Cystitis

1 What is Cystitis?

Cystitis (sis-TIE-tis) is the medical term for bladder inflammation usually caused by a bacterial infection. It is a common type of urinary tract infection (UTI). Mild bladder infection often resolves within a few days. A bladder infection can be painful and annoying, but can turn into a more serious health concern if the infection spreads upwards to affect your kidneys.

Rarely, cystitis may also occur as a reaction to certain drugs, radiation therapy or potential irritants such as feminine hygiene spray, spermicidal jellies or prolonged use of a urinary catheter. It may also occur as a complication of another disease. Generally, the treatment for bacterial cystitis is oral antibiotic therapy.

Treatment for other types of cystitis is decided depending on the underlying cause. However, some people may have frequent episodes of cystitis, which needs regular or long-term treatment.

2 Symptoms

The signs and symptoms of cystitis include: 

  • A strong, persistent urge to urinate even after emptying the bladder.
  • Pain, burning or stinging sensation when urinating.
  • Need to urinate more often.
  • Blood in the urine (hematuria).
  • Passing small amounts of cloudy or strong or foul smelling urine.
  • Pelvic discomfort.
  • A feeling of pressure or cramps in the middle portion of the lower abdomen or back.
  • Low-grade fever (not every time).
  • General malaise or tiredness.

In young children, symptoms such as fever of 38°C (100.4 F) or above, weakness, decreased appetite, vomiting, and irritability may occur. New episodes of accidental daytime wetting may indicate a urinary tract infection (UTI). Nighttime bed-wetting on its own cannot be associated with a UTI. 

When to see a doctor 

   Seek immediate medical attention if you develop signs and symptoms of a kidney infection, such as: 

  • Pain in the back or flank area.
  • Fever with chills 
  • Nausea and vomiting 

Consult your doctor if you develop a frequent urge to urinate or painful urination that persists for several hours or more or if you notice blood in your urine. If you have had a  UTI in the past, and you develop similar symptoms as your previous UTI, call your doctor. You may also consult your doctor if symptoms of cystitis recur even after completing a course of antibiotic treatment. Your doctor may prescribe a different type of medication. Cystitis is uncommon in otherwise healthy men, and if symptoms develop, get evaluated by your doctor. If your child has unusual wetting incidents during daytime, call your pediatrician.

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3 Causes

The causes of cystitis may vary depending on its types.

Your urinary system consist of a pair of kidneys, ureters, urinary bladder, and urethra. All these organs play a unique role in removal of wastes from your body. Your kidneys are a pair of bean-shaped organs, which purify your blood by filtering out wastes and also regulate the concentrations of many substances. Ureters are slender tubes that transport urine from your kidneys to the bladder, where it is collected until gets expelled from your body through the urethra. 

 

   Bacterial cystitis: UTIs usually develop when bacteria from outside the body gain entry into the urinary tract through the urethra and start multiplying. Cystitis is most commonly caused by Escherichia coli (E. coli) bacteria. Bacterial cystitis often occurs in women as a result of sexual intercourse. However, sexually inactive girls and women may also develop lower UTIs as the female genital area often harbors bacteria that can cause cystitis. 

   Noninfectious cystitis: There are several noninfectious factors that may cause inflammation of the bladder. Examples include: Interstitial cystitis, also called painful bladder syndrome is a chronic bladder inflammation, the cause of which is not clear. Most cases are seen in women, and this condition is hard to diagnose and treat.

    Drug-induced cystitis: Certain medications, especially chemotherapy drugs such as cyclophosphamide and ifosfamide, may lead to bladder inflammation as their breakdown products exit your body. 

    Radiation cystitis: Radiation therapy targeted to the pelvic region may cause inflammatory changes in the tissue of your bladder. 

    Foreign-body cystitis: Prolonged use of a urinary catheter can make you susceptible to bacterial invasion and tissue damage, both of which lead to bladder inflammation. 

    Chemical cystitis: People with hypersensitivity to chemicals present in certain products, such as bubble bath, feminine hygiene sprays or spermicidal jellies can develop an allergic-type reaction within the bladder, resulting in an inflammation. 

    Cystitis associated with other disorders: Cystitis may sometimes develop as a complication of disorders, such as diabetes, kidney stones, an enlarged prostate gland or spinal cord injuries.

4 Making a Diagnosis

Making a diagnosis of cystitis is done by performing several tests

If you develop signs and symptoms of cystitis, consult your primary care provider as soon as possible. After an initial evaluation, you may be referred to a doctor who specializes in urinary tract disorders (urologist or nephrologist). 

  What you can do to prepare for your appointment?

  • Be aware of anything you need to do in advance, such as collection of a urine sample. 
  • Make a list of your symptoms, including those that may seem unrelated to cystitis. 
  • Make a list of all your regular medications, vitamins or other supplements. 
  • Ask a family member or friend to accompany you as sometimes it could be difficult for you to remember everything that your doctor tells you. The person who accompanies you may remember something that you may miss or forget. 

