Cystitis can destroy lives

Argus title : Beware of this ‘minor’ illness

Just under a month ago, Olivia Crowther, 23, who studied English Literature at Sussex University and was planning a career in publishing, fell to her death from the Golden Gate Bridge.

Olivia left her London flat without telling her family and on Tuesday 24th June checked into a hotel in San Francisco. She was found by California Highway Patrol the next morning. It has emerged that prior to travel she had trawled suicide websites showing tall buildings and bridges.

Her parents are reported to be devastated. They said their daughter had no history of depression, describing her as “… a loving daughter who seemed to be making her way in the world.” They are struggling to understand what drove her to suicide.

Her uncle, Robert Leader, said the only unhappiness in her life was a nagging bladder problem – reported to be cystitis – which had afflicted her for a year and which doctors had failed to cure. There had been no indication it might drive her to kill herself. He said “It is a huge mystery and the only thing I can think of is that she had this health problem that became all-consuming for her and that was a constant nagging source of discomfort.”

Simon Davies studied with Olivia at Sussex University. He said: “.. she was a very clever girl and she never seemed unhappy. We often talked about the future and it seemed to me she’d go on to be successful.”

Her friend Zoey Monk worked with Olivia at SHE magazine. She said: “…. She was so well spoken and such a lovely girl. I would have never thought this would happen to her….”

Olivia was a beautiful young woman with everything to live for. Her family members are understandably angry that she was so readily able to access suicide websites which in effect showed her how to die. However, there is another source of concern here and that is the disease that caused her such torment.

Cystitis is a “minor” illness which is usually experienced by women and the elderly. As such it is often not taken seriously. Yet it can cause serious kidney infection, chronic pain, relationship breakdown and deep depression – and in the elderly, confusion akin to dementia.

Cystitis occurs when the normally sterile lower urinary tract is infected by bacteria and becomes irritated and inflamed. In 85% of cases bacterial infection is the cause – usually brought about by transfer of escherichia-coli (e-coli) from the bowel through the urethra into the bladder. It is very common in women because of the relatively short distance between the opening of the urethra and the anus and because the urethra is short and bacteria do not have to travel far to do damage.
Cystitis can easily be precipitated by sexual intercourse especially if there is bruising to the surrounding area (hence the term “honeymoon cystitis”). Once bacteria enter the bladder, they are normally removed through urination, however if bacteria multiply faster than they are removed infection results. This is why one of the simplest and most effective self-help techniques is to urinate immediately after intercourse.

The condition commonly affects sexually active adult women. In fact, almost all adult women will experience at least one attack. However, it may also occur in men, those who are not sexually active, catheter-users or children. Older adults are at particular risk.

The symptoms are a frequent need to urinate and a sharp, burning pain when doing so. Other possible symptoms include cloudy and sometimes bloody urine, backache, lower abdominal pain and fever. In elderly people, the most obvious symptom may be increased confusion.

It is true that many people who suffer from this complaint do not experience repeated or serious attacks. Nowadays proprietary brands of medicine, usually containing Potassium Citrate, are available over the counter. These can be used at the first sign of a symptom and often do the trick. However, for anyone who cannot afford the remedies, or who does not recognize the symptoms, it can be a very different story.

I vividly remember the excruciating pain I experienced the first time I had cystitis. After the lab results were returned the doctor commented with fascinated sympathy – and some macabre glee – that neither he nor the lab assistants had “ever seen such a virulent attack”. I paid dearly for it, because my kidneys were affected and after that I experienced repeated attacks. Each time I was given antibiotics, but was never taught the self help techniques which could have prevented the disease.

I recall one particularly unpleasant night attack. I had a high temperature and was bleeding and in great pain. In desperation I called an out of hours doctor to provide a prescription for antibiotics. The next day I reported this by telephone to the surgery only to have one of the receptionists comment in horror “You called out a doctor for cystitis!” I felt too ill and humiliated to object, but have thought about that ignorant and callous comment a great deal since poor Olivia died.

On one occasion, I was completely incapacitated after getting what my grandmother would have called a “chill on the kidneys” while boating on the Serpentine. My doctor poured considerable scorn on the idea that a “chill” could precipitate cystitis, saying that this was an old wives tale. Nonetheless, I discovered over time that a combination of dehydration and a chill across my back would almost always precipitate an attack. I learned that by drinking a great deal of water, keeping my lower back warm and taking a teaspoon of Potassium Citrate in water at the first sign of symptoms, I could completely avoid attacks.

Things changed for sufferers in the 1970s when Angela Kilmartin, herself a chronic cystitis sufferer, published her book “Understanding Cystitis”. It was part of a wave of publications about women’s health which sprang from the women’s movement of the time. These had in common deep scepticism about conventional medical practice and a commitment to prevention and self-help.

Kilmartin’s book became a bestseller. It emerged that thousands of women had suffered in silence from chronic cystitis and that there had been more than one cystitis-related suicide. At last, women began to realize that they were not just “making a fuss”, but were experiencing a significant and potentially serious health problem.

Self-help techniques began to be well publicised and circulated, first by women themselves and then by some doctors. Cystitis sufferers began to realize that repeated doses of antibiotics were causing chronic thrush which in its turn was causing re-infection. Women’s demand for better treatment eventually resulted in proprietary brands of medication for cystitis – and thrush – becoming available without prescription. However, it seems that in these so called post-feminist days, essential preventative techniques are being forgotten.

Women’s magazines, which in the 1970s and even the 1980s would have publicised such techniques, now seem more concerned with women’s sexual performance than with their health. Schools sex education programmes certainly don’t provide information. And yet, given the early sexual activity of so many young girls, infection is likely to be on the increase.

Cystitis is a sordid mean little disease. It doesn’t kill – at least not directly – but it can destroy lives. We will probably never know exactly what drove Olivia Crowther to her tragic death. All we can do is to try to understand her desperation and hope that as she jumped from that beautiful bridge, she felt an end to pain – and that for just one brief moment she thought she was flying.

Contact the Samaritans on 0845 7909090.

NOTE:

Effective preventative techniques are simple:
• drink 6-8 glasses of water a day and one glass of cranberry juice;
• urinate frequently (and immediately after sexual intercourse);
• keep scrupulously clean; and wipe from front to back after a bowel movement

If an attack occurs use proprietary treatments or get help from a doctor.