Cystitis refers to inflammation of the bladder, specifically, inflammation of the wall of the bladder.
Bacteria called Escherichia coli fasten to the lining of the bladder by means of thread-like structures (pili).
Cystitis usually occurs when the urethra and bladder, which are normally sterile (microbe free) become infected by bacteria – the area becomes irritated and inflamed.
Cystitis is a fairly common lower urinary tract infection, which affects people of both sexes and all ages. It is more common among females than males.
Approximately 80% of all urinary tract infections are caused by Escherichia coli. These bacteria form part of the healthy intestinal flora. However, virulent types may get into the bladder via the urethra and cause urinary tract infections. Urinary tract infections account for a large proportion of hospital-acquired infections, especially among patients using urinary catheters.
Causes of cystitis
There are many possible causes of cystitis:
- When women insert a tampon there is a slight risk of bacteria entering via the urethra.
- When a urinary catheter is changed there may be damage to the area.
- There is a higher incidence of cystitis among women who use the diaphragm for contraception, compared to sexually active women who don’t.
- The patient does not empty his/her bladder completely, creating an environment for bacteria to multiply in the bladder. This is fairly common among pregnant women, and also men whose prostates are enlarged.
- Sexually active women have a higher risk of bacteria entering via the urethra.
- Part of the urinary system may be blocked.
- Other bladder or kidney problems.
- Frequent and/or vigorous sex increases the chances of physical damage or bruising, which in turn makes the likelihood of cystitis developing higher.
- During the menopause women produce less mucus in the vaginal area. This mucus stops the bacteria from multiplying. Women on HRT (hormone replacement therapy) have a lower risk of developing cystitis compared to menopausal women not on HRT.
- During the menopause the lining of a woman’s urethra gets thinner as her levels of estrogen drop. The thinner the lining becomes, the higher the chances are of infection and damage.
- A woman’s urethra opening is much nearer the anus than a man’s. Consequently, there is a higher risk of bacteria entering the urethra from the anus.
Symptoms of cystitis
The following are common signs and symptoms of cystitis:
- Urine may have traces of blood
- Urine is dark and/or cloudy
- Urine has a strong smell
- Pain just above the pubic bone
- Pain in the lower back
- Pain in the abdomen
- Only small amount of urine is passed each time
- Frequent need to urinate
- Burning sensation when urinating
- Older women may feel weak and feverish but have none of the other symptoms mentioned above
- When children have cystitis they may have any of the symptoms listed above, plus vomiting and general weakness.
Other illnesses or conditions may have the same symptoms as cystitis. They include:
- Urethritis (inflammation of the urethra)
- Urethral syndrome
- Some bacterial infections
- Prostatitis (inflammation of the male prostate gland)
- Candida (thrush)
Diagnosis of cystitis
A doctor will ask the patient some questions, carry out an examination, and do a urine test. The urine test will either be sent to a laboratory, or the GP may use a dipstick. A “clean catch” (urine culture) or catheterized urine specimen may be performed to determine the type of bacteria in the urine. After finding out which specific bacterium is causing the infection the patient will be prescribed an oral antibiotic.
Treatments for cystitis
In the vast majority of cases, mild cystitis will resolve itself within a few days. Any cystitis that lasts more than about four days should be consulted with your GP.
Sometimes a short 3-day course of antibiotics is given. Most patients will experience the beneficial effects of an antibiotic within the first day of treatment. If symptoms do not improve after taking the antibiotics the patient should return to her/his doctor. The following antibiotics are commonly used for cystitis: Nitrofurantoin, Trimethoprim-sulfamethoxazole, Amoxicillin, Cephalosporins, Ciprofloxacin or levofloxacin, and Doxycycline.
Elderly people, and those with possible weakened immune systems, such as people with diabetes, have a higher risk of the infection spreading to the kidney, as well as other complications. Vulnerable people should be treated promptly.
The following home remedies and measures may help:
- Painkillers, such as paracetamol (Tylenol) or ibuprofen may help with the discomfort. If you are pregnant discuss this with either your doctor or a well-qualified pharmacist.
- Drink plenty of fluids. This will help flush the bacteria from the system.
- Do not consume alcohol.
- Sodium citrate or potassium citrate in sachets or solutions sometimes ease symptoms.
- Cranberry juice has been shown to be good for the urinary tract and effective in fighting urinary tract infections (2010 study). Drinking some cranberry juice each day may prevent recurrences – some people have even experienced relief of symptoms. Cranberry juice also has condensed tannins, Manoose – D and proanthocyanidins which have been found to inhibit the activity of E. coli by preventing the bacteria from sticking to mucosal surfaces lining the bladder and gut, helping to clear bacteria from the urinary tract.Although the above study suggests cranberry juice to be effective in assisting with fighting cystitis and urinary tract infections, it should be noted that not all evidence finds in its favour. Indeed, one study from October 2012 suggests that cranberry juice actually has little benefit. Scientists from the university of Stirling, Scotland, found that cranberry extract had no effect in preventing bladder infections, such as cystitis, nor urinary tract infections.
Many cases of cystitis are not preventable. However, the following measures may help:
- Practice good hygiene after sex, especially women. Try using neutral soaps around the genitals, not perfumed ones.
- When you urinate try to make sure you have emptied your bladder completely.
- If you feel you need to urinate go straight away – do not postpone it.
- Avoid tight underwear, and tight pants (trousers).
- Wear cotton underwear.
- Wipe from front to back.
- When having sex make sure sexual organ is lubricated, if necessary use a lubricant.
- Empty bladder as soon as possible after sex.
- If you wear a catheter ask your doctor or nurse how to avoid damage when you have to change it.