Happy Down Below by Dr. Oliver Gralla

Author:Dr. Oliver Gralla
Language: eng
Format: epub, mobi
Publisher: Greystone Books
Published: 2016-10-06T16:00:00+00:00

Pain without an Infection

HERE’S A SITUATION that often arises in my practice. A patient comes as an emergency case complaining about her bladder infection despite having taken various antibiotics. Examination, however, turns up no signs of infection from the urine test strip’s chemical analysis and not even the slightest hint of pathological findings under the microscope. But the patient describes typical bladder infection symptoms. What to do now? Send her home with a clean bill of health? Refer her to a psychiatrist? Give her a course of yet another antibiotic?

I have to assume that the patient didn’t have an overwhelming desire to visit a urologist and probably could do without the pain. I can safely conclude that her condition is as she describes it. When everything speaks against an acute infection but the symptoms suggest one, the answer often lies in the bladder wall’s mucosal barrier. It’s often difficult to judge whether this disruption has been caused by all the antibiotic treatments, by the infection itself, or by some other factor.

I think of the bladder’s mucous membrane in these cases as weakened, breached, or raw. Whether it’s because of bacteria or not, the bladder hurts, typically after passing water, when the wall of the emptied bladder deflates and the mucous membranes rub against each other. Long-term treatment options include the already mentioned cranberry extracts, to slowly strengthen the protective layer on the interior bladder wall. But if the pain is acute, two to three months of treatment is not really an option. Bladder instillation therapy is an effective and, above all, quick alternative measure. In instillation therapy a tube is inserted into the bladder and medication is infused through it to coat the bladder wall. The active ingredients of products for this on the market include components of the interior protective layers of the bladder. Glycosaminoglycan (GAG) layers cover the injured mucous membrane like a bandage, protecting it against irritation. Symptoms often improve after only one session. But to build up enough protection, the active ingredients should be infused at least four times in a month. Instillation therapy is a good way of achieving rapid recovery in complicated and severe cases. Unfortunately, not all health insurance systems cover it, and the treatment is not exactly inexpensive.

Reading between the lines in consultations with afflicted patients, I’ve found that bladder infections happen more often in times of stress. You’ve probably noticed a link between stress and problems peeing. The bladder sometimes acts like the psyche’s plaything. If the link is patently obvious and the patient has an open ear to her psyche, then mental health treatment might make sense to discover the root causes. One method for confronting stress and its consequences is mindfulness-based stress reduction (MBSR). A sample program consists of eight weeks of two-hour workshops focusing on mindful awareness for stress management. From my own experience, I can say that a workshop like this can be very helpful and even fun.

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