cystitis

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Cystitis

 

Definition

Cystitis is defined as inflammation of the urinary bladder. Urethritis is an inflammation of the urethra, which is the passageway that connects the bladder with the exterior of the body. Sometimes cystitis and urethritis are referred to collectively as a lower urinary tract infection, or UTI. Infection of the upper urinary tract involves the spread of bacteria to the kidney and is called pyelonephritis.

Description

The frequency of bladder infections in humans varies significantly according to age and sex. The male/female ratio of UTIs in children younger than 12 months is 4:1 because of the high rate of birth defects in the urinary tract of male infants. In adult life, the male/female ratio of UTIs is 1:50. After age 50, however, the incidence among males increases due to prostate disorders.

Cystitis in women

Cystitis is a common female problem. It is estimated that 50% of adult women experience at least one episode of dysuria (painful urination); half of these patients have a bacterial UTI. Between 2-5% of women's visits to primary care doctors are for UTI symptoms. About 90% of UTIs in women are uncomplicated but recurrent.

Cystitis in men

UTIs are uncommon in younger and middle-aged men, but may occur as complications of bacterial infections of the kidney or prostate gland.

Cystitis in children

In children, cystitis often is caused by congenital abnormalities (present at birth) of the urinary tract. Vesicoureteral reflux is a condition in which the child cannot completely empty the bladder. It allows urine to remain in or flow backward (reflux) into the partially empty bladder.

Causes and symptoms

The causes of cystitis vary according to sex because of the differences in anatomical structure of the urinary tract.

Females

Most bladder infections in women are so-called ascending infections, which means they are caused by disease agents traveling upward through the urethra to the bladder. The relative shortness of the female urethra (1.2-2 inches in length) makes it easy for bacteria to gain entry to the bladder and multiply. The most common bacteria associated with UTIs in women include Escherichia coli (about 80% of cases), Staphylococcus saprophyticus, Klebsiella, Enterobacter, and Proteus species. Risk factors for UTIs in women include:
  • Sexual intercourse. The risk of infection increases if the woman has multiple partners.
  • Use of a diaphragm for contraception
  • An abnormally short urethra
  • Diabetes or chronic dehydration
  • The absence of a specific enzyme (fucosyltransferase) in vaginal secretions. The lack of this enzyme makes it easier for the vagina to harbor bacteria that cause UTIs.
  • Inadequate personal hygiene. Bacteria from fecal matter or vaginal discharges can enter the female urethra because its opening is very close to the vagina and anus.
  • History of previous UTIs. About 80% of women with cystitis develop recurrences within two years.
The early symptoms of cystitis in women are dysuria, or pain on urination; urgency, or a sudden strong desire to urinate; and increased frequency of urination. About 50% of female patients experience fever, pain in the lower back or flanks, nausea and vomiting, or shaking chills. These symptoms indicate pyelonephritis, or spread of the infection to the upper urinary tract.

Males

Most UTIs in adult males are complications of kidney or prostate infections. They usually are associated with a tumor or kidney stones that block the flow of urine and often are persistent infections caused by drug-resistant organisms. UTIs in men are most likely to be caused by E. coli or another gram-negative bacterium. S. saprophyticus, which is the second most common cause of UTIs in women, rarely causes infections in men. Risk factors for UTIs in men include:
  • Lack of circumcision. The foreskin can harbor bacteria that cause UTIs.
  • Urinary catheterization. The longer the period of catheterization, the higher the risk of UTIs.
The symptoms of cystitis and pyelonephritis in men are the same as in women.

Hemorrhagic cystitis

Hemorrhagic cystitis, which is marked by large quantities of blood in the urine, is caused by an acute bacterial infection of the bladder. In some cases, hemorrhagic cystitis is a side effect of radiation therapy or treatment with cyclophosphamide. Hemorrhagic cystitis in children is associated with adenovirus type 11.

Diagnosis

When cystitis is suspected, the doctor will first examine the patient's abdomen and lower back, to evaluate unusual enlargements of the kidneys or swelling of the bladder. In small children, the doctor will check for fever, abdominal masses, and a swollen bladder.
The next step in diagnosis is collection of a urine sample. The procedure differs somewhat for women and men. Laboratory testing of urine samples now can be performed with dipsticks that indicate immune system responses to infection, as well as with microscopic analysis of samples. Normal human urine is sterile. The presence of bacteria or pus in the urine usually indicates infection. The presence of hematuria, or blood in the urine, may indicate acute UTIs, kidney disease, kidney stones, inflammation of the prostate (in men), endometriosis (in women), or cancer of the urinary tract. In some cases, blood in the urine results from athletic training, particularly in runners.

