Filed under: Boomer's Health
Cystitis is the medical term for inflammation of the bladder. Most of the time, the inflammation is caused by a bacterial infection, in which case it may be referred to as a urinary tract infection (UTI). A bladder infection can be painful and annoying, and can become a serious health problem if the infection spreads to your kidneys.
Less commonly, cystitis may occur as a reaction to certain drugs, radiation therapy or potential irritants, such as feminine hygiene spray, spermicidal jellies or long-term use of a catheter. Cystitis may also occur as a complication of another illness.
The usual treatment for bacterial cystitis is antibiotics. Treatment for other types of cystitis depends on the underlying cause.
Cystitis signs and symptoms often include:
* A strong, persistent urge to urinate
* A burning sensation when urinating
* Passing frequent, small amounts of urine
* Blood in the urine (hematuria)
* Passing cloudy or strong-smelling urine
* Discomfort in the pelvic area
* A feeling of pressure in the lower abdomen
* Low-grade fever
In young children, new episodes of accidental wetting (enuresis) also may be a sign of a urinary tract infection (UTI) — especially if wetting occurs:
* Both at night and during the day
* Only during the day
* At least once each week
Nighttime bed-wetting on its own isn't likely to be associated with a UTI.
When to see a doctor
Call your doctor immediately if you have signs and symptoms common to a kidney infection, including:
* Back or side pain
* Fever and chills
* Nausea and vomiting
If you develop urgent, frequent or painful urination that lasts for several hours or longer or if you notice blood in your urine, call your doctor. If you've been diagnosed with a UTI in the past and you develop symptoms that mimic a previous UTI, call your doctor.
Also call your doctor if cystitis symptoms return after you've finished a course of antibiotics. You may need a different type of medication.
If your child starts having daytime wetting accidents, call your pediatrician.
Your urinary system includes your kidneys, ureters, bladder and urethra. All play a role in removing waste from your body. Your kidneys — a pair of bean-shaped organs located toward the back of your upper abdomen — filter waste from your blood and regulate the concentrations of many substances. Tubes called ureters carry urine from your kidneys to the bladder, where it's stored until it exits your body through the urethra.
UTIs typically occur when bacteria outside the body enter the urinary tract through the urethra and begin to multiply. The urinary system is designed to keep out such microscopic invaders. The bladder secretes a protective coating that prevents bacteria from attaching to its wall. Urine also has antibacterial properties that inhibit the growth of bacteria. However, certain factors increase the chances that bacteria will take hold and multiply into a full-blown infection.
Bacterial bladder infections may occur in women as a result of sexual intercourse. During sexual activity, bacteria may be introduced into the bladder through the urethra. But even sexually inactive girls and women are susceptible to lower urinary tract infections because the female genital area often harbors bacteria that can cause cystitis.
Most cases of cystitis are caused by Escherichia coli (E. coli), a species of bacteria commonly found in the genital area. A new strain of antibiotic-resistant E. coli may be the cause of increasingly hard-to-treat UTIs in women.
Main types of infections
The two main types of bacterial bladder infections are:
* Community-acquired bladder infections. These infections occur when people who aren't in a medical care facility, such as a hospital or nursing home, develop a bladder infection. This condition is common in women in their early 20s through age 50, but it is less common in men of the same age. However, men older than 55 may be at risk of this type of infection because of prostate enlargement, a common condition that can block urine flow in older men.
* Hospital-acquired, or nosocomial (nos-o-KO-me-ul), bladder infections. These infections occur in people in a medical care facility, such as a hospital or nursing home. Most often they happen in those who have had a urinary catheter placed through the urethra and into the bladder to collect urine, a common practice before some surgical procedures, for some diagnostic tests, or as a means of urinary drainage for older adults or people confined to bed.
Although bacterial infections are the most common cause of cystitis, a number of noninfectious factors also may cause the bladder to become inflamed. Some examples:
* Interstitial cystitis. The cause of this chronic bladder inflammation, also called painful bladder syndrome, is unclear. Most cases are diagnosed in women. The condition can be difficult to diagnose and treat.
* Drug-induced cystitis. Certain medications, particularly the chemotherapy drugs cyclophosphamide and ifosfamide, can cause inflammation of your bladder as the broken-down components of the drugs exit your body.
* Radiation cystitis. Radiation treatment of the pelvic area can cause inflammatory changes in bladder tissue.
* Foreign-body cystitis. Long-term use of a catheter can predispose you to bacterial infections and to tissue damage, both of which can cause inflammation.
* Chemical cystitis. Some people may be hypersensitive to chemicals contained in certain products, such as bubble bath, feminine hygiene sprays or spermicidal jellies, and may develop an allergic-type reaction within the bladder, causing inflammation.
