Urinary tract infection (UTI) is one of the most common infections in the community, accounting for an estimated 7 to 10 million adult physician office visits each year in the USA [1]. The urinary tract comprises of the kidneys, ureters, bladder, and urethra. Urinary tract infections are twice as common in women as men, and around 50 % of women have at least one episode of UTI in their lifetime. The high prevalence of UTI in children, women and the elderly, and the need for antibiotic therapy results in a significant public health problem with considerable personal impact on the individual’s life.

What is Bladder Infection?

The urinary bladder is normally sterile. The presence of disease causing bacteria, or uropathogens, in the bladder leads to bladder infection or acute cystitis, characterized by an inflammatory reaction of the bladder to the bacteria.

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What are the causes of Bladder Infection?

The causes of bladder infection are:

1. Bacteria: Escherichia coli (75–80 %), other bacteria like Proteus, Klebsiella and Enterococcus.
2. Viral cystitis due to adenovirus is sometimes seen in children but is rare in adults.
3. Fungus: A lesser known cause can be yeast, or organisms of the Candida species.

Cystitis in men is rare and implies an associated urinary condition as infected stones, prostatitis, or chronic urinary retention. Urinary infections are more common in women than men possibly due to the short length of the urethra, making it possible for external bacteria to ascend quickly into the tract. The pathogenic bacteria can also be pushed into the urethra and therefrom into the bladder during sexual intercourse. Among women, pregnant, menopausal and contraceptive using women are at more risk of getting bladder infection. Children and the elderly are also prone to get bladder infection easily.

What are the symptoms of Bladder Infection?

The most common symptoms of bladder infection are painful urination (dysuria), pain in lower abdomen just above the pubis area (suprapubic pain), needing to urinate frequently, urgency (unable to hold urine), hesitancy (difficulty in initiating urination), and incomplete voiding. Fever may occur sometimes. Rarely, there may be blood in urine. Presence of high fever, blood in urine, chills and pain in lower back signify the spread of the infection to the kidneys, and require emergency treatment.

The connection between Bladder Infection and Yeast:

A yeast, Candida albicans, is responsible for the majority of fungal infections in the urinary tract. With the exception of the yeast called Candida, the urinary tract infection is rarely caused by fungal infections. Rare fungal diseases, such as aspergillosis may involve the urinary tract but are often part of disseminated disease in immunocompromised patients, like organ transplant or HIV patients.

Although this yeast is normally found in the human body and on human skin, it can infect different organs, leading to Candidiasis. Commonly affected areas are skin, penis, vulva and vagina, throat, mouth and in severe cases blood, leading to sepsis. Yeast is the most common infectious agent causing inflammation of the glans penis Sometimes the Candida can be present in the urine without any symptoms, known as asymptomatic candiduria. The yeast infections have increased dramatically over the last few decades due to use of broad-spectrum antibiotics. Bladder infection due to yeast has also become common due to increase in indwelling vascular and urinary catheters, and corticosteroid and immunosuppressant therapies.

Can I get bladder infection after Yeast Infection?

Although Candida infection can spread to the urinary tract through blood, it can also ascend into the bladder from the urethral opening. Thus, if there is yeast infection in the vagina and vulva, it is possible to get a bladder infection. Since genitourinary yeast infections are common in women, the difference in the symptoms must be understood. The Candidal vaginitis or vulvitis present with itching and sensitivity to touch in the vaginal and vulval area. If untreated, a thick, curdy, foul-smelling vaginal discharge appears. If the urinary bladder gets infected, you will start having the urinary symptoms of pain or burning during urination, suprapubic pain, urgency, hesitancy, which are more severe urinary symptoms.

Can I Have Bladder Infection and Yeast Infection at the Same Time?

Yes, it is possible to have a bladder infection (of any cause) and yeast infection of the genital area simultaneously. Sometime presence of poor hygiene, diabetes or any reason for immunosuppression can cause both the infections at the same time.

