Trigonitis is a term denoting metaplastic changes in the bladder epithelium (conversion of transitional to squamous nonkeratinizing), and since its description at the beginning of the 20th century, very few reports exist in the literature [1] [2] [3]. Inflammatory events occurring in the bladder were initially assumed to be the main pathogenic stimulus for this epithelial change, and bacterial infections of the lower urinary tract (eg. cystitis) are considered as a possible risk factor for trigonitis [1]. It was subsequently confirmed, however, that the effect of estrogens on the bladder epithelium is the principal mechanism of this change [1] [3]. Consequently, trigonitis is almost always diagnosed in females of childbearing age, as only six male cases have been reported [1] [4] so far. The main symptoms are frequent micturition and a sense of urgency [1] [2]. Moreover, studies have identified that the presence of pelvic and/or urethral pain is strongly associated with trigonitis, as well as dysuria [1] [5].

• Recurrent Urinary Tract Infection

  There seems to be a link between pseudomembranous trigonitis and recurrent urinary tract infections (UTIs). [ncbi.nlm.nih.gov]

  History Individuals with squamous metaplastic changes in the bladder may be asymptomatic or present with irritative voiding symptoms (eg, frequency, urgency, dysuria), recurrent urinary tract infections (UTIs), hematuria, or pelvic pain. [emedicine.medscape.com]

• Fatigue

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: January 30, 2019 [patientslikeme.com]

  Some sleep problems can lead to serious health issues such as heart attack, stroke, high blood pressure, fatigue-related motor vehicle accidents, and decreased quality of life. [excelahealth.org]

• Abdominal Pain

  People suffering from trigonitis may complain about lower abdominal pain and pain while urinating. [medical-questions-answered.blogspot.com]

  Symptoms of Pseudomembranous Trigonitis A few common symptoms of this disorder are severe bladder pain, abdominal pain, sudden and abnormal increase in urge to urinate, sensitivity to certain food items especially cranberry juice, chocolate and citrus [sweet-cures.com]

• Blister

  A milder form of inflammation is termed cysitis cystica because the bladder lining breaks out in multiple tiny blisters. In cystitis glandularis the blisters have a slightly thicker lining and the bladder itself acquires a cobblestoned appearance. [bladderhealthuk.org]

  A milder form of inflammation is termed cystitis cystica because the bladder lining breaks out in multiple tiny blisters. [cobf.websitetoolbox.com]

• Confusion

  […] boxes warn you about similar and potentially confusing word parts and medical terms. Games and activities on accompanying Evolve website offer an easily accessible source for extra interactive practice and learning. [books.google.com]

  There is often confusion about trigonitis since the term -itis usually indicates inflammation. While there may have been some inflammation, the condition trigonitis specifically focuses on the changes in the normal cells lining the bladder. [healthhype.com]

• Pelvic Pain

  I also had vulvar pain to begin with and then developed chronic pelvic pain in surrounding muscles. [empowher.com]

  It can cause urinary urgency and pelvic pain. Diagnosis is typically made during a scope examination of the bladder. Treatment may include antibiotics or surgical laser treatment. [patientslikeme.com]

  Urinary urgency and frequency, and chronic urethral and/or pelvic pain in females. Can doxycycline help?. J Urol. 2004 Jul. 172(1):232-5. [Medline]. Costantini E, Zucchi A, Del Zingaro M, Mearini L. [emedicine.medscape.com]

• Bladder Pain

  Similarities between Pseudomembranous Trigonitis, Interstitial Cystitis and Painful Bladder Syndrome in terms of symptoms Bladder pain/pelvic pain Blood in the urine Urinary frequency, increased urge to urinate (more so at night)+ reduced bladder capacity [sweet-cures.com]

  Symptoms Trigonitis causes bladder pain, reduced bladder capacity, and an abnormal increase in the frequency and urge to urinate, particularly at night. [wisegeek.org]

  […] taken at a low dosage can help to reduce pain Antibiotics if there is an infection that is accompanying your bladder inflammation Using an instillation or bladder coating is sometimes used to give you fast pain relief. [healthool.com]

  […] problem that causes bladder pain and frequent, urgent urination Bladder cancer Doctors diagnose bladder diseases using different tests. [icdlist.com]

  A bladder coating is applied to the bladder via a catheter and is typically a cocktail of medications used to control pain and inflammation, and to help the bladder heal. [dawnscarzellamd.com]