* Cystitis associated with other conditions. Cystitis may sometimes occur as a complication of other disorders, such as gynecologic cancers, pelvic inflammatory disorders, endometriosis, Crohn's disease, diverticulitis, lupus and tuberculosis.
Some people are more likely than are others to develop bladder infections or recurrent urinary tract infections. Women are one such group. A key reason is physical anatomy. Women have a shorter urethra than men have, which cuts down on the distance bacteria must travel to reach the bladder.
Women at greatest risk of UTIs include those who:
* Are sexually active. Sexual intercourse can result in bacteria being pushed into the urethra.
* Use certain types of birth control. Women who use diaphragms are at increased risk of a UTI. Diaphragms that contain spermicidal agents further increase your risk.
* Are pregnant. Hormonal changes during pregnancy may increase the risk of a bladder infection.
Other risk factors in both men and women include:
* Interference with the flow of urine. This can occur in conditions such as a stone in the bladder or, in men, an enlarged prostate.
* Changes in the immune system. This can occur with conditions such as diabetes, HIV infection and cancer treatment. A lowered immune system increases the risk of bacterial and, in some cases, viral bladder infections.
* Prolonged use of bladder catheters. These tubes may be needed in people with chronic illnesses or in older adults. Prolonged use can result in increased vulnerability to bacterial infections as well as bladder tissue damage.
When treated promptly and properly, bladder infections rarely lead to complications. But left untreated, they can become something more serious. Complications may include:
* Kidney infection. An untreated bladder infection can lead to kidney infection (pyelonephritis). Kidney infections may permanently damage your kidneys. Young children and older adults are at the greatest risk of kidney damage due to bladder infections because their symptoms are often overlooked or mistaken for other conditions.
Blood in the urine. Cystitis sometimes is accompanied by blood cells in your urine that can be seen only with a microscope (microscopic hematuria) and that usually resolves with treatment. If the blood cells remain after you've been treated, your doctor may recommend you see a specialist who can determine whether there is another underlying cause.
While blood in your urine that can be seen by the naked eye (gross hematuria) is rare with typical, bacterial cystitis, this sign is not uncommon with chemotherapy- or radiation-induced cystitis. This is sometimes referred to as hemorrhagic cystitis. Increasing fluid intake is usually the first step in treatment. If bleeding becomes severe, the treatment that initiated the bleeding is usually postponed until the bleeding stops. Severe bleeding is treated with medication or blood transfusion, if necessary.
Preparing for your appointment
If you have signs or symptoms common to cystitis, make an appointment with your primary care provider. After an initial evaluation, you may be referred to a doctor who specializes in urinary tract disorders (urologist or nephrologist).
Here's some information to help you prepare for your appointment and what to expect from your doctor.
What you can do
* Write down any symptoms you've had, and for how long.
* Make a list of your key medical information, including any other conditions for which you're being treated and the names of any medications, vitamins or supplements you're taking.
* Take a family member or friend along. Sometimes it can be difficult to absorb all the information during an appointment. Someone who accompanies you may remember something that you missed or forgot.
* Write down questions to ask your doctor. Creating your list of questions can help you make the most of your time with your doctor.
For cystitis, some basic questions to ask your doctor include:
* What is the most likely cause of my signs and symptoms?
* Are there any other possible causes?
* Do I need any tests to confirm the diagnosis?
* What factors do you think may have contributed to my cystitis?
* What treatment approach do you recommend?
* If the first treatment doesn't work, what will you recommend next?
* Am I at risk of complications from this condition?
* What is the risk that this problem will recur?
* What steps can I take to reduce my risk of a recurrence?
* Should I see a specialist?
In addition to the questions that you've prepared, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow for time to go over points you want to spend more time on. Your doctor may ask:
* What are your symptoms?
* When did you first notice these symptoms?
* Have you had these symptoms in the past?
* Have you ever been treated for a bladder or kidney infection?
* How severe is your discomfort?
* Do your symptoms include an urgent need to urinate?
* How frequently do you urinate?
* Are your symptoms relieved by urinating?
* Do your symptoms include low back pain?
* Do your symptoms include fever?
* Do your symptoms include vaginal discharge?
* Have you noticed any blood in your urine?
* Are you sexually active?
* Do you use contraception? What kind?
* If you use a contraceptive device, does it contain spermicide?
* Are you pregnant?
* Have you previously been diagnosed with any other medical conditions?
* What treatments have you received for other medical conditions?
* Have you ever used a catheter?
* What medications are you currently taking, including over-the-counter and prescription drugs as well as vitamins and supplements?
* Do you have any medication allergies?