Females

Female patients often require a pelvic examination as part of the diagnostic workup for bladder infections. Normally, however, a midstream urine sample of 200 ml is collected to test for infection.
A count of more than 104 bacteria CFU/ml (colony forming units per milliliter) in the midstream sample indicates a bladder or kidney infection. A colony is a large number of microorganisms that grow from a single cell within a substance called a culture. A bacterial count can be given in CFU or (colony forming units).
In recent years, many health providers and insurance companies have adopted telephone treatment of women with presumed cystitis. Trained nurses diagnose uncomplicated bladder infections over the telephone based on the patient's symptoms and a series of questions prepared by physicians. The practice has been found safe and cost-effective.

Males

In male patients, the doctor will cleanse the opening to the urethra with an antiseptic before collecting the urine sample. The first 10 ml of specimen are collected separately. The patient then voids a mid-stream sample of 200 ml. Following the second sample, the doctor will massage the patient's prostate and collect several drops of prostatic fluid. The patient then voids a third urine specimen for prostatic culture.
A high bacterial count in the first urine specimen or the prostatic specimens indicates urethritis or prostate infections respectively. A bacterial count greater than 100,000 bacteria CFU/ml in the midstream sample suggests a bladder or kidney infection.

Other tests

Women with recurrent UTIs can be given ultrasound exams of the kidneys and bladder together with a voiding cystourethrogram to test for structural abnormalities. (A cystourethrogram is an x-ray test in which an iodine dye is used to better view the urinary bladder and urethra.) Voiding cystourethrograms are also used to evaluate children with UTIs. In some cases, computed tomography scans (CT scans) can be used to evaluate patients for possible cancers in the urinary tract.

Treatment

Medications

Uncomplicated cystitis is treated with antibiotics. These include penicillin, ampicillin, and amoxicillin; sulfisoxazole or sulfamethoxazole; trimethoprim; nitrofurantoin; cephalosporins; or fluoroquinolones. (Flouroquinolones generally are not used in children under 18 years of age.) A 2003 study showed that fluoroquinolone was preferred over amoxicillin, however, for uncomplicated cystitis in young women. Treatment for women is short-term; most patients respond within three days. Men do not respond as well to short-term treatment and require seven to 10 days of oral antibiotics for uncomplicated UTIs.
Patients of either sex may be given phenazopyridine or flavoxate to relieve painful urination.
Trimethoprim and nitrofurantoin are preferred for treating recurrent UTIs in women.
Over 50% of older men with UTIs also suffer from infection of the prostate gland. Some antibiotics, including amoxicillin and the cephalosporins, do not affect the prostate gland. Fluoroquinolone antibiotics or trimethoprim are the drugs of choice for these patients.
Patients with pyelonephritis can be treated with oral antibiotics or intramuscular doses of cephalosporins. Medications are given for 10-14 days, and sometimes longer. If the patient requires hospitalization because of high fever and dehydration caused by vomiting, antibiotics can be given intravenously.

Surgery

A minority of women with complicated UTIs may require surgical treatment to prevent recurrent infections. Surgery also is used to treat reflux problems (movement of the urine backward) or other structural abnormalities in children and anatomical abnormalities in adult males.

Alternative treatment

Alternative treatment for cystitis may emphasize eliminating all sugar from the diet and drinking lots of water. Drinking unsweetened cranberry juice not only adds fluid, but also is thought to help prevent cystitis by making it more difficult for bacteria to cling to the bladder wall. A variety of herbal therapies also are recommended. Generally, the recommended herbs are antimicrobials, such as garlic (Allium sativum), goldenseal (Hydrastis canadensis), and bearberry (Arctostaphylos uva-ursi), and/or demulcents that soothe and coat the urinary tract, including corn silk and marsh mallow (Althaea officinalis).
Homeopathic medicine also can be effective in treating cystitis. Choosing the correct remedy based on the individual's symptoms is always key to the success of this type of treatment. Acupuncture and Chinese traditional herbal medicine can also be helpful in treating acute and chronic cases of cystitis.

