Definition

Cystitis is an infection of the bladder. The bladder is the part of the urinary tract that collects the urine from the kidneys.

© 2009 Nucleus Medical Media, Inc.

Causes

The urinary tract normally contains no microorganisms. However, sometimes bacteria or yeast from the lower gastrointestinal tract or rectal area enter the urinary tract, usually through the urethra (tube that allows urine to pass out from the bladder). When bacteria or yeast cling to the urethra, they can multiply and infect the urethra. They can then travel up and infect the bladder.

Most cases of cystitis are caused by bacteria from the rectal area. In women, the rectum and urethra are fairly close to each other. This makes it relatively easy for bacteria to make their way into the urethra. Some women develop cystitis after a period of frequent sexual intercourse. This happens because bacteria enter the urethra during sex and cause infection.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors include:

• Sex: female
• Being sexually active
• Using a diaphragm for birth control
• Condom use —This may also increase infection rates in women, especially when Nonoxynol-9-coated condoms are used.
• Menopause
• Abnormalities of the urinary system, including vesicoureteral reflux or polycystic kidneys
• Paraplegia and other neurologic conditions
• Sickle-cell disease
• History of kidney transplant
• Diabetes type 1 and type 2
• Kidney stones
• Enlarged prostate (in men)
• Weak immune system
• Bladder catheter in place or recent instrumentation of the urinary system
• Tight underwear and clothing
• Chemicals in soaps, douches, and lubricants

Symptoms

The symptoms of cystitis vary from person-to-person and can range from mild to severe. They include:

• Frequent and urgent need to urinate
• Passing only small amounts of urine
• Pain in the abdomen or pelvic area, or in the low back
• Burning sensation during urination
• Leaking urine
• Increased need to get up at night to urinate
• Cloudy, bad-smelling urine
• Blood in the urine
• Low-grade fever
• Fatigue

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be performed. In addition, a sample of your urine will be tested for blood, pus, and bacteria. If bacteria are present in the urine, you will likely be diagnosed with cystitis.

Children and men who develop cystitis may require additional testing. The doctor will use a cystoscope to check for structural abnormalities of the urinary system that predispose them to infection.

Treatment

Bacterial cystitis is treated with antibiotic drugs. Antibiotics (usually trimethoprim/sulfamethoxazole, nitrofurantoin, or fluoroquinolones) will be prescribed for at least 2-3 days and perhaps for as long as several weeks. The length of the treatment depends on the severity of the infection and your personal history. You will probably start to feel better after a day or two. However, it is important that you complete the entire course of medication. Otherwise, the infection is likely to return. You may have your urine checked after you finish taking the antibiotic. This is to make sure that the infection is truly gone.

If you experience recurrent infections, your doctor may prescribe stronger antibiotics or have you take them for a longer period of time. He or she may also recommend that you take low-dose antibiotics as a preventive measure, either daily or after sexual intercourse. If you still experience recurrent infections, you may be referred to a specialist.

Phenazopyridine (Pyridium) is a medicine that decreases pain and bladder spasms. Taking phenazopyridine will turn your urine and sometimes your sweat an orange color. This medication is generally available without a prescription and can usually relieve symptoms effectively while waiting for medical treatment to work.

Prevention

You can lessen your chance of having cystitis by preventing bacteria from entering the urinary tract. Of the following logical and commonly recommended steps, only the use of cranberry juice has been clearly shown to be of value in reducing infection risk.

• Drink plenty of liquids.
• Urinate when you have the urge and do not resist it.
• After sexual intercourse, empty your bladder and then drink a full glass of water.
• Wash genitals daily.
• If you're a woman, always wipe from the front to the back after having a bowel movement.
• Avoid using douches and feminine hygiene sprays.
• Drinking cranberry juice may help prevent and relieve cystitis.
• Avoid wearing tight underwear or clothing.

The above prevention recommendations apply largely to healthy young women at risk for bladder infections. Those with some of the unusual risk factors listed above, or women for whom the above suggestions do not reduce recurrence, may find other medically recommended prevention techniques to be useful.