Tests and diagnosis
If you have symptoms of cystitis, talk to your doctor as soon as possible. In addition to discussing your signs and symptoms and your medical history, your doctor may order these tests:
* Urine analysis. If it's suspected that you have a bladder infection, your doctor may ask for a urine sample to determine whether bacteria, blood or pus is in your urine.
* Cystoscopy. Inspection of your bladder with a cystoscope — a thin tube with a light and camera attached that can be inserted through the urethra into your bladder — may help with the diagnosis. Your doctor can also use the cystoscope to remove a small sample of tissue (biopsy) for analysis in the laboratory. This test most likely won't be needed if this is the first time you've had signs or symptoms of cystitis.
* Imaging tests. Imaging tests usually aren't necessary but in some instances — especially when no evidence of infection is found — they may be helpful. Tests, such as X-ray or ultrasound, may help rule out other potential causes of bladder inflammation, such as a tumor or structural abnormality.
Treatments and drugs
Cystitis caused by bacterial infection is generally treated with antibiotics. Treatment for noninfectious cystitis depends on the underlying cause.
Treating bacterial cystitis
Antibiotics are the first line of treatment for cystitis caused by bacteria. Which drugs are used and for how long depend on your overall health and the bacteria found in your urine.
Usually symptoms improve significantly within a day or so of treatment. However, you'll likely need to take antibiotics for three days to a week, depending on the severity of your infection. No matter what the length of treatment, take the entire course of antibiotics prescribed by your doctor to ensure that the infection is completely eradicated.
If you have recurrent UTIs, your doctor may recommend longer antibiotic treatment or refer you to a doctor who specializes in urinary tract disorders (urologist or nephrologist) for an evaluation, to see if urologic abnormalities may be causing the infections. For some women, taking a single dose of an antibiotic after sexual intercourse may be helpful.
Hospital-acquired bladder infections can be a challenge to treat because bacteria found in hospitals are often resistant to the common types of antibiotics used to treat community-acquired bladder infections. For that reason, different types of antibiotics and different treatment approaches may be needed.
Treating interstitial cystitis
With interstitial cystitis, the cause of inflammation is uncertain, so there's no single treatment that works best for every case. Therapies used to ease the signs and symptoms of interstitial cystitis include:
* Medications that are taken orally or instilled directly into your bladder
* Procedures that manipulate your bladder to improve symptoms, such as bladder distention or, sometimes, surgery
* Nerve stimulation, which uses mild electrical pulses to relieve pelvic pain and, in some cases, reduce urinary frequency
Treating other forms of noninfectious cystitis
If you're hypersensitive to certain chemicals in products such as bubble bath or spermicides, avoiding these products may help ease symptoms and help prevent further episodes of cystitis.
Treatment of cystitis that develops as a complication of chemotherapy or radiation therapy focuses on pain management, usually with medications, and hydration to flush out bladder irritants. Most cases of chemotherapy-induced cystitis tend to resolve after the chemotherapy is finished.
Lifestyle and home remedies
Cystitis can be painful, but you can take steps to ease your discomfort:
* Use a heating pad. Sometimes a heating pad placed over your lower abdomen can help minimize feelings of bladder pressure or pain.
* Stay hydrated. Drink plenty of fluids, but avoid coffee, alcohol, soft drinks with caffeine, citrus juices and spicy foods until your infection has cleared. These items can irritate your bladder and aggravate your frequent or urgent need to urinate.
* Take a sitz bath. It may be helpful to soak in a bathtub of warm water (sitz bath) for 15 to 20 minutes.
If you have recurrent bladder infections, let your doctor know. Together, you can develop a strategy to reduce recurrences and the discomfort that cystitis can bring.
Cranberry juice or tablets containing proanthocyanidin are the only home remedies proven to reduce your risk of recurrent bladder infections. However, don't drink cranberry juice if you're taking the blood-thinning medication warfarin (Coumadin). Possible interactions between cranberry juice and warfarin can lead to bleeding.
Although other preventive self-care steps have not been well studied, doctors routinely recommend the following for women who've had repeated bladder infections:
* Drink plenty of liquids, especially water. Drinking lots of fluids is especially important if you're undergoing chemotherapy or radiation therapy, particularly on treatment days.
* Urinate frequently. If you feel the urge to urinate, don't delay using the toilet.
* Wipe from front to back after a bowel movement. This prevents bacteria in the anal region from spreading to the vagina and urethra.
* Take showers rather than tub baths. If you're susceptible to infections, showering rather than bathing may help prevent them.
* Gently wash the skin around the vagina and anus. Do this daily, but don't use harsh soaps or wash too vigorously. The delicate skin around these areas can become irritated.
* Empty your bladder as soon as possible after intercourse. Drink a full glass of water to help flush bacteria.
* Avoid using deodorant sprays or feminine products in the genital area. These products can irritate the urethra and bladder.