• Urinary Urgency

  It can cause urinary urgency and pelvic pain. Diagnosis is typically made during a scope examination of the bladder. Treatment may include antibiotics or surgical laser treatment. [patientslikeme.com]

  Urinary urgency and frequency, and chronic urethral and/or pelvic pain in females. Can doxycycline help?. J Urol. 2004 Jul. 172(1):232-5. [Medline]. Costantini E, Zucchi A, Del Zingaro M, Mearini L. [emedicine.medscape.com]

• Urinary Incontinence

  ", "menopause genitourinary syndrome", "vulvovaginal atrophy", "urinary incontinence", "pelvic organ prolapse", "lichen sclerosus", "complications" and "vaginal laxity". [ibecs.isciii.es]

  Some common ones are Cystitis - inflammation of the bladder, often from an infection Urinary incontinence - loss of bladder control Overactive bladder - a condition in which the bladder squeezes urine out at the wrong time Interstitial cystitis - a chronic [icdlist.com]

  There are certainly several different types of urinary leakage. We call urinary leakage, urinary incontinence. [cheyenneurological.com]

  SYMPTOMS: Trigonitis and chronic cystitis can cause severe bladder pain and burning, pelvic pain and pressure, reduced bladder capacity, an increase in the frequency and urge to urinate, particularly at night, blood in the urine and urinary incontinence [dawnscarzellamd.com]

• Bladder Spasm

  Inflammation of this trigone region, whether it is from a bacterial infection or chronic cystitis, will produce hypersensitivity and bladder spasm causing increased frequency and urgency, burning with urination, painful intercourse, bladder pain, blood [dawnscarzellamd.com]

  Medicine may help to: Ease bladder spasms or pain Treat any infections that may be present (antibiotics) Prevention Catheters increase the risk of trigonitis. Limiting use and length of use may decrease the risk. [winchesterhospital.org]

  Pain relief options include muscle relaxants to relieve bladder spasms, anti-inflammatories, and antidepressants, some of which can reduce pain when taken at low doses. Antibiotics are prescribed when infection accompanies the bladder inflammation. [wisegeek.org]

  For example, you may be prescribed: antibiotics if you have bacteria in your urine low-dose antidepressants, which can help control pain muscle relaxers to relieve bladder spasms anti-inflammatories Your doctor may also advise a cystoscopy with fulguration [healthline.com]

  Antibiotics for infection in the bladder. Muscle relaxers to relieve the bladder spasms. Anti-inflammatory medications. Instillation for fast pain relief. The instillation or bladder coating is applied through a catheter. [epainassist.com]

Given the nonspecific clinical presentation of lower urinary tract symptoms, the diagnosis is difficult. Firstly, it is necessary to rule out more common causes of such complaints, such as infections, which is why a thorough patient history that will assess the course and progression of symptoms, and a detailed physical examination that focuses on abdominal palpation and observation of vital signs and other systems, are necessary steps in the workup. Pharmacologic administration of estrogen was reported in males to be a precipitating event, thus male patients could be asked about recent medication [2]. Urinalysis in the setting of trigonitis reveals a sterile urine culture and normal findings [2]. As the diagnosis is not yet confirmed, more advanced urological procedures should be employed. Ultrasonography (US) is of limited use (although it may show thickening of the bladder neck) [6], while cystoscopy is the gold standard for diagnosis. A grayish mucosa with a hyperemic margin in the trigone area is considered highly specific for trigonitis [2]. In presence of clinical suspicion, a biopsy sample for histological examination is recommended. The diagnosis is confirmed when the non-keratinizing squamous epithelium is seen instead of the standard transitional epithelium of the bladder on light microscopy [1] [2].

