Cystitis

• A strong, persistent urge to urinate
• A burning sensation when urinating
• Passing frequent, small amounts of urine
• Blood in the urine (hematuria)
• Passing cloudy or strong-smelling urine
• Discomfort in the pelvic area
• A feeling of pressure in the lower abdomen
• Low-grade fever

In young children, new episodes of accidental wetting (enuresis) also may be a sign of a urinary tract infection (UTI) — especially if wetting occurs:

• Both at night and during the day
• Only during the day
• At least once each week

Nighttime bed-wetting on its own isn't likely to be associated with a UTI.

Causes

Your urinary system includes your kidneys, ureters, bladder and urethra. All play a role in removing waste from your body. Your kidneys — a pair of bean-shaped organs located toward the back of your upper abdomen — filter waste from your blood and regulate the concentrations of many substances. Tubes called ureters carry urine from your kidneys to the bladder, where it's stored until it exits your body through the urethra.

Bacterial cystitis

UTIs typically occur when bacteria outside the body enter the urinary tract through the urethra and begin to multiply. The urinary system is designed to keep out such microscopic invaders. The bladder secretes a protective coating that prevents bacteria from attaching to its wall. Urine also has antibacterial properties that inhibit the growth of bacteria. However, certain factors increase the chances that bacteria will take hold and multiply into a full-blown infection.

Bacterial bladder infections may occur in women as a result of sexual intercourse. During sexual activity, bacteria may be introduced into the bladder through the urethra. But even sexually inactive girls and women are susceptible to lower urinary tract infections because the female genital area often harbors bacteria that can cause cystitis.

Most cases of cystitis are caused by Escherichia coli (E. coli), a species of bacteria commonly found in the genital area. A new strain of antibiotic-resistant E. coli may be the cause of increasingly hard-to-treat UTIs in women.

Main types of infections

The two main types of bacterial bladder infections are:

• Community-acquired bladder infections. These infections occur when people who aren't in a medical care facility, such as a hospital or nursing home, develop a bladder infection. This condition is common in women in their early 20s through age 50, but it is less common in men of the same age. However, men older than 55 may be at risk of this type of infection because of prostate enlargement, a common condition that can block urine flow in older men.
• Hospital-acquired, or nosocomial, bladder infections. These infections occur in people in a medical care facility, such as a hospital or nursing home. Most often they happen in those who have had a urinary catheter placed through the urethra and into the bladder to collect urine, a common practice before some surgical procedures, for some diagnostic tests, or as a means of urinary drainage for older adults or people confined to bed.

Noninfectious cystitis

Although bacterial infections are the most common cause of cystitis, a number of noninfectious factors also may cause the bladder to become inflamed. Some examples:

• Interstitial cystitis. The cause of this chronic bladder inflammation, also called painful bladder syndrome, is unclear. Most cases are diagnosed in women. The condition can be difficult to diagnose and treat.
• Drug-induced cystitis. Certain medications, particularly the chemotherapy drugs cyclophosphamide and ifosfamide, can cause inflammation of your bladder as the broken-down components of the drugs exit your body.
• Radiation cystitis. Radiation treatment of the pelvic area can cause inflammatory changes in bladder tissue.
• Foreign-body cystitis. Long-term use of a catheter can predispose you to bacterial infections and to tissue damage, both of which can cause inflammation.
• Chemical cystitis. Some people may be hypersensitive to chemicals contained in certain products, such as bubble bath, feminine hygiene sprays or spermicidal jellies, and may develop an allergic-type reaction within the bladder, causing inflammation.
• Cystitis associated with other conditions. Cystitis may sometimes occur as a complication of other disorders, such as gynecologic cancers, pelvic inflammatory disorders, endometriosis, Crohn's disease, diverticulitis, lupus and tuberculosis.

Risk factors

Some people are more likely than are others to develop bladder infections or recurrent urinary tract infections. Women are one such group. A key reason is physical anatomy. Women have a shorter urethra than men have, which cuts down on the distance bacteria must travel to reach the bladder.

Women at greatest risk of UTIs include those who:

• Are sexually active. Sexual intercourse can result in bacteria being pushed into the urethra.
• Use certain types of birth control. Women who use diaphragms are at increased risk of a UTI. Diaphragms that contain spermicidal agents further increase your risk.
• Are pregnant. Hormonal changes during pregnancy may increase the risk of a bladder infection.

Other risk factors in both men and women include:

• Interference with the flow of urine. This can occur in conditions such as a stone in the bladder or, in men, an enlarged prostate.
• Changes in the immune system. This can occur with conditions such as diabetes, HIV infection and cancer treatment. A lowered immune system increases the risk of bacterial and, in some cases, viral bladder infections.
• Prolonged use of bladder catheters. These tubes may be needed in people with chronic illnesses or in older adults. Prolonged use can result in increased vulnerability to bacterial infections as well as bladder tissue damage.

Complications

When treated promptly and properly, bladder infections rarely lead to complications. But left untreated, they can become something more serious. Complications may include:

• Kidney infection. An untreated bladder infection can lead to kidney infection (pyelonephritis). Kidney infections may permanently damage your kidneys. Young children and older adults are at the greatest risk of kidney damage due to bladder infections because their symptoms are often overlooked or mistaken for other conditions.
• Blood in the urine. Cystitis sometimes is accompanied by blood cells in your urine that can be seen only with a microscope (microscopic hematuria) and that usually resolves with treatment. If the blood cells remain after you've been treated, your doctor may recommend you see a specialist who can determine whether there is another underlying cause. While blood in your urine that can be seen by the naked eye (gross hematuria) is rare with typical, bacterial cystitis, this sign is not uncommon with chemotherapy- or radiation-induced cystitis. This is sometimes referred to as hemorrhagic cystitis. Increasing fluid intake is usually the first step in treatment. If bleeding becomes severe, the treatment that initiated the bleeding is usually postponed until the bleeding stops. Severe bleeding is treated with medication or blood transfusion, if necessary.

