Cystitis – Causes, Complications, Diagnosis, Symptoms, Treatment

Cystitis is the medical term for inflammation of the bladder. Most of the time, the inflammation is caused by a bacterial infection, in which case it may be referred to as a urinary tract infection (UTI). A bladder infection can be painful and annoying, and can become a serious health problem if the infection spreads to your kidneys.

Less commonly, cystitis may occur as a reaction to certain drugs, radiation therapy or potential irritants, such as feminine hygiene spray, spermicidal jellies or long-term use of a catheter. Cystitis may also occur as a complication of another illness.

The usual treatment for bacterial cystitis is antibiotics. Other treatments are used for other types of cystitis.

Causes

Your urinary system is composed of the 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 adjust the body composition 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 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 between the ages of 30 and 50, but it is rare in men of the same age. However, men older than 50 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 (nos-o-KO-me-ul), bladder infections. These infections occur in people in a medical care facility, such as a hospital or nursing home. Most often they occur 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 elderly people or people confined to bed.

Noninfectious cystitis
Although bacterial infections are the most common cause of cystitis, a number of other noninfectious factors 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 substances 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.

Symptoms

Cystitis symptoms often include:

  • 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 bed-wetting (enuresis) also may be a sign of a UTI.

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 anatomy. Women have a shorter urethra than men have, which cuts down on the distance bacteria must travel to reach the bladder.

Women who are sexually active tend to have more UTIs, because sexual intercourse can result in bacteria being pushed into the urethra. Women who use diaphragms for birth control also may be at higher risk. Hormonal changes during pregnancy may increase the risk of a bladder infection as well.

Other risk factors in both men and women include:

  • Interference with the flow of urine. This can occur in conditions such as an enlarged prostate or a stone in the bladder.
  • 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.

Prevention

You can take steps to reduce the risk of bladder infections. Women, in particular, may benefit from the following:

  • Drink plenty of liquids, especially water. Cranberry juice may have infection-fighting properties. 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. 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 void, don’t delay going to the bathroom.
  • 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 tub baths. If you’re susceptible to infections, doing so can help prevent infections.
  • 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.

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, as well:

  • Urine analysis. If your doctor suspects you have a bladder infection, he or she 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.
  • 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.

Treatment

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. Make sure your doctor is aware of any other medications you’re taking or any allergies you might have.

Usually symptoms clear up within a few days 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 recommended 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. Currently, researchers are testing whether using catheters pre-treated with antimicrobial products may help reduce the incidence of this type of bladder infection. Research is under way to investigate the development of vaccines that might prevent cystitis and decrease the need for frequent antibiotic use.

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 personal 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. Cystitis caused by radiation therapy, however, may recur months or even years after treatment is over, sometimes triggered by a UTI.

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), which could be associated with a bacterial bloodstream infection (bacteremia). 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. Blood found in the urine (hematuria) 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 improves. Severe bleeding is treated with medication or blood transfusion, if necessary.