Cystitis

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Steven C. Campbell, M.D., Ph.D.

Overview

Cystitis is inflammation of the urinary bladder. The condition more often affects women, but can affect either gender and all age groups.

Types

There are several types of cystitis:

• bacterial cystitis, the most common type, which is most often caused by coliform bacteria being transferred from the bowel through the urethra into the bladder
• interstitial cystitis is considered more of an injury to the bladder and rarely involves the presence of infection. IC patients are often misdiagnosed with UTI/cystitis for years before they are told that their urine cultures are negative. Antibiotics are not used in the treatment of IC. The cause of IC is unknown. However, there is hope. Several therapies are now available.
• eosinophilic cystitis is a rare form of cystitis that is diagnosed via biopsy. In these cases, the bladder wall is infiltrated with a high number of eosinophils. The cause of EC is also unknown though it has been triggered in children by certain medications.
• radiation cystitis often occurs in patients undergoing radiation for the treatment of cancer.
• hemorrhagic cystitis

Causes, incidence and risk factors

Cystitis occurs when the normally sterile lower urinary tract (urethra and bladder) is infected by bacteria and becomes irritated and inflamed. It is very common [citation needed].

The condition frequently affects sexually active women ages 20 to 50 but may also occur in those who are not sexually active or in young girls. Older adults are also at high risk for developing cystitis, with the incidence in the elderly being much higher than in younger people.

Cystitis is rare in males. Females are more prone to the development of cystitis because of their relatively shorter urethra—bacteria do not have to travel as far to enter the bladder—and because of the relatively short distance between the opening of the urethra and the anus.

More than 85% of cases of cystitis are caused by escherichia coli ("E. coli"), a bacterium found in the lower gastrointestinal tract. Sexual intercourse may increase the risk of cystitis because bacteria can be introduced into the bladder through the urethra during sexual activity. Once bacteria enter the bladder, they are normally removed through urination. When bacteria multiply faster than they are removed by urination, infection results.

Risks for cystitis include obstruction of the bladder or urethra with resultant stagnation of urine, insertion of instruments into the urinary tract (such as catheterization or cystoscopy), pregnancy, diabetes, HIV, and a history of analgesic nephropathy or reflux nephropathy.

The elderly of both sexes are at increased risk for developing cystitis due to incomplete emptying of the bladder associated with such conditions as benign prostatic hyperplasia (BPH), prostatitis and urethral strictures. Also, lack of adequate fluids, bowel incontinence, immobility or decreased mobility and placement in a nursing home, all put people at increased risk for cystitis.

Symptoms

• Pressure in the lower pelvis
• Painful urination (dysuria)
• Frequent urination (AKA polyuria) or urgent need to urinate (AKA urgency)
• Need to urinate at night (nocturia, similar to prostate cancer or BPH)
• Abnormal urine color (cloudy), similar to a urinary tract infection
• Blood in the urine (hematuria) (similar to a female's period or bladder cancer)
• Foul or strong urine odor

Signs and Tests

• A urinalysis commonly reveals white blood cells (WBCs) or red blood cells (RBCs).
• A urine culture (clean catch) or catheterized urine specimen may be performed to determine the type of bacteria in the urine and the appropriate antibiotic for treatment.

Treatment

Because of the risk of the infection spreading to the kidneys (complicated UTI) and due to the high complication rate in the elderly population and in diabetics, prompt treatment is almost always recommended.

Medication

Antibiotics are used to control bacterial infection. It is vital that one finish an entire course of prescribed antibiotics. Commonly used antibiotics include:

• Nitrofurantoin
• Trimethoprim-sulfamethoxazole
• Amoxicillin
• Cephalosporins
• Ciprofloxacin or levofloxacin
• Doxycycline

The choice of antibiotic should preferably be guided by the result of urine culture.

Chronic or recurrent UTI should be treated thoroughly because of the chance of kidney infection (pyelonephritis). Antibiotics control the bacterial infection. They may be required for long periods of time. Prophylactic low-dose antibiotics are sometimes recommended after acute symptoms have subsided.

Pyridium may be used to reduce the burning and urgency associated with cystitis. In addition, common substances that increase acid in the urine, such as ascorbic acid or cranberry juice, may be recommended to decrease the concentration of bacteria in the urine.

Monitoring

Follow-up may include urine cultures to ensure that bacteria are no longer present in the bladder.

Outcomes

Most cases of cystitis are uncomfortable but disappear without complication after treatment.

Possible complications

• Chronic or recurrent urinary tract infection
• Complicated UTI (pyelonephritis)
• Acute renal failure

Prevention

Keeping the genital area clean and remembering to wipe from front to back may reduce the chance of introducing bacteria from the rectal area to the urethra.

Increasing the intake of fluids may allow frequent urination to flush the bacteria from the bladder. Urinating immediately after sexual intercourse may help eliminate any bacteria that may have been introduced during intercourse. Refraining from urinating for long periods of time may allow bacteria time to multiply, so frequent urinating may reduce risk of cystitis in those who are prone to urinary tract infections.

Drinking cranberry juice prevents certain types of bacteria from attaching to the wall of the bladder and may lessen the chance of infection. Cranberry extract tablets have also been found to be effective in preventing cystitis, and avoid the taste of cranberry juice, which some find unpleasant.

External links

• Uncomplicated urinary infections: How do short and long courses of antibiotics compare?
• Interstitial Cystitis Network (ICN)
• Canada IC & OAB Resource Center
• Interstitial Cystitis Advice (A Patient Based Community for People with IC)

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