From the Guidelines
Bladder prolapse (cystocele) should be treated simultaneously with recurrent urinary tract infections (UTIs) to address incomplete bladder emptying and reduce bacterial colonization. For the prolapse, pelvic floor physical therapy is recommended as first-line treatment, along with a vaginal pessary fitted by a healthcare provider 1. For recurrent UTIs, a course of antibiotics like nitrofurantoin 100mg twice daily for 5-7 days can treat active infections, while preventive measures include:
- Daily cranberry supplements (containing at least 36mg proanthocyanidins)
- Proper hydration with 2-3 liters of water daily
- Urinating before and after sexual activity Some patients benefit from prophylactic antibiotics such as nitrofurantoin 100mg taken after intercourse or daily at bedtime 1. Topical vaginal estrogen (such as Estrace cream 0.5g or Vagifem 10mcg tablets) can help postmenopausal women by improving vaginal tissue integrity and reducing UTI risk 1. For severe cases of prolapse causing persistent UTIs despite these measures, surgical repair may be necessary. These approaches work together by improving bladder emptying, strengthening pelvic support structures, and reducing bacterial colonization of the urinary tract. It is essential to note that the definition of recurrent UTIs varies, but it is generally defined as two or more symptomatic episodes in six months or three episodes in one year 1. The treatment and prevention of recurrent lower urinary tract infections in women require a comprehensive approach, including patient education, lifestyle modifications, and medical interventions 1.
From the Research
Bladder Prolapse and Recurrent UTI
- Bladder prolapse is a type of pelvic organ prolapse (POP) that can cause symptoms such as pelvic pressure, vaginal bulge, urinary and bowel dysfunction, or sexual dysfunction 2.
- Recurrent urinary tract infections (UTIs) are a common problem that can be burdensome and detrimental to a patient's quality of life 3.
- Risk factors for recurrent UTI in women include incomplete bladder emptying, which can be associated with bladder prolapse 4.
- Treatment options for POP, including bladder prolapse, include observation, pelvic floor physical therapy, pessary use, and surgery 2.
- For recurrent UTIs, treatment strategies include antibiotic and non-antibiotic approaches, as well as holistic management approaches 3, 5.
- Pelvic-floor muscle training (PFMT) can be used to manage female urinary incontinence and prolapse, and is both a physical therapy and a behavioral therapy 6.
- In patients with incomplete bladder emptying, such as those with bladder prolapse, intravesical therapy may be used to prevent and treat recurrent UTIs 4.
Management of Bladder Prolapse and Recurrent UTI
- Management of bladder prolapse and recurrent UTI requires a comprehensive approach that takes into account the patient's symptoms, medical history, and treatment preferences 2, 3.
- Non-antibiotic prevention measures for recurrent UTI, such as increased fluid intake, vaginal estrogen therapy, and cranberry, may be recommended 5.
- Antibiotic prophylaxis may be considered for carefully selected patients with recurrent UTI 5.
- PFMT can be used to improve bladder emptying and reduce symptoms of urinary incontinence and prolapse 6.