Sunday 17 November 2019

Caitlin Moran: Let's talk about cystitis

It's the painful, misery-inducing debilitating health malfunction that can stem from something beautiful. But why did it take one-woman feminist powerhouse Caitlin Moran to write about the trauma of cystitis for the condition to make the mainstream?

Trauma: Caitlin Moran
Trauma: Caitlin Moran

Suzanne Harrington

Let's talk about your urinary tract. Not when it's all normal and happy, but when it has an infection. You know - cystitis. No, wait, come back! Look, I know cystitis isn't sexy, but when you think that two out of every five women will suffer from it at least once during their lives - and some of us considerably more often than that - we really need to be discussing it a bit more. In fact, we should be screaming about it. And not just from behind a closed bathroom door.

The only woman who has ever put cystitis in popular fiction - or anywhere beyond the chemist shop - is Caitlin Moran, herself a long-time sufferer (she likens it to "a billion Lilliputian arrows"). In Moran's novel How To Build A Girl, the protagonist gets it so badly she has to lie in a hot bath as a rock band parties in the next room.

"I've written the subsequent chapter about cystitis straight after the sex with the man whose penis is too large," she told Stylist magazine. "A whole chapter on cystitis - nobody's ever done that." Referring to her own recurring cystitis, she's tweeted, "I have an Achilles urethra. This is the real Big C."

Not that a too-large penis is required to spark a raging case of cystitis. Any size will do, or even none at all - you don't always have to have sex to get cystitis. Sometimes a perfect storm of sugar, caffeine, acidic foods, alcohol, or a mixture of all four, can cause your urinary tract to throw a hissy fit. Just like that. Out of nowhere.

On a recent visit to the doctor, having had it for four long days and nights - I was away, and unable to access proper treatment - the GP, staring into the plastic cup of my cloudy pee - made a suggestion. How about, she said, you take a small dose of penicillin every time you have sex? I assumed she was kidding - ha ha, Doc, that's a good one - except she wasn't.

This is as far as cystitis treatment has gone - like chemotherapy killing everything else as well as cancer, antibiotics will kill not only your urinary tract's invading bacteria, but also all friendly flora as well, so that you finish your cystitis only for it to be replaced by thrush. Thank you, biochemistry.

Yet it continues to be filed under 'one of those things' instead of the painful, misery-inducing health malfunction it actually is. Is this because nobody dies of cystitis? Or is it because it almost exclusively affects only lady urethras?

Cystitis is known as the "honeymoon" condition, which sounds lovely and romantic, until you get it, and it feels like peeing hot vinegar and razor blades, even when your bladder is empty. Untreated, you can become hot, feverish, pee blood, get back ache, can't sleep, can't be more than 10 seconds from the loo, and generally feel very miserable indeed.

This is about as far from a honeymoon as you could imagine. Or as the Cystitis and Overactive Bladder Foundation helpfully tells us on its website, "Relationships could be affected, especially with your partner. You may find that an attack of cystitis follows sexual intercourse, which can place a strain on the relationship."

Not half.

It is not, however, a sexually transmitted disease, so there is no moral outrage around it, but because men rarely get it, it's just not regarded as a big a deal.

If men did suffer from cystitis even a tenth as much as women, one imagines it would be eradicated overnight, like leprosy or typhus. Instead, doctors shake their heads sadly, and tell us take a paracetemol for the "discomfort."

So what is it, what causes it, and what can prevent it? You can get cystitis when you are being treated by radio- or chemotherapy, when you are menopausal, or in later life. Or if you have kidney stones or any other urinary blockages.

Bacterial cystitis, however, is the one most of us get. This can be the so-called 'honeymoon' variety - basically a bruised urethra which then becomes infected - or through dehydration, salt/sugar imbalance, or through our basic unfortunate physiology.

Brace yourselves - this is the poo bit. The female urethra is near the anus, and so E Coli bacteria can sometimes make its way from one aperture to the other, resulting in a urinary tract infection or irritation of the bladder lining. Which is why you always see euphemisms about scrupulous hygiene, and advice to avoid thongs. Big pants, ladies - and nothing nylon that could cause further spontaneous combustion.

Also, no chemicals - scrupulous hygiene means do not use anything perfumed, artificial, or laden with factory ingredients. Just water, both internally and externally.

The implication in official cystitis-prevention advice is that we are sex-mad thong-wearing soap-dodgers who just need to drink more cranberry juice.

If cranberry juice worked, the manufacturers of potassium citrate - the powder sachets we buy over the counter to "alleviate" the symptoms - would no longer be in business. (Except they don't work either, once the infection has caught hold).

Says one long-term jaded sufferer, "My nutritionist - because yes, it got so bad I pay a nutritionist for advice - says you'd have to drink a swimming pool of cranberry juice. I take super concentrated cranberry extract, and that doesn't really work either."

As a preventative, I've tried cranberry in every form (fresh berries, juice, powder extract), cider vinegar, coconut oil, penicillin, lemon juice in water, alkalising supplements from the internet, a sugar-free diet, four litres of water a day, careful sex, no sex, and about 50 million of those stupid sachets you get in the chemist.

I never drink alcohol, and eat mostly wholefoods. I've just finished my second course of antibiotics in six months, and in between the antibiotics - which I take only in absolute desperation - have built up something of a tolerance to paracetemol.

"Mmmm," nods my doctor. "It's a very common condition, isn't it?"

So why do we never talk about it? And more to the point, why, when we can build the Hadron Collidor and send cameras to Mars, does the Cystitis and Overactive Bladder Foundation deem it "incurable"?

Because it's a female thing. We just sip our cranberry juice and politely wince.

Suffering in silence

Gerry, 76

"I've had cystitis all my life, not so often when I was young, although sex used to set it off. As I got older it got worse - having my hips replaced aggravated it. I've had eight courses of antibiotics in the past year. I've tried all the usual things, and now get very expensive probiotics and alkalisers sent over from America.

I have tried naturopathy, homepathy, acupuncture, the lot. I gave up caffeine, alcohol, and sugar. The only thing that ever truly stopped it was following a totally macrobiotic diet. Then it disappeared for two years, but being strictly macrobiotic is hard.

I'm going on a walking holiday in the Himalayas soon, and I will be bringing lots of antibiotics with me, even though I absolutely hate taking them."

Sara, 27

"I just got it for the first time recently, and I felt like the girl in Caitlin Moran's book - it was from sex. The worst thing was I didn't know what it was, so I was in agony.

By the time I got to the GP it needed antibiotics, because the stuff from the chemist wasn't working. It was awful, I had no idea you could feel so bad from it. And I had no idea how many people get it, but when I talked to friends they'd all had it as well at some point."

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