What is Cystitis?
Inflammation of the bladder is known as cystitis. This infection is a form of bacterial infection and is also known as urinary tract infection (UTI). Cystitis or bladder infection is a painful and an irritating condition and if left untreated can become more serious with the spread of infection to the kidneys. Sometimes, cystitis can result due to a drug reaction to some medications or radiation therapy, or cosmetic agents like feminine hygiene spray etc. It can also be caused by using catheter for long durations. Some illnesses may also result in cystitis. Treatment depends on the type of cystitis and its cause. Antibiotics are the usual choice of treatment for bacterial cystitis. Women are more prone to bladder infections than men, as they have a shorter urethra.
Classification and Types of Cystitis or Urinary Tract Infection (UTI)
The Two Main Types Of Cystitis Are:
- Community-acquired Bladder Infections: This type of cystitis occurs in individuals who are not residing in a medical care facility.
- Hospital-acquired Bladder Infections: Also known as nosocomial infections occur in those individuals who are residing in a medical care facility like a hospital or nursing home. They commonly occur in those patients who have a urinary catheter placed via the urethra into the bladder for collecting urine.
Other Types Of Cystitis With A Noninfectious Cause Are:
- Interstitial Cystitis: This is a chronic bladder inflammation, also known as painful bladder syndrome. The cause for this is not known. Women are more affected than men. This type of cystitis is difficult to diagnose and treat.
- Drug-induced Cystitis: Specific medications such as chemotherapy drugs like cyclophosphamide and ifosfamide may cause inflammation of the bladder when the broken-down components of the drugs exit the body.
- Radiation Cystitis: Radiation to the pelvic region may cause inflammatory changes in bladder tissue resulting in cystitis.
- Foreign-body Cystitis: Presence of foreign body such as using a catheter for long-term makes an individual more susceptible to bacterial infections and tissue damage.
- Chemical Cystitis: Sensitivity to chemicals present in certain products, such as feminine hygiene sprays, bubble bath or spermicidal jellies can result in an allergic-type of reaction within the bladder leading to inflammation.
- Cystitis Associated with other Conditions: Cystitis can also occur as a complication of other disorders, such as pelvic inflammatory disorders, gynecologic cancers, endometriosis, diverticulitis, Crohn’s disease, tuberculosis or lupus.
Etiology and Risk Factors of Cystitis or Urinary Tract Infection (UTI)
The urinary system comprises of kidneys, ureters, bladder and urethra; the function of which is eliminating waste from the body.
- Bacterial cystitis occurs when the bacteria present outside the body enters into the urinary tract via urethra and start multiplying. The Escherichia coli (E. coli) bacteria are responsible for the majority of bacterial cystitis cases.
- Women may suffer from bacterial bladder infections due to sexual intercourse; however, women who are not sexually active are also prone to lower urinary tract infections as the female genital area usually shelters the cystitis causing bacteria.
Risk Factors for Cystitis or Urinary Tract Infection (UTI) are:
Men who do not have an existing predisposing health condition, rarely encounter cystitis. Women carry a greater greatest risk for UTIs as they have a shorter urethra than men and especially those women who:
- Are sexually active as sexual intercourse may cause the bacteria to travel into the urethra.
- Use birth control like diaphragms, especially those which contain spermicidal agents.
- Pregnant women are more prone to UTIs because of the hormonal changes occurring during pregnancy.
Other Risk Factors For Both Men And Women Are:
- Obstruction with the flow of urine as seen in conditions like bladder stone or enlarged prostate.
- Changes in the immune system as seen in conditions such as diabetes, HIV infection and treatment for cancer. A weak immune system increases the risk of bacterial and also viral bladder infections.
- Prolonged use of bladder catheters increases the risk for bacterial infections as well as damage to the bladder tissue.
Signs and Symptoms of Cystitis or Urinary Tract Infection (UTI)
- Constant urinary urgency
- Burning sensation while urinating
- Patient generally passes urine frequently but in small amounts
- Urine may be foul smelling
- Pelvic discomfort
- Feeling of a pressure in the lower abdominal region
- Slight fever
- Young children suffering from UTI may have episodes of daytime wetting; however, nighttime bed-wetting alone is not likely to be related to UTI.
