient asked for a referral to a specialist. At my office, I
asked all of the routine questions and gave due diligence to trying to sort this out short of more extensive testing. I,
too, asked for a mid-stream specimen in an effort to reproduce her previous clinic experience. The urine, once again,
showed the presence of bacteria despite the lack of symptoms. At this point, I performed a catheter assisted urine
collection in an effort to be certain that the specimen came from the bladder.
Interestingly, the urine associated with the catheter came back with no bacteria. The problem was solved. The previously
performed mscc urines had led the caregivers down the wrong path despite the lack of symptoms. This scenario is common in
medical practice across the USA everyday. Everyday, women are being exposed to a guessing game relating to their health.
Everyday, women are asked to take antibiotics for the result of the mid-stream clean catch analysis, with or without
symptoms. Everyday, women suffer from immune suppression, needlessly, in association with inappropriate antibiotics and
the scourge of yeast vaginitis (a by-product of antibiotic usage).
Thus, this lady, who merely wanted a complete evaluation was misdiagnosed with a UTI and suffered the medical indignity of
needless office visits, needless anxiety, loss of work time and wages, as well as the overzealous application of
antibiotics. Additionally, she was put at risk for yeast infestation (vaginally and systemically), bacterial resistance,
and the expense of the antibiotics.
This clinical scenario, as stated earlier, is not an aberration but rather a common presentation played out in medical
offices every hour of every day. We can never know the true incidence of bladder infections in women as long as we are
willing to apply invalid, non-scientific testing to disease diagnosis. Women, who have frequency and urgency of urination
commonly fall prey to the antibiotic routine based on symptoms alone, when in reality the source of concern is chronic
inflammation.
In effect, women are being over diagnosed with UTI. Women with symptoms of frequency and urgency must insist on a
catheter-assisted specimen if the mid-stream specimen shows any level of bacteria. While a mid-stream urine specimen may
mislead a physician to over treat a patient, the absence of bacteria in this specimen precludes the presence of a
bacterial UTI and, thus, precludes the use of antibiotics.
The presence or absence of white blood cells (wbcs) in the urine specimen may also assist the physician with regard to an
acute or chronic event. Acute inflammation will likely be associated with a greater number of wbcs while a chronic level
of inflammation often shows few. The absence of a bacterial UTI signals the need for an alternative approach to the
symptoms.
One such approach suggests a trial of the all-natural female bladder product, Bladder Balance, for symptoms of frequency
and urgency. This formula is designed for women by a Urologist, who understands the meaning of voiding symptoms
experienced by women. This formula features a synergistic blend of health promoting vitamins, minerals, amino acids, and
herbs. Included in this blend, as example, is the combination of cranberry and blueberry, a duo of antioxidants, called
proanthocyanidins that have been shown to decrease the ability of bacteria to cling to the bladder wall. Additionally,
bladder-calming agents such as chamomile and passion flower provide a basis for eliminating frequency and urgency.
Excitement with this formula continues as women experience the benefit of grape skin and grape seed extract as well.
Previous to this formula, women have had little to choose from other than pharmaceutical composites with significant side
effects.
These products include Detrol and Ditropan. Side effects associated with these synthetic products include but are not
limited to dry mouth, dry eyes, blurred vision, and constipation. Bladder Balance notes no evidence of undesirable side
effects. Women with or without bladder symptoms may use Bladder Balance proactively or reactively as the most conservative
first step in bladder health. As always, patients are encouraged to work closely with their physicians in an effort to
make an informed choice in their care. Patients and physicians alike are reminded that the best choice for disease
treatment or prevention must always be the most conservative choice that works.
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