Can Bladder Infection antibiotics cause Yeast Infection?

Yes, the antibiotic therapy for the UTI can exacerbate the yeast infection. Broad-range antibiotics are one of the reasons why yeast infections are rising. The antibiotics kill off the good bacteria that normally inhabit the vagina, leading to rise in the yeast population.

Can a Bladder Infection be mistaken for aYeast Infection?

Sometimes a yeast infection of the vagina may be mistaken for bladder infection and vice versa. It may sometimes be difficult to differentiate one from the other and lead to further delay in diagnosis. The itching of the urethral meatus (opening of the urethra) caused by the yeast may be mistaken for the burning sensation caused by the bladder infection. Irritation of the urethral opening with the thick discharge of candidiasis can lead to burning during urination.

Can a Bladder Infection give you a Yeast Infection?

It is unusual for bladder infection to give you a yeast infection per se. However, the treatment of bladder infection can disturb the normal vaginal flora, and lead to overgrowth of yeast. In fact studies have not shown any evidence that an altered vaginal bacterial flora predisposes women to recurrent episodes of yeast infection of the vagina in the absence of any antibiotic therapy [2].

Can an untreated Yeast Infection cause a Bladder Infection?

Yeast infection, when left untreated can infect the bladder and can further lead to serious complications. The candida cystitis can worsen to serious kidney infection with the yeast, or fungal balls in the bladder leading to urinary obstruction, or spread to blood. People with diabetes, pregnant women, and people using catheters and immunosuppression are at special risk for yeast infection to infect the urinary tract. In addition to yeast infection, the bladder is also prone to get bacterial infection in people who have recurrent yeast infections.

Genitourinary candidiasis is a common health problem with significant psychological, medical, and socioeconomic impact. An identification of the causative pathogen in case of bladder infection, and timely diagnosis of yeast infections can lead to better outcomes with proper and adequate treatment, and avoidance of unnecessary and excess antibiotics.

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References

1. Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Dis Mon. 2003;49:53–70
2. Jacqueline M. Achkar and Bettina C. Fries. Candida Infections of the Genitourinary Tract. Clin. Microbiol. Rev. April 2010 vol. 23 no. 2 253-273 1 April 2010

Fatigue, by definition, is a feeling of tiredness accompanied by lack of energy and motivation. Fatigue is a normal response to a strenuous activity, and is normally alleviated by reducing or stopping the activity. We all feel tired sometimes, and that is normal. We may feel fatigue after poor sleep or overwork, and these are relieved by resting or sleeping well. Sometimes the fatigue can be severe, unrelieved by rest and disabling enough to significantly disrupt one’s life and work. Fatigue can be abnormal in terms of both severity and duration. Any fatigue that persists more than 6 months is termed as chronic fatigue. Make sure to check my signs and symptoms of yeast infection as well to see if you have any other signs and symptoms.

What is abnormal fatigue? Why is it caused?

Abnormal fatigue can lead to disinterest in activities and a lack of physical and mental motivation. Abnormal fatigue can be caused by many reasons, some common and some uncommon ones. The doctor takes a detailed history from the person complaining of abnormal fatigue, and carries out a thorough physical examination. Sometimes a battery of laboratory tests is required before a causal condition can be diagnosed. No reason can be found in up to one-third of the cases.

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What are the symptoms of abnormal fatigue?

A special kind of chronic fatigue can be caused by a condition known as chronic fatigue syndrome (CFS). CFS is not just fatigue lasting for more than six months, it has specific criteria that has to be fulfilled after all other causes have been ruled out, before a person can be diagnosed with it. Nearly 2% of patients who present with the complaint of fatigue meet the criteria for CFS. An important observation in CFS is the aggravation of fatigue by exercise and the post-exertion fatigue lasting for more than 24 hours. Memory or concentration, or cognitive abilities, are often impaired and the person with CFS may complain of muscle and joint pains. There may be headaches, tender lymph nodes in the neck or armpit or a recurrent sore throat. Research has shown that CFS may be triggered by certain infections like viruses (Epstein-Barr virus, human herpesvirus 6, rubella, etc.) and Candida albicans, a fungus that causes yeast infections.