• Pyuria

  […] of trigonitis with chronic cervicitis and vaginitis; diagnosis and treatment. ( 20290774 ) 1947 13 Epithelium of vaginal type in the female trigone; the clinical problem of trigonitis. ( 20243913 ) 1947 14 Urethro-trigonitis in relation to abacterial pyuria [malacards.org]

  I've raised this in another post here: http://www.icbpsforum.com/t45-sterile-pyuria-significant-or-not-could-this-warrant-further-research Good luck with your continued antibiotics. [icbpsforum.com]

• Squamous Metaplasia of the Bladder

  Others have suggested that squamous cell metaplasia is not associated with increased estrogen activity. [7, 8] Kvist et al did not find estrogen receptors in 36 historically collected samples of squamous metaplasia of the bladder urothelium, although [emedicine.com]

  Non-keratinizing squamous metaplasia of the bladder neck and trigone can be seen in 50-70% of premenopausal women and is considered a normal variant. [sharecare.com]

  Keratinizing squamous metaplasia of the bladder. Cystoscopic appearance of trigonitis as a well-defined white area overlying the trigone. Nonkeratinizing squamous metaplasia. [emedicine.medscape.com]

The cause of trigonitis is not known, and there is no solid treatment. Electrocautery is sometimes used, but is generally unreliable as a treatment, and typically does not have quick results. [en.wikipedia.org]

Treatment If a person does not have severe or significant signs or symptoms such as pain, frequent urination urge and difficulty during intercourse need not receive any treatment. Moreover, there is no specific treatment for trigonitis. [medical-questions-answered.blogspot.com]

Treatment of Trigonitis There are several medications that can treat Trigonitis. Treatment form may vary because a treatment plan for one person may not work for another person. [epainassist.com]

Treatment Approach Considerations Asymptomatic patients do not require treatment. A urologist may be consulted in symptomatic cases. [emedicine.medscape.com]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

Urothelial leukoplakia: new aspects of etiology and therapy. J Urol. 1987 May. 137(5):979-83. [QxMD MEDLINE Link]. Parsons CL. [emedicine.medscape.com]

Cook does not indicate any specific etiological factor for the pseudomembranous trigonitis. I feel it might be an indication of mechanical difficulties to the bladder neck, namely, bladder neck contractures. These are quite common in females. [jamanetwork.com]

[…] year-old boy with Klinefelter syndrome diagnosed with pseudomembranous trigonitis, the findings of raised estrogen levels in conjunction with increased expression of estrogen receptors in the trigone area of the biopsy suggest that estrogen could be an etiological [emedicine.com]

Definition / general Replacement of urothelium by stratified squamous epithelium, both vaginal (nonkeratinized) and keratinized subtypes Epidemiology Normal in women in trigonal area Etiology Urinary tract infections: Escherichia coli, Proteus and Streptococcus [pathologyoutlines.com]

Epidemiology The frequency of trigonitis differs in various reports, but the literature consistently shows that trigonitis occurs almost exclusively in women of childbearing age. [emedicine.medscape.com]

Pathophysiology Trigonitis, although its name suggests inflammation, is a metaplastic process. [emedicine.medscape.com]

Your sexual partner may also be advised to take antibiotics to prevent trigonitis from returning. Prevention If you have a catheter, talk to your doctor about how long it should be in place. Long-term use may result in trigonitis. [winchesterhospital.org]

Experts stumped as to what to do in kids both to prevent and treat it. [medscape.com]

The interstitial cystitis literature suggests that the mucosal coating of the bladder surface, also known as the glycosaminoglycan (GAG) layer, plays an important role in preventing the permeability of urinary solutes into the bladder wall. [12] Restriction [emedicine.com]

1. Stavropoulos M, Papatsoris AG, Konstantinidis C, Chrisofos M. Pseudomembranous Trigonitis: A Common but Underrecognized Urological Entity. Adv Urol. 2010;2010:269254.
2. Lian DW, Li FX, Ong CC, Kuick C, Chang KT. Pseudomembranous trigonitis in a male with Klinefelter syndrome: a case report and evidence of a hormonal etiology. Int J Clin Exp Pathol. 2014;7(6):3375-3379.
3. Stephenson TJ, Henry L, Harris SC, Giri DD, Fox M, Underwood JC. Pseudomembranous trigonitis of the bladder: hormonal aetiology. J Clin Pathol. 1989;42(9):922-926.
4. Henry L, Fox M. Histological findings in pseudomembranous trigonitis. J Clin Pathol. 1971;24:605–608.
5. Burkhard FC, Blick N, Hochreiter WW, Studer UE. Urinary urgency and frequency, and chronic urethral and/or pelvic pain in females. Can doxycycline help? J Urol. 2004;172(1):232-235.
6. Sugaya K, Nishijima S, Oda M, et al. Transabdominal vesical sonography of urethral syndrome and stress incontinence. Int J Urol. 2003;10(1):36-42.