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Cystitis

Cystitides

Cystitis is a condition, characterized by inflammation of the bladder, which majorly occurs due to bacterial infection. It is a common form of lower urinary tract infection.


Presentation

The condition of cystitis presents itself with the following signs and symptoms:

Pain
  • All patients who stopped using ketamine were free of bladder pain postoperatively. However, 10 patients who reused ketamine had recurrent bladder pain and recurrent urinary tract infection.[ncbi.nlm.nih.gov]
  • Signs and symptoms include increased frequency of urination, pain or burning during urination, fever, cloudy or bloody urine, and suprapubic pain. An acute or chronic inflammatory process affecting the bladder.[icd9data.com]
  • Living with a chronic pain condition raises your risk of depression. 5 Pain during sex. Many women with bladder pain syndrome report pain during sex.[womenshealth.gov]
  • Or surgery may be done to stop nerve pain. How can you manage your pain? Your doctor will help you manage your pain, but there are also things you can do.[healthy.kaiserpermanente.org]
Fatigue
  • IC/PBS can be associated with irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome and other pain syndromes. It is felt to fall under the larger entity – Chronic pelvic pain syndrome.[urology.ucsf.edu]
  • Hidden dangers: Complications include fatigue, dehydration and problems with the menstrual cycle.[dailymail.co.uk]
  • […] urination, usually in small amounts uncontrolled dribbling of urine urgency to urinate pain or burning on urination pressure or cramps in the lower body on urination bad-smelling or cloudy urine blood in the urine, or darkened urine painful intercourse fatigue[optionsforsexualhealth.org]
  • […] urge to urinate, even if you just did tingling or burning while urination frequent urination, with only small amounts coming out difficulty urinating A more severe infection may also cause: bloody urine cloudy or smelly urine pelvic discomfort fever fatigue[healthline.com]
  • It's hard to get a diagnosis Although it's a recognised condition, it's not yet known what causes interstitial cystitis, and there's tons of research still to be done into whether or not it's related to other illnesses, like fibromyalgia, chronic fatigue[cosmopolitan.com]
Falling
  • It is felt to fall under the larger entity – Chronic pelvic pain syndrome. IC/PBS is more common in women, estimated to occur in 3-8% of U.S. women and 2-3% of U.S. men.[urology.ucsf.edu]
  • When pyelonephritis is present body temperatures may fall. Affected animals may die suddenly without clinical signs having been observed, or as a result of chronic disease.[pigprogress.net]
  • Falling estrogen levels: During menopause, estrogen levels drop, and the lining of a woman's urethra gets thinner. The thinner the lining becomes, the higher the chances are of infection and damage. After menopause, the risk is higher.[medicalnewstoday.com]
  • The Fall 2018 IC Optimist Is Now Available The IC Optimist is the quarterly magazine for IC Network members.[ic-network.com]
Perineal Pain
  • In men with lower UTI symptoms, prostatitis must be ruled out especially when associated with fever, malaise, perineal pain, and obstructive urinary symptoms.[ncbi.nlm.nih.gov]
Nausea
  • The optimal immunosuppressive regimen is still unknown. 16-year-old girl with systemic lupus erythematosus was admitted with dysuria, renal impairment, diarrhea, abdominal pain, nausea and vomiting.[ncbi.nlm.nih.gov]
  • Common side effects: anorexia, nausea, vomiting and diarrhoea. If the medication is taken with or after food, then side effects can be prevented.[medexpress.co.uk]
  • In such cases you may experience fever, chills, nausea and vomiting.[mydr.com.au]
  • If you have blood in your urine, pain with urination, back or side pain, fever, nausea or vomiting, or abdominal pain, see your doctor immediately as these are signs of a possible infection in the urinary tract.[kidshealth.org]
Abdominal Pain
  • Lupus cystitis is a rare and underdiagnosed urinary manifestation of LES and the presence of mild urinary symptoms and abdominal pain may alert about this possibility.[ncbi.nlm.nih.gov]
  • Some sexually transmitted infections, such as chlamydia and gonorrhoea, can cause pain when urinating as well as abdominal pain.[onlinedoctor.superdrug.com]
  • If you have blood in your urine, pain with urination, back or side pain, fever, nausea or vomiting, or abdominal pain, see your doctor immediately as these are signs of a possible infection in the urinary tract.[kidshealth.org]
  • Symptoms of cystitis include: A burning sensation whilst urinating Cloudy, bloody or strong-smelling urine Frequent urge to urinate, and Lower abdominal pain.[bladderbowel.gov.au]
Suprapubic Pain
  • Signs and symptoms include increased frequency of urination, pain or burning during urination, fever, cloudy or bloody urine, and suprapubic pain. An acute or chronic inflammatory process affecting the bladder.[icd9data.com]
  • Abstract We describe a case of a young female with lupus that complained about suprapubic pain, dysuria, fever and vomits, symptoms first interpreted as pyelonephritis, despite negative cultures and imaging studies showing hydroureteronephrosis with inflammatory[ncbi.nlm.nih.gov]