Connection between Candida and abnormal fatigue:

Other than possibly causing CFS, Candida can contribute to abnormal fatigue in other ways. Recent studies have shown that Candida can overgrow in the large intestine leading to a number of complaints that are difficult to diagnose, leading to what is now termed as chronic yeast syndrome. The Candida overgrowth leads to malabsorption of nutrients and possibly aggravation of an allergic response, and consequently leads to fatigue.

Other diseases which can present with abnormal fatigue:

The common diseases, which may often have fatigue as the only initial symptom include anemia, diabetes mellitus, thyroid disorders, sleep apnea, lung diseases, psychosocial stress (e.g., workplace problems) and depression. There can be less common reasons like hormonal disorders, HIV, liver or kidney disease, psychiatric conditions, cancer, blood disorders, fibromyalgia, drug (medicinal or recreational) induced and autoimmune diseases.

Fatigue must be differentiated from other complaints like drowsiness, muscle weakness and shortness of breath, which are frequently confused with it, although these can coexist with fatigue. If fatigue is accompanied by abdominal or pelvic pain and abnormal bruising, or by shortness of breath and chest pain, or by a severe headache, one should immediately seek emergency medical services. Fatigue with abnormal bruising may be a manifestation of a connective tissue disorder like hypermobility syndrome.

Anemia is a common cause of fatigue, and can be accompanied by dizziness. A young woman with heavy menstrual cycles (prolonged and heavy bleeding with clots) can lose enough blood to lead to severe anemia and will complain of abnormal fatigue. Liver diseases like inflammation of liver or chronic liver failure can lead to severe fatigue, as can chronic kidney failure. People who have low blood pressure, known as hypotension, will often complain of fatigue, which may be exacerbated during exercise, and relieved with rest.

Exercise tolerance tests, or stress tests, can be useful for the diagnosis of heart disease, but can rarely lead to severe generalized fatigue or leg fatigue during or after the test. Poor heart function and circulation can be the culprits in such cases. Often muscle weakness, or the lack of strength for muscle movement, is confused with fatigue, and can be a sign of neuromuscular diseases. A sudden onset weakness of arms or legs can be brought about by a stroke, while a more gradual onset of fatigue and muscle weakness is seen in myasthenia gravis.

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In modern culture where physical fitness is both recommended medically and fashionable, a person with abnormal fatigue can feel isolated, depressed and unable to make others understand what they are struggling with. When fatigue can be correlated to lifestyle factors or precipitating activities, there is little cause for worry. However, if the fatigue seems prolonged or abnormal in its severity or is accompanied by other serious symptoms, it is best to seek medical help.

Although there is plenty of historical and contemporary research in existence about Candida I am still amazed that some clinicians today really have little idea of what kind of problems can arise from it. Many doctors still think that Candida either typically affects only women or they think that only patients with diseases which have already compromised their immune system, such as HIV, can suffer the symptoms of it. In part some of this misunderstanding develops because clinicians fail to distinguish between local Candida infections and those which are systemic, and here I want to speak a little about the difference and how systemic infections are approached when it comes to contemporary treatments.

Most of the patients that I either see or speak to, suffer from what are known as local Candida infections. This means that the infection has not broken through the defensive areas of the skin or intestinal system and traveled throughout the body. Local infections are usually confined to external issues, such as athlete’s foot or vaginal thrush, or those which invade the body but limit the impact to areas from the mouth down through the digestive tract and into the colon.

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However when a Candida infection becomes systemic this means it has broken through the defensive barrier of the body at some point and has traveled through it, usually by way of the blood, to set up infections in organs or joints.

