Cystitis
Cystitis refers to an inflammatory condition of the bladder, regardless of cause. One peculiar thing about the urinary tract to remember is that the bladder has only one way to manifest discomfort – telling your brain that you need to urinate. Whether the cause is infectious (UTI), inflammatory (interstitial cystitis), or irritative (bladder stones) urinary frequency is the way in which your bladder indicates to you that something is wrong.
To that end, cystitis, particularly in women, is usually manifest as an increased need to urinate.
Acute cystitis is almost always bacterial in nature. The most common trigger is sexual activity. Common symptoms of acute cystitis are painful urination, urinary frequency, urgency, foul odor, cloudy urine, blood in the urine, and incontinence from urgency. Treatment normally includes 3-5 days of antibiotic treatment. Commonly used antibiotics are fluoroquinolones (ciprofloxacin/levofloxacin), sulfa drugs (trimethoprim), penicillins, nitrofurantoin, and tetracyclines. An important corollary to the treatment regimen involves obtaining a urinalysis and urine culture PRIOR to treatment with any antibiotics.
The culture history is an important clue as to whether subsequent infections represent new infections or incompletely treated prior infections. Ancillary treatment with a urinary pain reliever such as phenazopyiridine can also help with the symptoms of acute cystitis. Improvement is usually rapid on the right anitibiotics. Most patients will have sporadic episodes of urinary infection that are best managed in cooperation with their physician. Although the temptation is to treat with a powerful antibiotic, this practice also promotes the development of bacterial resistance, so for maintenance usage, nitrofurantoin and trimethoprim are often the most frequently used. E. coli is the most common bacteria although other forms of GI bacteria are also implicated in cystitis.
Other non-medicinal means of treating and preventing cystitis are hydration, maintenance of good genital hygiene, cleaning the smegma from under the foreskin, use of wipes instead of toilet paper, cranberry pills, use of sexual lubricant to decrease friction, yogurt consumption to promote probiotic bacterial growth in the GI tract.
Occasionally, a bout of acute cystitis can change into more of a chronic issue. In these cases, research has shown several interesting findings. Certain types of bacteria develop resistance mechanisms quickly and encapsulate themselves in little "pods" on the bladder surface. Like a bunker, the pods allow the bacteria to stay protected and dormant from antibiotic treatment. Additionally, uropathogenic bacteria seem to have a better adherence mechanism for "sticking" to the urinary tract, making them very difficult to rid. In cases of chronic cystitis, repeat urine cultures show positivity for the same bacteria.
In cases of chronic cystitis, a longer term course of antibiotics may be necessary to eradicate the offending organism. A common patient complaint is the feeling that after a urinary infection, the acute symptoms may disappear and then return but in a much less intense form. Care must be taken with regard to the timing of urine cultures. A certain amount of irritation persists within the bladder, "overactivity" is its other name. The feelings of occasional but less intense urgency and frequency can persist for weeks or months following an episode of acute cystitis. In this scenario, retreatment with antibiotics may not result in improvement. Rather, these overactivity or irritability symptoms may be more effectively addressed with a bladder anti-spastic.
Interstitial cystitis is truly a mysterious condition. In its most classic form, it represents a non-bacterial inflammation of the bladder resulting in decreased storage capacity and refractory urgency and frequency. It has a defined set of diagnostic criteria including certain cystoscopic findings. Few patients meet these criteria, but many carry the diagnosis. IC is more often used as a diagnosis of exclusion for persistent urinary frequency of undetermined etiology.
The take-home message regarding all forms of cystitis is that although the presenting symptoms may be similar, the causes and hence the treatment options, may be inherently different.
Please schedule an appointment with our physicians to discuss your concerns about cystitis.