  • Symptoms: Urinary frequency Urinary urgency Burning with urination Dysuria (painful urination) Urinary retention (inability to empty the bladder completely when voiding) Hematuria (blood in the urine) Vague abdominal (or suprapubic) pain Things You Can[chemocare.com]
  • Cystitis is a clinical syndrome characterised by dysuria, frequency and urgency, with or without suprapubic pain. Causes of cystitis can be infective (bacterial, viral, other) or noninfective.[racgp.org.au]
  • PRACTICE RECOMMENDATIONS • Suspect interstitial cystitis (IC) in a patient who has had suprapubic pain, pressure, or discomfort and frequency of urination for 3 months in the absence of a urinary tract infection or other pelvic condition with similar[mdedge.com]
Lower Abdominal Pain
  • Symptoms of cystitis include: A burning sensation whilst urinating Cloudy, bloody or strong-smelling urine Frequent urge to urinate, and Lower abdominal pain.[bladderbowel.gov.au]
  • Severe lower abdominal pain that intensifies as the urinary bladder fills or empties. IC affects men and women of all racial and ethnic backgrounds and ages. However, it is more common in women than men.[cdc.gov]
  • Symptoms of Cystitis A burning feeling when peeing The feeling of needing to pee urgently even after just going to the toilet Urine or pee can be cloudy, strong smelling or contain small amounts of blood You can suffer from back pain or lower abdominal[spunout.ie]
Jaundice
  • Infants may feed poorly, vomit, sleep more, or show signs of jaundice.[en.wikipedia.org]
Dysuria
  • It is a very rare chronic inflammatory disease presenting with dysuria, pelvic pain and gross hematuria. Voided urine contains mucus or calcified mucopurulent stone like particles. Urinalysis always reveals alkaline pH.[ncbi.nlm.nih.gov]
Hematuria
  • We report a case of 52-year-old male who presented with fever, dysuria and gross hematuria who was found to have emphysematous cystitis.[ncbi.nlm.nih.gov]
  • Definition / general Clinical syndrome of gross hematuria, often with irritative bladder symptoms Clinical features Irritative voiding symptoms, gross hematuria Treatment Clot evacuation and hydration, bladder irrigation with saline or alkalinized saline[pathologyoutlines.com]
  • With cystitis, you may have blood cells in your urine that can be seen only with a microscope (microscopic hematuria) and that usually resolves with treatment.[mayoclinic.org]
Nocturia
  • After the treatment, his urgency, frequency, nocturia improved and his bladder capacity increased from less than 100ml to 350mL per urination. The following magnetic resonance imaging (MRI) and bladder biopsy result revealed complete reversal.[ncbi.nlm.nih.gov]
  • Estrogen replacement therapy has been shown to alleviate urgency, urge incontinence, frequency, nocturia, dysuria (discomfort on passing urine) and reduce urine infections.[womens-health-concern.org]
  • B 25 Oral cimetidine (Tagamet) can improve suprapubic pain and nocturia in patients with interstitial cystitis/painful bladder syndrome.[aafp.org]
  • People with severe cases of IC/PBS may urinate as many as 60 times a day, including frequent nighttime urination (nocturia). Pain levels can range from mild tenderness to intense, agonizing pain.[washington.edu]
Dyspareunia
  • Women may also experience pain during menstruation, or dyspareunia. More women than men develop interstitial cystitis.[news-medical.net]
  • In one study of more than 600 patients with IC/BPS, the most common locations of the pain were the lower abdomen, cited by 80% of those surveyed; the urethral area, cited by 74%; and the low back, by 65%. 7 (Dyspareunia is also common, and contributes[mdedge.com]
  • […] pressure, and feelings of pressure, pain, and tenderness around the bladder, pelvis, and perineum (the area between the anus and vagina or anus and scrotum) which may increase as the bladder fills and decrease as it empties; painful sexual intercourse (dyspareunia[medicinenet.com]
  • Most patients with interstitial cystitis/painful bladder syndrome are women with symptoms of suprapubic pelvic and/or genital area pain, dyspareunia, urinary urgency and frequency, and nocturia.[aafp.org]
  • Vaginitis is usually associated with vaginal discharge, dyspareunia, and pruritus and causes include bacterial vaginosis, trichomoniasis, or yeast infection.[ncbi.nlm.nih.gov]
Urinary Retention
  • Symptoms: Urinary frequency Urinary urgency Burning with urination Dysuria (painful urination) Urinary retention (inability to empty the bladder completely when voiding) Hematuria (blood in the urine) Vague abdominal (or suprapubic) pain Things You Can[chemocare.com]
  • Some of these other conditions include Urinary Tract Infection (UTI) (LINK), endometriosis, overactive bladder or urinary retention.[urology.ucsf.edu]
  • Fowler’s Syndrome was first described by Professor Clare J Fowler in 1985 and consists of difficulty in passing urine and urinary retention due to the bladder’s sphincter muscle’s failure to relax.[cobfoundation.org]
  • retention) Procedures that involve the urinary tract Staying still (immobile) for a long period of time (for example, when you are recovering from a hip fracture ) Most cases are caused by Escherichia coli ( E coli ).[nlm.nih.gov]
  • retention) Procedures that involve the urinary tract Staying still (immobile) for a long period of time (for example, when you are recovering from a hip fracture) Most cases are caused by Escherichia coli (E coli).[medlineplus.gov]