Serious Symptoms Requiring Immediate Medical Attention Are:
- Pain in the back or sides
- Fever and chills
- Very urgent, frequent or painful urination lasting for many hours or longer or hematuria.
Investigations for Cystitis or Urinary Tract Infection (UTI)
- Urine analysis to detect the presence of bacteria, blood or pus in the urine.
- Cystoscopy to inspect the bladder using a cystoscope. This helps with the diagnosis. The doctor may also perform a biopsy for further analysis.
- Imaging tests, although not necessary, may be done in some cases, particularly when there is no evidence of infection found. X-ray or ultrasound helps in excluding other serious causes of bladder inflammation such as a structural abnormality or a tumor.
Treatment for Cystitis or Urinary Tract Infection (UTI)
Cystitis caused by bacterial infection is generally treated with antibiotics. Treatment for noninfectious cystitis depends on the underlying cause.
- Bacterial Cystitis: Antibiotics are the first line of treatment for bacterial cystitis. The medicines used depend on the general health of the patient and the type of bacteria found in the urine. If the patient is suffering from infection for the first time, there is dramatic improvement in the symptoms with a day or two after starting antibiotics; however, depending on the severity of the infection, antibiotics may need to be taken for three days to a week. It’s important to take the complete course of antibiotics prescribed by the doctor so that the infection is completely eliminated.
- For Recurrent UTIs, your doctor may recommend a longer course of antibiotic treatment or refer you to urologist or nephrologist to rule out any urologic abnormalities, which may be causing the infections. Women suffering from recurrent UTIs benefit from taking a single dose of an antibiotic after sexual intercourse.
- Hospital-acquired Bladder Infections can be difficult to treat as bacteria found in hospitals are usually resistant to the common types of antibiotics used for treating community-acquired bladder infections. Due to this reason, various types of antibiotics and various treatment modalities are required.
- Postmenopausal women are more susceptible to cystitis. The doctor may recommend a vaginal estrogen cream for this condition.
As the cause of interstitial cystitis is not certain, single treatment may not work. For this reason different therapies used to alleviate the signs and symptoms are:
- Medications can be taken orally or inserted directly into the bladder
- Certain procedures can be done where the bladder is manipulated to improve symptoms, such as using water or gas (bladder distention) in order to stretch the bladder or surgery.
- Nerve stimulation where mild electrical pulses are transmitted help in relieving pelvic pain and also in reducing the frequency of urination.
For other types of noninfectious cystitis, avoiding certain chemicals such as found in products like as bubble bath or spermicides helps in easing the symptoms and preventing future episodes of cystitis.
Cystitis that has developed as a complication of chemotherapy or radiation therapy is treated by focusing mainly on managing pain using pain medications and lot of hydration in order to flush out the irritants in the bladder. Majority of the chemotherapy-induced cystitis usually resolve after the chemotherapy is finished.
Lifestyle and Home Remedies for Cystitis or Urinary Tract Infection (UTI)
- Using a heating pad over the lower abdomen helps in minimizing pain and the pressure sensation.
- Drinking lots of fluids.
- Avoiding coffee, alcohol, soft drinks containing caffeine, citrus juices and spicy foods.
- Sitz bath for 15 to 20 minutes helps a lot in relieving pain and discomfort.
- Never delay urinating if you have an urge to urinate.
- After having a bowel movement, always wipe from front to back, as this prevents the spreading of bacteria from the anal region to the vagina and urethra.
- Avoid tub baths and take showers instead.
- Always gently clean the area around the vagina and anus and avoid using harsh soaps or cleaning vigorously as the delicate skin around these areas becomes easily irritated.
- After sexual intercourse, empty your bladder as soon as possible. Also drink a glass of water to help flush out the bacteria.
- Avoid the use of deodorant sprays or feminine products in the genital region as they can cause irritation to the urethra and bladder.