Cystitis

What is Cystitis?

Cystitis refers to an inflammation of the bladder. It results in urgent, frequent, and painful urination with strong-smelling urine. Cystitis causes the bladder to become irritated, red, and swollen. It is more commonly seen in women.

Is Cystitis condition a medical emergency?

Cystitis is not a medical emergency but requires early diagnosis and treatment to prevent its spread to the kidneys and further complications.

Types

There are various types of cystitis depending on the cause as follows:

• Bacterial Cystitis: When caused by bacterial infection, it is called bacterial cystitis, also called as acute cystitis. The most common type of bacteria that causes cystitis is Escherichia coli (E. coli). One of the reasons for developing a bacterial infection is sexual intercourse. Infections generally enter the body from the outside. These infections are more common in women since the female genital area consists of bacteria that cause cystitis.
• Non-infectious Cystitis: Apart from infections, this condition can also be caused due to other reasons. Other types of cystitis that are non-infectious include the following:
  • Interstitial Cystitis: It is also called as chronic cystitis. This originates in the bladder. An underlying medical condition causes bladder pain and pressure. There is no presence of infection.
  • Drug-induced Cystitis: Intake of certain types of medications causes bladder inflammation. Example: Chemotherapy drugs.
  • Radiation Cystitis: When the pelvic area is exposed to radiation, the bladder and surrounding structures of the urinary tract can become inflamed, causing cystitis.
  • Chemical Cystitis: This type of bladder inflammation is caused by exposure of the female genital area to feminine hygiene products

Causes

Causes can include the following:

• Bacterial infection
• Reaction to certain medications
• Exposure to radiation therapy
• Irritation when exposed to personal hygiene sprays or products used
• Long-term use of a catheter
• As a complication from other illnesses such as diabetes, kidney stones, HIV, or spinal cord injuries

Risk factors

Women are more prone to cystitis as they have a shorter urethra that facilitates easy bacteria travel to the bladder and causes inflammation. Factors that increase the probability of developing this condition include the following:

• Sexual intercourse
• It is common in pregnancy. Pregnant women have hormonal changes in the body that increase the chances of acquiring bladder infections frequently
• The presence of medical conditions like diabetes, kidney stones, bladder stones, etc., can increase the risk of bladder inflammation
• Long-term use of external devices such as bladder catheters can cause bladder inflammation
• Individuals with a compromised immune system are at higher risk of developing cystitis and other urinary infections
• In some cases, hormonal changes in postmenopausal women are also associated with urinary tract infections.
• Radiation exposure to the pelvic area
• Overuse of personal hygiene products or sprays in the genital area can cause bladder inflammation and urinary tract infections
• Inappropriate care after undergoing any surgical procedure of the urinary system can increase the chance of developing an infection
• Individuals with interference or obstruction to the flow of urine are also at higher risk of developing this condition

Symptoms & signs

Signs and symptoms of cystitis are:

• Burning sensation while urinating
• Persistent urge to urinate
• Passing only a small amount of urine
• Passing cloudy urine
• Strong smelling urine
• Blood in the urine
• Pelvic pain and discomfort
• Pressure in the lower part of the abdomen, along with back pain
• The presence of low-grade fever, chills, and malaise

Investigations

Investigations that are performed to diagnose cystitis include:

• Laboratory tests:
  • CBP & ESR
  • Complete Urine Examination: A urine sample is collected to check for bacteria, blood, or pus in the urine. Along with urinalysis, urine dipstick and urine culture are also performed.
  • Renal Function tests
• Imaging Tests: To evaluate any presence of a tumor or any structural abnormality
  • X-Ray
  • Ultrasound
• Procedures:
  • Cystoscopy: A cystoscope is inserted into the bladder to view the inner lining of the urinary system for any presence of disease. A small tissue of any suspected region is removed to be examined under a microscope to determine any further signs of cystitis.

Diagnosis

A diagnosis is established based on medical history, clinical evaluation, and investigation results.

Treatment options

Cystitis treatment depends on the individual's type, severity, and general health. Based on the condition, medical and surgical interventions may be required to manage this condition.

Medical management

Cystitis that is caused due to a bacterial infection is treated with antibiotics. General antibiotics are used if the bacterial infection is caused for the first time. The condition may resolve usually within two to three days. The course of antibiotics can last from 4 days to 7 days. If the condition is repetitive, long-term use of antibiotics is prescribed.

However, if bacterial infection is hospital-acquired, different types of antibiotics are recommended. Hospital-acquired infection is a kind of infection acquired due to a longer stay in the hospital. Bacteria found in hospitals are resistant to normal types of antibiotics that are used to treat bladder infections. Hence, more complex types of antibiotics are prescribed for these infections. Antibiotics that are mostly used in the treatment of cystitis include nitrofurantoin, trimethoprim, and fosfomycin.

For interstitial cystitis or chronic cystitis, there is no known cure. For chronic conditions, where there is no particular cause of the disease, treatment includes prescribing medications orally or introducing them directly into the bladder. Nerve stimulation is also done to reduce pelvic pain and urinary frequency. Lifestyle changes and physical therapy also help improve the symptoms in individuals with chronic disease.
Treatment of cystitis that is caused as a complication of chemotherapy or radiation therapy to the pelvic region focuses on pain management and hydration to flush out the bladder irritants.

Interventional including surgery and indications for surgery

The following surgical intervention may be performed for the management of cystitis:

• Excision procedures: If cystitis is caused secondary to any tumors or ulcers in the bladder, a surgical procedure is performed to remove the ulcers or tumors.

Role of Diet/ Exercise/ Lifestyle changes/ Preventive measures

Some measures that can be taken to prevent or manage cystitis include the following:

• Consume cranberry juice
• Consume soy milk, barley water, and less acidic fruits like apple
• Drink plenty of liquids and water
• Avoid tub baths
• Avoid harsh soaps or other feminine products around the vagina and anus
• Empty bladder after sexual intercourse
• Avoiding holding urine in the bladder and urinating frequently prevents bladder infections
• Using a heating pad in the lower pelvic region to reduce bladder pressure and pain
• Taking sitz baths to cleanse the pelvic area
• Wearing cotton underwear and loose-fitting clothes
• Cessation of smoking
• Maintaining stress levels
• Avoiding beverages such as coffee, soda, alcohol, citrus fruits, hot peppers, and artificial sweeteners

Postmenopausal women are prescribed vaginal estrogen cream to prevent bladder or urinary tract infections.

Complications

Cystitis in women, if neglected, can cause certain complications, which are described below:

• Kidney infections are also known as pyelonephritis. If left untreated, they can gradually lead to kidney failure
• Hematuria
• Formation of adhesions in the urinary bladder
• Sepsis
• Candidemia
• Bladder rupture
• Recurrent urinary tract infection
• Adenocarcinoma of the bladder

Prognosis

The overall prognosis of cystitis is good. The average duration of the disease is 2 to 3 days with effective antibiotics. Recurrence is common, and recurrent cystitis may require long-term treatment with antibiotics. The outcomes are better in younger individuals. Cystitis in the elderly or postmenopausal women may have higher morbidity and mortality rates.

When to contact the doctor? / How to identify complications?

It is advisable to seek medical attention if the signs and symptoms are noticed.

Indications for hospitalization

Cystitis does not require hospitalization in all cases. However, if surgical treatment is advised, brief hospitalization may be needed.

Suggested clinical specialists/ Departments to consult for this condition

• Nephrology
• Urology