Workup

Prior to conducting tests, the signs and symptoms of the disease would be carefully studied. In addition, the following diagnostic tests are also required:

  • Urine analysis: Urine sample would be tested for presence of bacteria, pus or blood.
  • Imaging studies: If urine analysis reveal presence of bacteria, then imaging studies is seldom required. When urine tests do not draw definitive conclusion, then imaging tests such as X-ray or ultrasound are required to detect tumor or structural abnormality.
  • Cystoscopy: The bladder is examined with the help of cystoscope. The cystoscope is inserted to the bladder through the urethra in order to diagnose cystitis [9]. 
Nephrolithiasis
  • Other risk factors for developing complicated UTI include nephrolithiasis, immunocompromised status, the presence of foreign bodies such as a urinary catheter, urinary tract instrumentation, renal insufficiency, functional or anatomic abnormality in the[ncbi.nlm.nih.gov]
  • UTI, recurrent infections may be related to reinfection with the same or different species in the same way described above for uncomplicated infection or to relapse secondary to a persistent nidus of infection related to a complicating factor, such as nephrolithiasis[clinicaladvisor.com]
Pyuria
  • […] voiding frequency, urgency with urge incontinence, dysuria, nocturia, burning sensation during urination, post urination pain, painful hematuria, and small bladder capacity, but there are still differences that KC presented with more urgency, hematuria, pyuria[ncbi.nlm.nih.gov]
  • “This trial did not show a benefit of cranberry capsules in terms of a lower presence of bacteriuria plus pyuria among older women living in nursing homes.”[independent.co.uk]
  • Pyuria is present in almost all persons with cystitis (and in many with asymptomatic bacteriuria), but the presence of pyuria does not distinguish symptomatic from asymptomatic UTI.[clinicaladvisor.com]
  • Localizing symptoms and signs (pain with urination, urinary frequency, suprapubic/bladder pain, bloody urine, pain in the flank, new or worsening urgency or urinary incontinence), pyuria (white blood cells in the urine), or positive leukocyte esterase[medicinenet.com]
Clostridium Perfringens
  • The most common organism is E. coli [ 2 ], but other organisms reported to produce emphysematous cystitis include Enterobacter aerogenes, Klebsiella pneumonia, Proteus mirabilis, Staphylococcus aureus, streptococci, Clostridium perfringens [ 8 ], and[ncbi.nlm.nih.gov]

Treatment

Cystitis which occurs as a result of bacterial infections, is successfully treated with antibiotic regime. The patient shows signs of recovery within a day of antibiotic treatment. The length of antibiotic treatment would gravely depend on the severity of symptoms and also on whether it is a case of recurrent infections.

If drugs or exposure to radiation are the cause of cystitis, then medications to relieve the pain due to inflammation of the bladder and hydration would be employed to flush out the bladder contents. Certain medications that trigger episodes of cystitis are avoided in order to keep the condition under control and prevent its recurrence in future [10].

Prognosis

Prognosis of the condition depends on the underlying diseases and the duration of illness. Women continue to suffer from symptoms of cystitis even when treatment had been initiated on time. In cases, when there are other conditions such as somatization, urinary frequency and previous cystitis, all affect the severity of the symptoms and duration of symptoms.

Lower urinary tract infection resolves almost spontaneously with effective treatment regime and which prevents the progression of the condition to upper urinary tract infection. In about 25% of cases, affected women would suffer recurrent bouts of cystitis [7].

Etiology

Bacterial agents such as Escherichia coli account for 70 – 95% cases of cystitis. Women who are sexually active, are pregnant or are in their menopausal phase are at an increased risk of contracting cystitis [2]. In addition to bacterial infections, various non-infectious factors are also known to play foul in causation of cystitis. These include:

Epidemiology

Urinary tract infection (UTI) is a common phenomenon. It has been estimated that, about 25 – 40% of women aged 20 – 40 years, in the US, suffer from UTI. Cystitis occurs in about 0.3 – 1.3% pregnancies. Cases of acute cystitis in emergency department visits are estimated to be about 7 million per year [5].