Write down questions to ask your doctor.

   For cystitis, basic questions you may ask your doctor include: 

  • What may be the most likely cause of my signs and symptoms?
  • Are there any other possible causes? 
  • Do I need tests to confirm the diagnosis? 
  • What factors do you think are involved in causing my cystitis?
  • What kind of treatment approach do you suggest? 
  • If the initial treatment is ineffective, what will you recommend next? 
  • Am I at risk of developing complications from this condition? 
  • What is the risk of recurrence of this problem?
  • What steps can be taken to reduce my risk of recurrence?

What to expect from your doctor?

  Your doctor may ask you a number of questions, such as:

  • When were your symptoms first noticed?
  • Have you ever been treated for a bladder or kidney infection before? 
  • How severe is your pain? 
  • How often do you need to urinate? 
  • Do your symptoms get relieved after urinating? 
  • Do you have fever and low back pain?
  • Have you noticed vaginal discharge or blood in your urine? 
  • Are you sexually active? 
  • Do you use contraception? If yes, what kind?
  • Could you be pregnant? 
  • Are you undergoing treatment for any other medical conditions? 
  • Have you been using a catheter?
  • What medications do you take currently, including over-the-counter and prescription drugs as well as vitamins and supplements?

After discussing your signs and symptoms and your past medical history, your doctor may recommend certain tests, such as:

     Urine analysis: In conditions of a suspected bladder infection, your doctor may ask for a urine sample to determine whether bacteria, blood, pus, and certain chemicals such as nitrites are present in your urine. If so, a urine bacterial culture may be needed to identify the type of bacteria, which helps to choose an appropriate antibiotic. 

    Cystoscopy: During this procedure, your doctor passes a cystoscope (a thin tube with a light and camera attached at its end) through the urethra into your bladder to visualize your urinary tract, and check for signs of disease. Your doctor can also take a small sample of tissue (biopsy) during cystoscopy and send it for laboratory analysis. However, this test will not be recommended if you have had signs or symptoms of cystitis for the first time. 

    Imaging tests: An imaging test is not required generally, but in some conditions, when no other evidence of infection is detected — imaging may be needed. For instance, an X-ray or ultrasound can help your doctor find out other possible causes of bladder inflammation, such as a tumor or structural abnormality.

5 Treatment

Bacterial cystitis is generally treated with a course of oral antibiotic treatment. The treatment plan for noninfectious cystitis depends on the underlying cause. 

Treating bacterial cystitis 

 Antibiotics are the first line treatment choice for cystitis caused by bacteria. The choice of antibiotics and their duration depend on your overall health and the type of bacteria found in your urine. 

   

  •    First-time infection

   Symptoms begin to improve significantly within a day or so of antibiotic treatment. However, you should complete the course of antibiotics that may range from about three days to a week, depending on the severity of your infection. No matter what the length of treatment is, take the entire course of antibiotics as advised by your doctor in order to ensure that the infection subsides completely. 

  •    Repeat infection

    If you have recurrent UTIs, your doctor may recommend longer antibiotic treatment, which includes a daily dose of an antibiotic to prevent infections. You may require a thorough evaluation by your urologist or nephrologist to check whether there are any urologic abnormalities causing the infections. For some women, taking a single dose of an antibiotic after sexual intercourse may be helpful. Over-the-counter products that increase the acidity of your urine, such as ascorbic acid or cranberry juice, may be recommended. These products can decrease the bacterial concentration in the urine. In case of bladder infections with complications such as pregnancy, diabetes, or a mild kidney infection, you will need to take antibiotics for 7 - 14 days. It is important to complete the course of antibiotics prescribed by your doctor, even if you get better before finishing the treatment. People who discontinue thier course of antibiotic treatment may develop an infection that is more difficult to treat. 

  •  Hospital-acquired infection

    Hospital-acquired bladder infections are often challenging and hard to treat as bacterial strains found in hospitals are often resistant to the common antibiotics used to treat community-acquired bladder infections. For this reason, several different types of antibiotics and different treatment approaches may be required. Postmenopausal women are highly susceptible to cystitis. Your doctor may recommend a vaginal estrogen cream if its use does not increase your risk of other health problems.  

Treating interstitial cystitis 

    The cause of inflammation in interstitial cystitis is not clear, so there is no single treatment that suits every case. Therapies that may be used to treat interstitial cystitis include:

    Medications taken orally or inserted directly into your bladder 

    Manipulation of your bladder through procedures that involve stretching of the bladder with water or gas (bladder distention) or surgery 

    Nerve stimulation, which makes use of mild electrical pulses to ease pelvic pain and, in some cases, decrease frequency of urination

 Treating other forms of noninfectious cystitis 

  People with hypersensitivity to certain chemicals present in products such as bubble bath or spermicides should avoid these products in order to relieve symptoms and prevent further episodes of cystitis. Treatment of cystitis that occurs as a complication of chemotherapy or radiation therapy is focused on pain management with medications, and hydration to flush out the bladder irritants.