Prognosis

Females

The prognosis for recovery from uncomplicated cystitis is excellent.

Males

The prognosis for recovery from uncomplicated UTIs is excellent; however, complicated UTIs in males are difficult to treat because they often involve bacteria that are resistant to commonly used antibiotics.

Prevention

Females

Women with two or more UTIs within a six-month period sometimes are given prophylactic treatment, usually nitrofurantoin or trimethoprim for three to six months. In some cases the patient is advised to take an antibiotic tablet following sexual intercourse.
Other preventive measures for women include:
  • drinking large amounts of fluid
  • voiding frequently, particularly after intercourse
  • proper cleansing of the area around the urethra
In 2003, clinical trials in humans were testing a possible vaccine for recurrent urinary tract infections. The vaccine was administered via a vaginal suppository.

Key terms

Bacteriuria — The presence of bacteria in the urine.
Dysuria — Painful or difficult urination.
Hematuria — The presence of blood in the urine.
Pyelonephritis — Bacterial inflammation of the upper urinary tract.
Urethritis — Inflammation of the urethra, which is the passage through which the urine moves from the bladder to the outside of the body.

Males

The primary preventive measure for males is prompt treatment of prostate infections. Chronic prostatitis may go unnoticed, but can trigger recurrent UTIs. In addition, males who require temporary catheterization following surgery can be given antibiotics to lower the risk of UTIs.

Resources

Periodicals

Harrar, Sari. "Bladder Infection Protection." Prevention November 2003: 174.
Jancin, Bruce. "Presumed Cystitis Well Managed Via Telephone: Large Kaiser Experience." Family Practice News November 1, 2003: 41.
Prescott, Lawrence M. "Presumed Quinolone Gets the Nod for Uncomplicated Cystitis." Urology Times November 2003: 11.

cystitis

 [sis-ti´tis]
inflammation of the urinary bladder; it may result from an ascending infection coming from the exterior of the body by way of the urethra, or from an infection descending from the kidney. A simple cystitis that does not involve the rest of the urinary tract is not as serious as the descending type in which the kidneys and ureters as well as the bladder are involved. Often cystitis is not an isolated infection but is a result of some other physical condition, such as urinary retention, calculi in the bladder, tumors, or neurologic diseases that impair normal bladder function.

Prevention of recurrent cystitis in females that is not attributable to abnormal structures or other factors mentioned previously may be achieved by good personal hygiene and the following measures: (1) always wipe the anal region from front to back after a bowel movement; (2) avoid wearing nylon pantyhose, tight slacks, or any clothing that traps perineal moisture and prevents evaporation; (3) do not wash underclothing in strong soap, and rinse underclothing well; (4) do not use bubble bath, perfumed soap, feminine hygiene sprays, or products containing hexachlorophene; (5) avoid prolonged bicycling, motorcycling, horseback riding, and traveling involving prolonged sitting, which can contribute to irritation of the urethral meatus and to development of an ascending cystitis; and (6) do not ignore vaginal discharge or other signs of vaginal infection.
Symptoms and Treatment. The most common symptoms of cystitis are dysuria, frequency and urgency of urination, and in some cases hematuria. Chills and fever indicate involvement of the entire urinary tract and are not symptomatic of uncomplicated cystitis. Treatment of acute cystitis consists of antimicrobials, forcing of fluids, and bed rest. Hot sitz baths give some relief of the discomfort, and spasms of the bladder wall may respond to an antispasmodic drug such as hyoscyamine. Chronic cystitis is more difficult to cure and may require surgical dilatation of the urethra to facilitate drainage of urine. In many cases removal of the underlying cause, such as chronic vaginal infection, relieves the cystitis.
cystitis col´li inflammation of the bladder and bladder neck.
hemorrhagic cystitis cystitis with severe hemorrhage, a dose-limiting toxic condition with administration of ifosfamide or cyclophosphamide, or a complication of bone marrow transplantation.
interstitial cystitis a type seen mainly in women, with the inflammatory lesion a small patch of red to brown mucosa surrounded by a network of radiating vessels, usually in the vertex and involving the entire thickness of the wall. The lesions are known as Hunner's ulcers and often heal superficially so that they are difficult to detect.
radiation cystitis inflammatory changes in the urinary bladder caused by ionizing radiation; called also radiocystitis.

