What is acute cystitis?

Definition

The urinary tract normally contains no microorganisms. However, sometimes bacteria or yeast from the lower gastrointestinal tract or rectal area enter the urinary tract, usually through the urethra (the tube that allows urine to pass from the bladder). If bacteria or yeast cling to the urethra, they can multiply and infect the urethra. They then travel up and infect the bladder with a condition called acute cystitis.

Causes

Most cases of cystitis are caused by bacteria from the rectal area. In
women, the rectum and urethra are fairly close to each other. This makes it relatively
easy for bacteria to make their way into the urethra. Some women develop cystitis
after a period of frequent sexual intercourse. This happens because bacteria enter
the urethra during sex and cause infection.

Risk Factors

Risk factors for acute cystitis include being sexually active; using a
diaphragm for birth control; condom use (this may also increase infection rates in women,
especially when Nonoxynol-9-coated condoms are used); menopause; abnormalities of
the urinary system, including vesicoureteral reflux or polycystic
kidneys; paraplegia and other neurologic
conditions; sickle-cell disease; history of kidney transplant; diabetes
type 1 and type 2; kidney stones; enlarged prostate; weak immune system; bladder
catheter in place or recent instrumentation of the urinary system; tight underwear
and clothing; and chemicals in soaps, douches, and lubricants. Women are at higher
risk for acute cystitis.

Symptoms

The symptoms of cystitis, which vary from person to person and can range from
mild to severe, include frequent and urgent need to urinate; passing only small
amounts of urine; pain in the abdomen or pelvic area, or in the low back; burning
sensation during urination; leaking urine; increased need to get up at night to
urinate; cloudy, bad-smelling urine; blood in the urine; low-grade fever; and
fatigue.

Screening and Diagnosis

A health care provider will ask about symptoms and medical history, perform a
physical exam, and test the urine for blood, pus, and bacteria. If bacteria are
present in the urine, it is likely that cystitis will be diagnosed. Children and
men who develop cystitis may require additional testing. In these cases, a
cystoscope is used to check for structural abnormalities of the urinary
system that predispose a person to infection.

Treatment and Therapy

Bacterial cystitis is treated with antibiotic drugs. Antibiotics
(usually trimethoprim/sulfamethoxazole, nitrofurantoin, or fluoroquinolones) will
be prescribed for at least two to three days and perhaps for as long as several
weeks. The length of the treatment depends on the severity of the infection and
the patient’s personal history. Symptoms should subside in about one or two days.
To ensure that the infection has disappeared, the health care provider will again
test the patient’s urine.

Recurrent infections might be treated with stronger antibiotics or over more time. Low-dose antibiotics, which are prescribed as a preventive measure, might be prescribed either for daily use or for use after sexual intercourse. Patients with recurrent infections could be referred to a specialist.

Phenazopyridine (Pyridium) is a medicine that decreases pain and bladder spasms. Taking phenazopyridine will turn urine and sometimes sweat an orange color. This medication is generally available without a prescription and can relieve symptoms effectively while the patient waits for medical treatment to work.

Prevention and Outcomes

The chance of having cystitis can be lessened by preventing bacteria from entering the urinary tract. Of the following logical and commonly recommended steps, only the use of cranberry juice has been clearly shown to be of value in reducing infection risk. One should drink large amounts of liquids; urinate when having the urge; empty the bladder and then drink a full glass of water after having sexual intercourse; wash the genital area daily; wipe from front to back (for women) after having a bowel movement; avoid using douches and feminine hygiene sprays; drink cranberry juice (which may help prevent and relieve cystitis); and avoid wearing tight underwear or clothing.

The foregoing prevention recommendations apply largely to healthy young women at risk for bladder infections. Those with some of the unusual risk factors, or women for whom the foregoing suggestions do not reduce recurrence, might find that other medically recommended prevention techniques help.

Bibliography

Kahn, B. S., et al. “Management of Patients with Interstitial Cystitis or Chronic Pelvic Pain of Bladder Origin: A Consensus Report.” Current Medical Research and Opinion 21, no. 4 (2005): 509-516.

Katchman, E. A., et al. “Three-Day Versus Longer Duration of Antibiotic Treatment for Cystitis in Women: Systematic Review and Meta-Analysis.” American Journal of Medicine 118, no. 11 (2005): 1196-1207.

Parsons, M., and P. Toozs-Hobson. “The Investigation and Management of Interstitial Cystitis.” Journal of the British Menopause Society 11, no. 4 (2005): 132-139.

Phatak, S., and H. E. Foster, Jr. “The Management of Interstitial Cystitis: An Update.” Nature: Clinical Practice in Urology 3 (2006): 45-53.

Schrier, Robert W., ed. Diseases of the Kidney and Urinary Tract. 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2007.