Cystitis: Symptoms, Causes and Treatment

◉ What is cystitis ?

Cystitis refers to an infection of the lower urinary tract, or more specifically the bladder. It occurs when bacteria travel up the urethra, infect the urine and inflame the lining of the bladder.

Very common, nearly half of women will experience at least one episode of cystitis in their lifetime and nearly one in three women will have had at least one episode of cystitis at the age of 24.

The majority of uncomplicated cystitis cases are caused by bacteria called Escherichia coli (up to 90% of cases), but other types of bacteria can also cause infections.

Although cystitis is painful and annoying, it is not dangerous or contagious, and the infection cannot be transmitted to your partner during sex.

Mild cases often get better on their own within a few days. However, it is also possible that this infection leads to recurrent, chronic forms or more serious kidney infections.

◉ Where is the bladder located ?

The urinary system includes :

Kidneys: filter waste products from your blood.
ureters: tubes carry urine from the kidneys to the bladder.
Bladders: stores urine until you feel the need to urinate.
The urine then leaves your body through the urethra.

The bladder is a hollow, balloon-like muscular sac located in the lower abdomen.

In men, the bladder is located in front of the rectum, with the prostate below, a gland that surrounds the urethra.
In women, the bladder is in front of the vagina and uterus.

◉ What are the symptoms of cystitis ?

The symptoms of cystitis may include:

Pain or burning sensation when urinating.
Strong and frequent need to urinate (pollakiuria).
Dark, cloudy, or strong-smelling urine.
Blood in the urine (hematuria).
Pain during sex.
Pelvic discomfort: feelings of pressure or fullness of the bladder.
Cramps in the abdomen or back.
Feeling generally unwell, sore, sick, and tired.

If a bladder infection spreads to your kidneys, it can become a serious health issue. See a doctor if you have :

Back or side pain.
Fever and chills.
Nausea and vomiting.

In children, symptoms can be vague and young children cannot easily communicate what they are feeling :

A high temperature.
Only a very small amount of urine can be passed.
Abdominal pain in the area of the bladder.
Weakness and fatigue.
Irritability.
Loss of appetite and vomiting.

Note :

Cystitis in a child should always be investigated, as it may indicate a more serious condition such as urinary reflux.
In older women, the symptoms of cystitis can sometimes be subtle and more difficult to sort out. Urinary signs such as chronic dysuria, urinary incontinence or chronic urinary nocturia are not specific to UTIs.
The color and odor of urine are influenced by the ingestion of certain foods, dehydration and other non-infectious factors.

◉ Why cystitis is more common in women ?

Women are especially susceptible due to the proximity of the rectum to the urethral meatus as well as the relatively short urethral length in women.

UTIs in men are much less common due to the longer anatomic urethra, drier peri-urethral environment, and antibacterial defenses provided by prostatic fluid.

◉ What are the causes of cystitis ?

Infectious cystitis :

Although bacterial infections are the most common cause of cystitis, a number of non-infectious factors can also cause inflammation of the bladder. Here are some examples :

Interstitial cystitis (painful bladder syndrome): or cystitis with clear urine which is not infectious but of inflammatory origin. The cause of this chronic bladder inflammation is unclear.

Medicinal Cystitis: Some drugs used to treat cancer (eg mitomycin, doxorubicin) can cause inflammation of the bladder.

Radiation Cystitis: Acute radiation cystitis occurs during or soon after radiation therapy. It is usually self-limited.

Foreign Body Cystitis: Continued use of a catheter can increase your risk of bacterial infection and damage to urinary tract tissue.

Cystitis associated with other conditions:: Cystitis can sometimes occur as a complication of other conditions, such as diabetes, kidney stones, an enlarged prostate, or spinal cord injury spinal.

◉ Risk factors

You may be at higher risk for bladder infections or repeated urinary tract infections if you:

Having sex (bacteria can be pushed into the urethra).
Abnormalities of the urinary tract, such as vesicoureteral reflux.
Have a catheter (a tube to collect urine from the bladder into a bag).
Use certain types of contraception (Ex: diaphragm).
Hormonal changes during pregnancy can increase the risk of bladder infections.
Voiding behavior disorders (rare, delayed and incomplete urination).
Hormonal changes that occur after menopause.
Immunosuppression (diabetes, HIV infection and cancer treatment).
Stay motionless for a long time.
inserting a buffer
If you wipe your butt from back to front.
Having faecal incontinence.

◉ Diagnosis of Cystitis

The diagnosis of uncomplicated cystitis can be made with a high probability on the basis of lower urinary tract symptoms (dysuria, frequency, etc.) and the absence of fever, ascending pain and absence of vaginal discharge or irritation.

To confirm the diagnosis, a urine strip (BU) can be used. The absence of leukocytes and nitrites has a negative predictive value > 95%.

In the case of simple typical cystitis, a cytobacteriological examination of the urine is not indicated. It is recommended in case of failure of antibiotic treatment, recurrent cystitis (more than three infections per year), inconclusive result by urine dipstick or in a population at risk.

Note: In older women, genitourinary symptoms are not necessarily related to cystitis.

◉ Treatment of cystitis

Acute cystitis is treated with antibiotic therapy. First-line antimicrobial agents are :

1st line: fosfomycin trometamol in a single dose of 3 g.
2nd line: pivmecillinam for 5 days (7 days if pregnant).

If symptoms persist after 3 days of treatment, do a urine analysis and adapt the treatment according to the antibiogram and supplemented, in the slightest doubt, with an ultrasound.

Until you feel better, it may help to:

Drink lots of water.
Take a warm bath.
Apply a heating pad to the lower abdomen
Avoid coffee, citrus juices, spicy foods and alcohol.
Avoid having sex.

◉ Complications

The prognosis is generally good if the antibiotic treatment is early. The complications to be feared are:

Diffusion of the infection: pyelonephritis, orchitis, orchiepididymitis, sepsis.
Local suppuration: perineal abscess, renal abscess
Transition to chronicity

◉ How to prevent cystitis?

You cannot always prevent acute cystitis. The following tips can help you reduce the risk of developing cystitis:

Drink plenty of water to help you urinate more frequently and flush bacteria from your urinary tract before an infection starts. It is also especially important to drink plenty of fluids after chemotherapy or radiation therapy, especially on treatment days.
Maintain personal hygiene and wash your genitals daily (be careful, delicate skin in this area can become irritated).
Urinate as soon as possible after sex.
Avoid diaphragms or condoms treated with spermicide.
If you feel the urge to urinate, go to the bathroom soon.
Wipe back and forth after a bowel movement. This prevents bacteria from the anal area from spreading to the vagina and urethra.
Avoid using feminine products near the genital area that can irritate the urethra, such as douches, deodorant sprays, and powders.
Take showers instead of baths.
Wear cotton underwear rather than synthetic material such as nylon, and do not wear jeans or tight pants
Avoid using deodorant sprays or hygiene products in the genital area. These products can irritate the urethra and bladder.

Cranberry: You can also include cranberry juice or cranberry supplements in your diet, they are often recommended to help reduce the risk of recurrent bladder infections. But cranberry has not been shown to be an effective treatment if you already have a bladder infection.

D-mannose: D-mannose may be an option to try and prevent recurrent UTIs. D-mannose is an inert monosaccharide which is metabolized and excreted in urine and acts by inhibiting bacterial adhesion to the urothelium.