cys·ti·tis

(sis-tī'tis),
Inflammation of the urinary bladder.
[cyst- + G. -itis, inflammation]

cystitis

/cys·ti·tis/ (sis-ti´tis) inflammation of the urinary bladder.
cystitis follicula´ris  that in which the bladder mucosa is studded with nodules containing lymph follicles.
cystitis glandula´ris  that in which the mucosa contains mucin-secreting glands.
hemorrhagic cystitis  cystitis with severe hemorrhage, a dose-limiting toxic condition with administration of ifosfamide and cyclophosphamide or a complication of bone marrow transplantation.
interstitial cystitis  a bladder condition with an inflammatory lesion, usually in the vertex, and involving the entire thickness of the wall.
radiation cystitis  inflammatory changes in the bladder caused by ionizing radiation.

cystitis

(sĭ-stī′tĭs)
n.
Inflammation of the urinary bladder.

cystitis

[sistī′tis]
Etymology: Gk, kystis + itis, inflammation
an inflammatory condition of the urinary bladder and ureters, characterized by pain, urgency and frequency of urination, and hematuria. It may be caused by a bacterial infection, calculus, or tumor. Increased sexual activity in women can cause cystitis, and certain venereal diseases such as gonorrhea and chlamydia may cause cystitis-like symptoms. Depending on the diagnosis, treatment may include antibiotics, increased fluid intake, bed rest, medications to control bladder wall spasms, and, when necessary, surgery.
enlarge picture
Cystitis

cystitis

Urology Bacterial infection and inflammation of the bladder and urethra, which is most common in ♀, attributable in part to the short urethra and short distance between the urethral opening and the anus–ages 20 to 50; it is rare in ♂ with anatomically normal urinary tracts; older adults are at high risk for cystitis–incidence in elderly is up to 33%, due to incomplete emptying of bladder associated with BPH, prostatitis, urethral strictures, dehydration, bowel incontinence, ↓ mobility; most cystitis is caused by E coli; sexual intercourse ↑ risk of cystitis because bacteria can be introduced into the bladder via the urethra Risk factors Bladder or urethral obstruction with stasis of urine, insertion of instruments into urinary tract–catheterization or cystoscopy, pregnancy, DM, analgesic nephropathy or reflux nephropathy. See Acute cystitis, Honeymoon cystitis, Interstitial cystitis, Urinary tract infection.

cys·ti·tis

(sis-tī'tis)
Inflammation of the urinary bladder.
[cyst- + G. -itis, inflammation]

cystitis

Inflammation of the urinary bladder caused by infection. There is undue frequency of urination, burning or ‘scalding’ pain on passing urine, and sometimes incontinence. Treatment with antibiotics is usually effective.

cystitis

a painful inflammation of the bladder caused by infection with the gut bacterium Escherichia coli.

cystitis (sis·tīˑ·ts),

n inflammatory condition that occurs in the ureter and urinary bladder with symptoms such as hematuria, pain, frequent urination and persistent urge to urinate.

cystitis

inflammation of the urinary bladder. The condition may result from an ascending infection coming from the exterior of the body by way of the urethra, or it may be caused by an infection descending from the kidney. Often cystitis is not an isolated infection but is rather a result of some other physical condition. For example, urinary retention, calculi in the bladder, tumors, or neurological diseases impairing the normal function of the bladder may lead to cystitis.
Clinical signs include freqency, pain on urination, blood-stained urine, a thickened bladder wall. Significant clinical pathology findings include hematuria, a high cell count indicative of inflammation, and a positive bacterial culture.

cystitis cystica
cystitis marked by the presence of submucosal cysts.
emphysematous cystitis
an occasional complication of diabetes mellitus in dogs and cats, caused by gas-forming bacteria.
epizootic equine cystitis
an Australian disease of horses similar to Sorghum spp. poisoning.
gangrenous cystitis
results from severe inflammation and ischemia; the bladder wall is green to black.
cystitis glandularis
mucin-secreting glands present in the mucosa in a case of cystitis.
hemorrhagic cystitis
hemorrhage is the main clinical feature.
interstitial cystitis
a lower urinary tract disease of women in which there is painful urination and hemorrhagic lesions in the bladder wall, but no cause can be diagnosed. A similar syndrome is believed to occur in cats.
polypoid cystitis
the mucosa is folded with polypoid projections.

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