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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:

  • Dysuria
  • Increase in urge to urinate
  • Development of hematuria
  • Presence of low grade fever
  • Strong smell and cloudy urine
  • Passing small amounts of urine
  • Development of pressure in the lower abdomen
  • Feeling of discomfort in the pelvic region
  • Young children who wet their bed accidently during day time, signifies that they are suffering from urinary tract infection. In such cases, children should receive prompt attention and treatment [8].
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]
  • METHODS: 16-year-old girl with systemic lupus erythematosus was admitted with dysuria, renal impairment, diarrhea, abdominal pain, nausea and vomiting.[ncbi.nlm.nih.gov]
  • Men with IC may experience testicular, scrotal, and/or perineal pain, and painful ejaculation. FREQUENCY: Day and/or night frequency of urination, sometimes severe.[fmcpaware.org]
  • 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]
Perineal Pain
  • Men with IC may experience testicular, scrotal, and/or perineal pain, and painful ejaculation. FREQUENCY: Day and/or night frequency of urination, sometimes severe.[fmcpaware.org]
Abdominal Pain
  • METHODS: 16-year-old girl with systemic lupus erythematosus was admitted with dysuria, renal impairment, diarrhea, abdominal pain, nausea and vomiting.[ncbi.nlm.nih.gov]
  • We herein reported a case of xanthogranulomatous cystitis in a 54-year-old male who presented with low abdominal pain and painless, total macrohematuria. Microscopy showed proliferation of large foam histiocytes which expressed CD68 and vimentin.[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]
Lower Abdominal Pain
  • Severe lower abdominal pain that intensifies as the urinary bladder fills or empties. Who is at risk for IC? IC affects men and women of all racial and ethnic backgrounds and ages. However, it is more common in women than men.[cdc.gov]
  • Lower back pain, lower abdominal pain, pelvic pressure, and urine that is cloudy or blood-tinged are other telltale symptoms. Sometimes there is a mild fever (101 or less) and chills.[healthcentral.com]
  • Symptoms may be absent or include urinary frequency, urgency, dysuria, lower abdominal pain, and flank pain. Systemic symptoms and even sepsis may occur with kidney infection. Diagnosis is based on analysis and culture of urine.[merckmanuals.com]
Malar Rash
  • When she developed malar rash, anasarca and nephrotic syndrome, the diagnosis of lupus cystitis with stage IV nephropathy was made, and she started immunosuppressive induction treatment with three pulses of corticosteroids followed by oral prednisolone[ncbi.nlm.nih.gov]
Neuralgia
  • She presented with an established diagnosis of interstitial cystitis; however, she also fulfilled diagnostic criteria for pudendal neuralgia and persistent genital arousal disorder.[ncbi.nlm.nih.gov]
Dysuria
  • 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]
  • METHODS: 16-year-old girl with systemic lupus erythematosus was admitted with dysuria, renal impairment, diarrhea, abdominal pain, nausea and vomiting.[ncbi.nlm.nih.gov]
  • Cystitis is usually associated with painful urination (dysuria), increased frequency, urgency, and suprapubic pain. 595 Cystitis 595.0 Acute cystitis convert 595.0 to ICD-10-CM 595.1 Chronic interstitial cystitis convert 595.1 to ICD-10-CM 595.2 Other[icd9data.com]
  • The clinical presentation of ketamine cystitis varies and may mimic those presented in interstitial cystitis (IC), such as voiding frequency, urgency with urge incontinence, dysuria, nocturia, burning sensation during urination, post urination pain, painful[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]
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 ) .[medlineplus.gov]
Hematuria
  • , and small bladder capacity, but there are still differences that KC presented with more urgency, hematuria, pyuria and upper urinary tract involvement such as ureteral stenosis, vesico-ureteric reflux, hydronephrosis and renal function impairment.[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]
  • 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]
  • Hematuria may be present in patients with cystitis and pyelonephritis.’ ‘Interstitial cystitis is a painful bladder condition that may be aggravated by acidic foods and beverages like coffee, orange juice or tomato sauce.’[en.oxforddictionaries.com]
Nocturia
  • OUTCOMES: After the treatment, his urgency, frequency, nocturia improved and his bladder capacity increased from less than 100ml to 350mL per urination.[ncbi.nlm.nih.gov]
  • The nocturia time was markedly reduced, while bladder capacity, the interval between micturition, the void volume, and the maximum flow rate were remarkably increased at 1 month. Additionally, the ICSI and ICPI were significantly improved.[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]
  • Overactive Bladder Symptoms BY SEAN · PUBLISHED NOVEMBER 21, 2017 · UPDATED NOVEMBER 21, 2017 Overactive bladder (OAB) is defined as being a chronic urological condition that causes urgency, with or without urge incontinence, and commonly with frequency and nocturia[cobfoundation.org]
  • Nocturia (nighttime urinary frequency) may disrupt sleeping patterns. This can lead to drowsiness and lack of mental clarity during the day. IC also may affect an individual's social functioning.[ssa.gov]
Dyspareunia
  • The main vulvodynia symptom is pain in your genital area, which can be characterized by burning, soreness, itching, stinging, rawness, painful intercourse (dyspareunia), or throbbing.[fmcpaware.org]
  • Women may also experience pain during menstruation, or dyspareunia. More women than men develop interstitial cystitis.[news-medical.net]
  • […] 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]

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]. 
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]
  • Four of these studies measured the outcome of asymptomatic UTIs (bacteriuria with or without pyuria), but only Avorn 1994 reported a significant result.[doi.org]

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:

  • Chemical agents such as spermicidal jellies, hygiene sprays used by women and bubble bath, are also known to cause irritation of the bladder causing inflammation [3].
  • Diseases such as Crohn disease, gynecologic cancer, tuberculosis, diverticulitis, pelvic inflammatory disease and endometriosis can also predispose an individual to develop cystitis as a complication of these disorders.
  • Drugs and radiation: Certain medications such as ifosfamide and cyclophosphamide can cause cystitis, because the broken components of these medications cause inflammation of the bladder when they exit the body. Exposure to radiation can trigger inflammatory changes in the bladder [4].

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: 2017-08-09 18:10