Cystitis

Introduction

  • Cystitis refers to inflammation of the bladder, most commonly caused by a bacterial infection known as a urinary tract infection (UTI).
  • Commonly affects women but can also occur in men and children.
  • Symptoms include pain during urination, frequent urination, and lower abdominal discomfort.
  • Early diagnosis and appropriate treatment are essential to prevent complications.

Causes of Cystitis

  1. Infectious Causes
    • Bacteria: Primarily caused by Escherichia coli (E. coli).
    • Other bacteria: Staphylococcus saprophyticus, Klebsiella pneumoniae.
  2. Non-Infectious Causes
    • Interstitial Cystitis: Chronic inflammation without infection.
    • Chemical Irritants: Certain soaps, hygiene sprays, or medications.
    • Radiation Cystitis: Following pelvic radiation therapy.
  3. Predisposing Factors
    • Sexual activity (honeymoon cystitis).
    • Use of catheters or urinary retention.
    • Menopause due to hormonal changes.
    • Diabetes and immunosuppression.

Symptoms of Cystitis

  1. Common Symptoms
    • Pain or burning during urination (dysuria).
    • Frequent urination, often in small amounts.
    • Urgency to urinate.
    • Lower abdominal or pelvic pain.
    • Cloudy, strong-smelling urine.
  2. Severe Symptoms
    • Blood in urine (hematuria).
    • Fever, chills, nausea, or vomiting (may indicate kidney involvement).
  3. Chronic or Interstitial Cystitis
    • Persistent pelvic pain.
    • Frequent urination day and night.
    • Flare-ups triggered by certain foods or stress.

Complications of Cystitis

  • Kidney Infections (Pyelonephritis): Infection spreading to the kidneys.
  • Bladder Damage: Scarring or reduced capacity.
  • Recurrent Infections: Multiple episodes of cystitis over time.
  • Sepsis: Rare but life-threatening in severe cases.

Diagnosis of Cystitis

  1. Medical History and Physical Examination
    • Symptom assessment and risk factor identification.
  2. Urinalysis
    • Checks for white blood cells, red blood cells, and bacteria.
  3. Urine Culture
    • Identifies specific bacteria and determines antibiotic sensitivity.
  4. Imaging Tests
    • Ultrasound or CT scan for recurrent or complicated cases.
  5. Cystoscopy
    • Used for chronic or interstitial cystitis to visualize the bladder.

Treatment Options for Cystitis

1. Antibiotic Therapy

  • First-Line Antibiotics for Uncomplicated Cystitis
    • Nitrofurantoin (Macrobid): 100 mg twice daily for 5 days. Approx. $20 for 30 capsules (Manufacturer: Alvogen).
    • Trimethoprim-sulfamethoxazole (Bactrim): 160/800 mg twice daily for 3 days. Approx. $15 for 10 tablets (Manufacturer: Sun Pharma).
    • Fosfomycin (Monurol): 3 g single dose. Approx. $90 per sachet (Manufacturer: Almirall).
  • Antibiotics for Complicated Cystitis
    • Ciprofloxacin (Cipro): 500 mg twice daily for 7–14 days. Approx. $10 for 14 tablets (Manufacturer: Bayer).
    • Levofloxacin (Levaquin): 500 mg once daily for 7–14 days. Approx. $20 for 7 tablets (Manufacturer: Janssen).
  • Recurrent Infections
    • Prophylactic low-dose antibiotics or post-coital antibiotics.

2. Pain Management

  • Phenazopyridine (Pyridium): Short-term relief for urinary discomfort. Approx. $12 for 30 tablets (Manufacturer: Teva Pharmaceuticals).
  • NSAIDs: Ibuprofen for lower abdominal pain.

3. Non-Antibiotic Measures

  • Increased fluid intake to flush out bacteria.
  • Avoid bladder irritants: Caffeine, alcohol, spicy foods.
  • Use heating pads for abdominal pain relief.

4. Interstitial Cystitis Management

  • Dietary changes to avoid trigger foods.
  • Medications: Pentosan polysulfate sodium (Elmiron): Approx. $450 for 90 capsules (Manufacturer: Janssen).
  • Bladder instillations with dimethyl sulfoxide (DMSO).

Monitoring Parameters

  • Symptom improvement within 48–72 hours of starting treatment.
  • Follow-up urine culture for complicated or recurrent cases.
  • Regular monitoring for chronic or interstitial cystitis symptoms.

Patient Counseling Points

  • Complete the full course of antibiotics, even if symptoms resolve early.
  • Stay hydrated and urinate frequently to flush the bladder.
  • Practice good hygiene: Wipe front to back and avoid irritants.
  • Urinate after sexual activity to reduce infection risk.
  • Avoid holding urine for prolonged periods.

Use in Children

  • Symptoms include fever, irritability, or bedwetting. Antibiotics are weight-based.

Use in Pregnancy

  • Safe antibiotics include amoxicillin: Approx. $10 for 20 capsules (Manufacturer: Mylan), nitrofurantoin, and cephalexin. Avoid fluoroquinolones.

Use in Elderly

  • Symptoms may include confusion or falls. Monitor for dehydration and recurrent infections.

FAQs About Cystitis

Q1: What causes cystitis?

  • Most cases are caused by bacterial infections, particularly E. coli.

Q2: Can cystitis go away without treatment?

  • Mild cases may resolve with hydration, but antibiotics are recommended to prevent complications.

Q3: Is cystitis contagious?

  • No, but sexual activity can increase the risk of infection.

Q4: How can cystitis be prevented?

  • Drink plenty of water, urinate frequently, and maintain good hygiene.

Q5: Can cranberry juice cure cystitis?

  • It may reduce recurrence risk but does not treat active infections.

Q6: How long does it take to recover from cystitis?

  • Symptoms improve within 2–3 days of antibiotic treatment.

Q7: What foods should I avoid with cystitis?

  • Avoid caffeine, alcohol, spicy foods, and acidic drinks.

Q8: Can men get cystitis?

  • Yes, though less common, often linked to prostate issues.

Q9: What are the risks of untreated cystitis?

  • Complications like kidney infections and recurrent UTIs.

Q10: Can children develop cystitis?

  • Yes, it is common, especially in girls, and presents with fever or irritability