Systemic Candida can, and usually is, very serious. This is more so because often, as clinicians are aware, the disease takes advantage of the weakened condition of a patient’s immune system when they are already suffering from an existing disease. However there is also research to suggest that systemic infections can be set up by invasive surgery. This is usually surgery where replacement joints or other parts are inserted into the patient’s body, such as a hip or valve, and infections are transferred because biofilms are already in existence on part of the equipment used.

Biofilms, for those readers who are not aware, are made up of communities of microflora which reside in the body. In fact, biofilms can and do exist anywhere. For example, the plaque on your teeth is a biofilm. It is a community of microflora protected by a resilient film and, as we all know, can be the very devil to move. We have known about biofilms for a long time but for the most part they have been researched relating to their influence on industry rather than medicine, however more recently it has been discovered that around 60% of bacteria in the human body live in a biofilm rather than as single organisms as was previously believed. Because biofilms are very difficult to destroy in their entirety, it is now believed that many systemic diseases are caused by biofilms being transferred into a patient during an invasive procedure and those procedures are not limited to surgical ones. In fact even catheters can be sources of biofilms and pathogenic organisms are thought to be introduced by this route. I have written more on the topic in biofilms and candida connection article.

Yet there can be little doubt that, when it comes to researched cases of systemic Candida, it is patients with an already compromised immune system who susceptible to such an invasion. What this means is that various areas of the body can become infiltrated by Candida resulting in serious disruption to the vital functions. This happens because Candida can penetrate the intestinal wall after its integrity is lost due to inflammatory actions and toxins. The kinds of illnesses arising from such systemic invasion are listed below, and, as you can clearly see, are of a very serious nature:

1. Bones and Joints

• Candida osteomyelitis
• Candida Arthritis

2. CNS (Central Nervous System)

• Neurosurgery related CNS Candida

3. Eye

• Candida Endophthalmitis

4. Gallbladder

• Billiary Candidiasis

5. Heart

• Cardia Candidiasis

6. Kidney and Bladder

• Urinary tract fungus balls
• Insignificant fungus

7. Lung

• Candida pneumonia

8. Liver and Spleen

• Hepatosplenic Candidiasis

9. Pancreas

• Pancreatic Candidiasis

And, if those conditions aren’t worrisome enough, Candida has also been known to affect the brain.

When it comes to contemporary treatments for local Candida infections, I am always loathe to utilize any of the ‘zole’ drugs and much prefer Nystatin. However because this targets Candida when it is localized rather than systemic, it is of little use in such cases. This is where the ‘zole’ drugs are utilized because, unfortunately, little else is available. The main drugs you will see in use for systemic Candidiasis include:

• Fluconazole (Diflucan)

Although popular this particular drug can cause digestive difficulties and often does. I always recommend it is taken in conjunction with a very good probiotic. Treatment, for local infections is usually limited to 2 weeks and a loading dose of 200 mg on the first day and 100 mg on subsequent days, however it can be raised to 400 mg. It is given for both systemic and local Candida infections and is very popular with clinicians.

• Fungizone (amphotericin B)

This is given intravenously and is used only in serious cases of systemic Candidiasis or where the infection is severe. It is usually very hard on the digestive system and is sometimes given in conjunction with other drugs depending on the nature of the infection. Patients with local Candida infections are no longer given this drug as a standard medical procedure.

• Itraconazole (Sporanox)

This drug needs stomach acid to be absorbed so if you are prescribed it remind your clinician that you need a stomach acid pH test before taking it. Lack of stomach acid is called achlorhydria or hypochlorhydria. Testing the pH or amount of hydrochloric acid in the esophagus is not relevant and so not required. It should also be taken with food and is usually prescribed at a dosage of 200 mg per day.

• Ketoconazole (Nizoral)

This is similar to Itraconazole in that it needs stomach acid to be absorbed so the above guidelines apply regarding both testing and taking the drug with food. It is usually given at dosages of between 200-400 mg per day and is not a good option for patients with low food intake.

No doubt that systemic Candida does exist and when it arises the consequences for the patient can sometimes prove to be life-threatening and, like local infections, are often difficult to eradicate.

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