6 Prevention

Your doctor may recommend the following preventative self-care measures if you've suffered from cystitis more than once. However, the effectiveness of many of these measures are unclear:

  • Drink plenty of fluids, especially water: Drinking lots of fluids is especially important if you're getting chemotherapy or radiation therapy, particularly on treatment days.
  • Urinate frequently: Go to the toilet as soon as you feel the need to urinate, and always empty your bladder fully. 
  • Wiping your bottom from front to back after a bowel movement. This prevents bacteria in the anal region from spreading to the vagina and urethra. 
  • Have a shower rather than a tub bath: Showering avoids prolonged exposure of your genitals to harsh chemicals in your cleaning products. If you are vulnerable to bladder infections, showering rather than bathing can prevent them. While you take a shower, gently wash the skin around the vagina and anus. Do not use harsh soaps or wash too vigorously as the skin around these areas is delicate, and can become irritated. 
  • Empty your bladder as soon as possible following sexual intercourse.
  • Do not use diaphragm for contraception. 
  • Stay hydrated: Drinking plenty of fluids can stop bacterial growth in your bladder, and can help flush bacteria out of your bladder. 
  • Avoid using perfumed bubble bath, soap or talcum powder, deodorant sprays or feminine products around your genital area. These products can cause irritation of the urethra and bladder.

Drinking cranberry juice or taking tablets containing proanthocyanidin are often thought to be helpful in reducing the risk of recurrent bladder infections. However, recently studies have suggested that it is less effective than previously thought. Some smaller studies demonstrate a small benefit, but large studies have found no significant differences. As a home remedy, avoid cranberry juice if you are on blood-thinning medication, warfarin (Coumadin). Possible interactions between cranberry juice and warfarin can cause bleeding. 

7 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with cystitis.

Cystitis is painful condition, but you may follow some tips to relieve your discomfort: 

    Place a heating pad: A heating pad can be placed over your lower abdomen to soothe, and reduce your feelings of pressure or pain in your bladder.

    Keep yourself hydrated: Drinking lot of fluids may help in staying hydrated. 

    Avoid the intake of alcohol, caffienated beverages such as coffee, soft drinks with caffeine, citrus juices, and spicy foods till your infection subsides. These substances cause further irritation of your bladder, and aggravate your symptoms of frequent or urgent need to urinate. 

    Sitz bath: Take a bath in a bathtub filled with warm water (sitz bath) for about 15-20 minutes to relieve your pain and discomfort.

 If you suffer from recurrent bladder infections, your doctor will help you develop a strategy to get rid of discomfort and recurrences that cystitis can cause.

8 Risks and Complications

There are several risks and complications associated with cystitis.

Some people are more susceptible to bladder infections or recurrent urinary tract infections than others. Women are more likely to develop bladder infections than men. A key reason for this is physical anatomy. In women, the length of the urethra is shorter, which decreases the distance bacteria have to travel to reach the bladder.

Women at a greater risk of UTIs include those who: 

  • Are sexually active: Sexual intercourse can result in forcing of bacteria into the urethra. 
  • Use certain types of contraceptive methods: Women using diaphragms are at an increased risk of developing a UTI. Diaphragms containing spermicidal agents may further increase your risk. 
  • Are pregnant: Hormonal changes occurring during pregnancy may enhance your risk of developing a bladder infection.
  • Have achieved menopause: Postmenopausal women often develop UTIs due to altered hormonal levels. 

Other risk factors in both men and women include: 

  • Obstruction in the flow of urine: This can occur in conditions such as bladder stone and prostate gland enlargement in men. 
  • Suppressed immune system: This can happen in certain conditions, such as diabetes, HIV infection, and cancer therapy. An immunocompromised state can increase the risk of bacteria and, in some cases, viral bladder infections. 
  • Prolonged use of bladder catheters: Bladder catheters may be needed in older people with chronic illnesses. Long-term use can increase your vulnerability to bacterial infections as well as bladder tissue damage. 

In otherwise healthy men without any predisposing conditions, cystitis is rare. Bladder infections rarely lead to complications when treated promptly. If left untreated, it can become serious.

Complications that may occur include: 

  • Kidney infection: An untreated cystitis can lead to kidney infection, also called pyelonephritis (pie-uh-low-nuh-FRY-tis). Kidney infections results in permanent damage to your kidneys. Young children and older adults are at a higher risk of getting their kidney damaged as a result of bladder infections as their symptoms are often overlooked or mistaken for other conditions. 
  • Blood in the urine: Normally, in cystitis, blood cells may be present in your urine but it can be seen only under a microscope (microscopic hematuria), and this usually resolves with treatment. Blood in the urine that is visible to our naked eyes or gross hematuria rarely occurs with bacterial cystitis, but this occurs more commonly with chemotherapy- or radiation-induced cystitis.
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