Sex distribution
Age distribution

Pathophysiology

The urinary system comprises of kidneys, bladder, urethra and ureters. All these play a pivotal role in removal of waste materials from the body. Urinary tract infections primarily occur when bacterial agents from outside enter the body through the urinary tract via the urethra causing infections.

Cystitis is a common occurrence in sexually active women who otherwise have a healthy profile. Urine is considered to be a good medium for bacterial growth. Therefore, voiding and frequently emptying the bladder can significantly reduce the incidence of urinary tract infections. The development of urinary tract infections is triggered by 3 mechanisms which include colonization, hematogenous and periurogenital spread [6].

Prevention

  • The efficacy of cranberry juice in preventing the occurrence of cystitis is not yet very well established [11]. However, the following measures can be adopted for preventing recurrent cystitis.
  • Individuals undergoing chemotherapy or radiation therapy are advised to drink plenty of water.
  • Urinating frequently also helps flush out bacteria
  • After every bowel movement, it is necessary to appropriately clean the area around the vagina and anus. This would help in preventing the spread of the bacteria from the vagina and urethra.
  • Sexually active women are advised to immediately empty their bladder after intercourse.

Summary

Infection of the bladder is a very painful condition and pretty uncomfortable for the affected individual. If the condition is not promptly treated, it can turn out to be a potential cause of serious health concerns. The condition of cystitis is more common in women than men. Majority of the women will suffer from cystitis at least once in their lifetime. Anatomically, women have a shorter urethra than men, which makes it easy for the bacteria from the anus to travel to the urethra causing infection [1].

Patient Information

  • Definition: Cystitis is inflammation of the bladder that occurs usually due to bacterial infections. Majority of the women suffer from cystitis at least once in their lifetime. The condition is more common in women compared to men; especially amongst those who are sexually active or are pregnant.
  • Cause: Bacterial infections by Escherichia coli are the most common cause of cystitis. Other common factors include exposure to radiation, certain medications, being sexually active, prolonged use of catheter and use of feminine hygienic products also predispose an individual to develop cystitis.
  • Symptoms: Symptoms of cystitis include increase in urge to urinate, burning sensation while urination, feeling of discomfort in the pelvic region, low grade fever and passing of cloudy urine.
  • Diagnosis: The condition of cystitis is diagnosed through urine tests and cystoscopy. In rare cases, imaging studies are also required for determining structural abnormalities.
  • Treatment: Antibiotics form the primary basis of treatment regime. In cases, when infections are the cause, then avoiding medications that trigger episodes of cystitis is indicated.

References

Article

  1. Abrahamian FM, Moran GJ, Talan DA. Urinary tract infections in the emergency department. Infect Dis Clin North Am. Mar 2008;22(1):73-87, vi.
  2. Jackson SL, Boyko EJ, Scholes D, et al. Predictors of urinary tract infection after menopause: a prospective study. Am J Med 2004; 117:903.
  3. Fihn SD, Boyko EJ, Normand EH, et al. Association between use of spermicide-coated condoms and Escherichia coli urinary tract infection in young women. Am J Epidemiol 1996; 144:512.
  4. Kahlmeter G. Prevalence and antimicrobial susceptibility of pathogens in uncomplicated cystitis in Europe. The ECO.SENS study. Int J Antimicrob Agents 2003; 22 Suppl 2:49.
  5. Hsiao CJ, Cherry DK, Beatty PC, Rechtsteiner EA. National Ambulatory Medical Care Survey: 2007 summary. Natl Health Stat Report. Nov 3 2010;1-32. 
  6. Czaja CA, Stamm WE, Stapleton AE, et al. Prospective cohort study of microbial and inflammatory events immediately preceding Escherichia coli recurrent urinary tract infection in women. J Infect Dis. Aug 15 2009;200(4):528-36.
  7. Foxman B. Recurring urinary tract infection: incidence and risk factors. Am J Public Health 1990; 80:331.
  8. Little P, Merriman R, Turner S, Rumsby K, Warner G, Lowes JA, et al. Presentation, pattern, and natural course of severe symptoms, and role of antibiotics and antibiotic resistance among patients presenting with suspected uncomplicated urinary tract infection in primary care: observational study. BMJ. Feb 5 2010;340:b5633.
  9. Fowler JE Jr, Pulaski ET. Excretory urography, cystography, and cystoscopy in the evaluation of women with urinary-tract infection: a prospective study. N Engl J Med 1981; 304:462.
  10. Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. Mar 1 2005;40(5):643-54.
  11. Raz R, Chazan B, Dan M. Cranberry juice and urinary tract infection. Clin Infect Dis 2004; 38:1413.

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Last updated: 2019-07-11 22:43