Diagnosis

If you have symptoms of cystitis, talk to your doctor as soon as possible. In addition to discussing your signs and symptoms and your medical history, your doctor may order these tests:

• Urine analysis. If it's suspected that you have a bladder infection, your doctor may ask for a urine sample to determine whether bacteria, blood or pus is in your urine.
• Cystoscopy. Inspection of your bladder with a cystoscope — a thin tube with a light and camera attached that can be inserted through the urethra into your bladder — may help with the diagnosis. Your doctor can also use the cystoscope to remove a small sample of tissue (biopsy) for analysis in the laboratory. This test most likely won't be needed if this is the first time you've had signs or symptoms of cystitis.
• Imaging tests. Imaging tests usually aren't necessary but in some instances — especially when no evidence of infection is found — they may be helpful. Tests, such as X-ray or ultrasound, may help rule out other potential causes of bladder inflammation, such as a tumor or structural abnormality.

Treatments and drugs

Cystitis caused by bacterial infection is generally treated with antibiotics. Treatment for noninfectious cystitis depends on the underlying cause.

Treating bacterial cystitis

Antibiotics are the first line of treatment for cystitis caused by bacteria. Which drugs are used and for how long depend on your overall health and the bacteria found in your urine.

Usually symptoms improve significantly within a day or so of treatment. However, you'll likely need to take antibiotics for three days to a week, depending on the severity of your infection. No matter what the length of treatment, take the entire course of antibiotics prescribed by your doctor to ensure that the infection is completely eradicated.

If you have recurrent UTIs, your doctor may recommend longer antibiotic treatment or refer you to a doctor who specializes in urinary tract disorders (urologist or nephrologist) for an evaluation, to see if urologic abnormalities may be causing the infections. For some women, taking a single dose of an antibiotic after sexual intercourse may be helpful.

Hospital-acquired bladder infections can be a challenge to treat because bacteria found in hospitals are often resistant to the common types of antibiotics used to treat community-acquired bladder infections. For that reason, different types of antibiotics and different treatment approaches may be needed.

Treating interstitial cystitis

With interstitial cystitis, the cause of inflammation is uncertain, so there's no single treatment that works best for every case. Therapies used to ease the signs and symptoms of interstitial cystitis include:

• Medications that are taken orally or instilled directly into your bladder
• Procedures that manipulate your bladder to improve symptoms, such as bladder distention or, sometimes, surgery
• Nerve stimulation, which uses mild electrical pulses to relieve pelvic pain and, in some cases, reduce urinary frequency

Treating other forms of noninfectious cystitis

If you're hypersensitive to certain chemicals in products such as bubble bath or spermicides, avoiding these products may help ease symptoms and help prevent further episodes of cystitis.

Treatment of cystitis that develops as a complication of chemotherapy or radiation therapy focuses on pain management, usually with medications, and hydration to flush out bladder irritants. Most cases of chemotherapy-induced cystitis tend to resolve after the chemotherapy is finished.

Lifestyle remedies

Cystitis can be painful, but you can take steps to ease your discomfort:

• Use a heating pad. Sometimes a heating pad placed over your lower abdomen can help minimize feelings of bladder pressure or pain.
• Stay hydrated. Drink plenty of fluids, but avoid coffee, alcohol, soft drinks with caffeine, citrus juices and spicy foods until your infection has cleared. These items can irritate your bladder and aggravate your frequent or urgent need to urinate.
• Take a sitz bath. It may be helpful to soak in a bathtub of warm water (sitz bath) for 15 to 20 minutes.

If you have recurrent bladder infections, let your doctor know. Together, you can develop a strategy to reduce recurrences and the discomfort that cystitis can bring.

Prevention

Cranberry juice or tablets containing proanthocyanidin are the only home remedies proven to reduce your risk of recurrent bladder infections. However, don't drink cranberry juice if you're taking the blood-thinning medication warfarin (Coumadin). Possible interactions between cranberry juice and warfarin can lead to bleeding.

Although other preventive self-care steps have not been well studied, doctors routinely recommend the following for women who've had repeated bladder infections:

• Drink plenty of liquids, especially water. Drinking lots of fluids is especially important if you're undergoing chemotherapy or radiation therapy, particularly on treatment days.
• Urinate frequently. If you feel the urge to urinate, don't delay using the toilet.
• Wipe from front to back after a bowel movement. This prevents bacteria in the anal region from spreading to the vagina and urethra.
• Take showers rather than baths. If you're susceptible to infections, showering rather than bathing may help prevent them.
• Gently wash the skin around the vagina and anus. Do this daily, but don't use harsh soaps or wash too vigorously. The delicate skin around these areas can become irritated.
• Empty your bladder as soon as possible after intercourse. Drink a full glass of water to help flush bacteria.
• Avoid using deodorant sprays or feminine products in the genital area. These products can irritate the urethra and bladder.

References:

https://en.wikipedia.org/wiki/Urinary_tract_infection

https://www.dred.com/ie/chronic-cystitis.html

https://www.hse.ie/eng/health/az/B/Bladder-infection/