CYSTITIS

Cystitis is inflammation of the urinary bladder. The condition more often affects women,
but can affect either sex and all age groups.
There are several types of cystitis:
Traumatic cystitis is probably the most common form of cystitis in the
female, and is due to bruising of the bladder, usually by abnormally forceful sexual
intercourse. This is often followed by bacterial cystitis, frequently by coliform bacteria
being transferred from the bowel through the urethra into the bladder.
interstitial cystitis (IC is considered more of an in!ury to the bladder
resulting in constant irritation and rarely involves the presence of infection. IC patients
are often misdiagnosed with "TI#cystitis for years before they are told that their urine
cultures are negative. $ntibiotics are not used in the treatment of IC. The cause of IC is
un%nown, though some suspect it may be autoimmune where the immune system attac%s
the bladder. &everal 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 'C is also un%nown though it has been triggered in children by certain medications.
&ome consider it a form of interstitial cystitis.
radiation cystitis often occurs in patients undergoing radiation therapy for
the treatment of cancer.
hemorrhagic cystitis, can occur as a side effect of cyclophosphamide
therapy, and is often prevented by administering mesna.
In sexually active women the most common cause is from E. coli and
Staphylococcus saprophyticus.
Symptoms
(ressure in the lower pelvis
(ainful urination (dysuria
)requent urination (polyuria or urgent need to urinate (urinary urgency
*eed to urinate at night (nocturia, similar to prostate cancer or +(,
$bnormal urine color (cloudy, similar to a urinary tract infection
+lood in the urine (hematuria (similar to bladder cancer
)oul or strong urine odour
)eeling of having painful orgasms
Treatment
+ecause of the ris% of the infection spreading to the %idneys and due to the high
complication rate in the elderly population and in diabetics, prompt treatment is almost
always recommended. It is advised to avoid vaginal penetration until the infection has
cleared up.
Medication
$ntibiotics are used to control bacterial infection. It is vital that a course of antibiotics,
once started, be completed. Cystitis can also be treated with over-the-counter medicines,
where self-treatment is appropriate.
Commonly used antibiotics include:
*itrofurantoin
Trimethoprim-sulfamethoxa.ole
$moxicillin
Cephalosporins
Ciprofloxacin or levofloxacin
/oxycycline
The choice of antibiotic should preferably be guided by the result of urine culture.
Chronic or recurrent "TI should be treated thoroughly because of the chance of %idney
infection (pyelonephritis. $ntibiotics control the bacterial infection. They may be
required for long periods of time. (rophylactic low-dose antibiotics are sometimes
recommended after acute symptoms have subsided.
(yridium may be used to reduce the burning and urgency associated with cystitis.
There is some evidence that ma%ing the urine either more acidic (e.g. with ascorbic acid
or more al%aline may calm the pain of cystitis. Cranberry !uice also contains condensed
tannins, 0annose - / and proanthocyanidins which have been found to inhibit the
activity of '. coli by preventing the bacteria from stic%ing to mucosal surfaces lining the
bladder and gut, helping to clear bacteria from the urinary tract123.
Monitoring
)ollow-up may include urine cultures to ensure that bacteria are no longer present in the
bladder.
Prevention
4eeping the genital area clean and remembering to wipe from front to bac% may reduce
the chance of introducing bacteria from the rectal area to the urethra.
Increasing the inta%e of fluids may allow frequent urination to flush the bacteria from the
bladder. "rinating immediately after sexual intercourse may help eliminate any bacteria
that may have been introduced during intercourse. 5efraining from urinating for long
periods of time may allow bacteria time to multiply, so frequent urinating may reduce
ris% of cystitis in those who are prone to urinary tract infections.
/rin%ing cranberry !uice prevents certain types of bacteria from attaching to the wall of
the bladder and may lessen the chance of infection.
163
Cranberry extract tablets have also
been found to be effective in preventing cystitis and are a possible alternative for those
who disli%e the taste of cranberry !uice. Cauterisation of the bladder lining through a
cystoscopy gives long-term relief (sometimes several years from this condition.
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