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
- Infectious Causes
- Bacteria: Primarily caused by Escherichia coli (E. coli).
- Other bacteria: Staphylococcus saprophyticus, Klebsiella pneumoniae.
- Non-Infectious Causes
- Interstitial Cystitis: Chronic inflammation without infection.
- Chemical Irritants: Certain soaps, hygiene sprays, or medications.
- Radiation Cystitis: Following pelvic radiation therapy.
- Predisposing Factors
- Sexual activity (honeymoon cystitis).
- Use of catheters or urinary retention.
- Menopause due to hormonal changes.
- Diabetes and immunosuppression.
Symptoms of Cystitis
- 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.
- Severe Symptoms
- Blood in urine (hematuria).
- Fever, chills, nausea, or vomiting (may indicate kidney involvement).
- 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
- Medical History and Physical Examination
- Symptom assessment and risk factor identification.
- Urinalysis
- Checks for white blood cells, red blood cells, and bacteria.
- Urine Culture
- Identifies specific bacteria and determines antibiotic sensitivity.
- Imaging Tests
- Ultrasound or CT scan for recurrent or complicated cases.
- 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