Overview
Cystitis is inflammation of the bladder. It is usually caused by a bacterial urinary tract infection. It is much more common in women than men; about half of women of reproductive age experience at least one episode of cystitis in their lives.
It is most often due to bacterial infection; however, it can also be caused by medications, radiation, chemicals, or other irritants.
Symptoms
- Burning, pain when urinating (dysuria)
- Frequent urge to urinate
- Passing small amounts of urine
- Foul-smelling urine
- Cloudy or bloody urine
- Pressure, fullness in the lower abdomen
- Mild fever (not usually high)
- Pelvic discomfort
- Frequent night urination
Different symptoms in the elderly:
- Confusion, agitation
- Falls
- Refusal to eat
- Urinary incontinence
In children:
- Fever
- Abdominal pain
- Loss of appetite
- Vomiting
- Sudden incontinence (in previously dry children)
Types
- Bacterial cystitis (most common)
- Drug-induced cystitis: Some chemotherapy drugs
- Radiation cystitis
- Foreign body cystitis: Catheter
- Chemical cystitis: Hygiene products
- Interstitial cystitis: Chronic, no proven cause
Causes
Bacterial:
- Escherichia coli (most common, 80-90%)
- Klebsiella, Proteus, Enterococci
Routes of transmission:
- Travel from the bowel up through the urethra
- After sexual intercourse
- Catheters
- Medical procedures
Risk Factors
In women:
- Anatomy (short urethra, urethra close to the anus)
- Sexual activity
- Diaphragm, spermicides
- Menopause (decreased estrogen)
- Pregnancy
General:
- Previous urinary tract infection
- Conditions blocking urine flow (stones, prostate)
- Catheter use
- Diabetes
- Weakened immunity
- Insufficient water intake
- Holding urine for long periods
- Hygiene habits
- Birth control methods
Complications
- Recurrent infections
- Kidney infection (pyelonephritis)
- Bloodstream infection (sepsis)
- Hematuria (blood in urine)
- Pregnancy complications (preterm birth)
- Structural changes in the urinary tract
When to See a Doctor
- If you have cystitis symptoms
- Complaints lasting more than 2 days
- Recurring cases
- Bloody urine
- Flank pain, fever, chills (upper tract infection)
- Any urinary complaint during pregnancy
- In male patients
- Urinary complaints in children
- In diabetic and immunocompromised patients
Diagnosis and Treatment
Diagnosis:
- Urinalysis (leukocytes, nitrites, bacteria, blood)
- Urine culture (definitive diagnosis + antibiotic sensitivity)
- Blood tests (when needed)
- Cystoscopy (in recurrent cases)
- Imaging: ultrasound, CT (in complicated cases)
Treatment:
Acute bacterial cystitis:
- Antibiotics (3-7 days):
- Nitrofurantoin
- Trimethoprim-sulfamethoxazole
- Fosfomycin (single dose)
- Cephalosporins
- Fluoroquinolones (ciprofloxacin) — last choice
Symptom-directed treatment:
- Plenty of fluids
- Pain relievers (paracetamol, phenazopyridine)
- Warm application (lower abdomen)
Recurrent cystitis:
- Long-term low-dose antibiotic
- Single-dose antibiotic after intercourse (sexually-related)
- Vaginal estrogen cream after menopause
- D-mannose
- Cranberry juice/tablets
- Probiotics
Prevention
Hygiene habits:
- Wipe front to back after the toilet (for women)
- Urinate after sexual intercourse
- Cleansing before and after intercourse
- Do not douche vaginally
- Avoid heavily perfumed hygiene products
- Prefer cotton underwear
- Avoid tight pants
Nutrition and fluids:
- Drink 2-2.5 liters of water per day
- Cranberry juice (especially in recurrent cases)
- Limit caffeine
- Limit alcohol
- Limit acidic foods
Behavioral:
- Do not hold urine
- Urinate frequently
- Use appropriate lubricant during intercourse
- Reconsider your birth control method (alternatives to diaphragm, spermicide)
- Prevent constipation
Medical:
- Manage your diabetes
- Consider topical estrogen in menopause
- Treat anatomical issues
- Stay under regular follow-up