CYSTITIS

DEFINITION

Cystitis (pronounced sis-TIE-tess) is inflammation of the bladder. The condition is often associated with inflammation of other structures adjoining the bladder. For example, cystitis is often accompanied by urethritis (pronounced yur-ih-THRI-tess). Urethritis is inflammation of the urethra. The urethra is the tube through which the bladder empties to the exterior of the body. Cystitis and urethritis together are sometimes called lower urinary tract infections (UTI).

DESCRIPTION

In children under the age of twelve months, cystitis is about four times more common among boys than girls. Among adults, this pattern is very different. The condition is fifty times as common among women as among men. After the age of fifty, the pattern changes again. The rate of cystitis among men increases because of a greater number of prostate problems among men. The prostate is a gland surrounding the male urethra in front of the bladder.

The nature of cystitis varies considerably in men and women. The reason for this variation is the difference between the urinary tract in males and females.

Cystitis is a common female problem. About one-quarter of all adult women are thought to have had at least one episode of cystitis. Between 2 and 5 percent of women's visits to doctors are for UTI symptoms. About 90 percent of these cases are uncomplicated. Many women, however, experience repeated bouts of cystitis.

UTIs are uncommon in younger and middle-aged men. They become more common as men grow older. Older men are more likely to develop bacterial infections of the kidney or prostate gland. These infections may spread and cause cystitis.

Cystitis in children is usually a congenital problem. A congenital problem is one that is present at birth. For example, some children are unable to empty their bladders completely. Urine may remain in or flows backward into the bladder. This condition may lead to cystitis.

CAUSES

The causes of cystitis are somewhat different in women than in men. Most bladder infections in women are so-called ascending (going upward) infections. Ascending infections are caused when disease agents travel upward through the urethra from outside the body. The female urethra is relatively short, about 1 to 2 inches in length. Microorganisms that cause disease can travel this distance very easily. The organism that most commonly causes cystitis in women is Escherichia coli (or E. coli; pronounced ESH-ur-ickee-uh KO-lie). It is responsible for about 80 percent of all cases of the disease.

Other organisms that can cause cystitis include Staphylococcus saprophyticus (pronounced STAFF-uh-lo-kock-us SAP-ro-FIT-ick-us), and members of the Klebsiella (pronounced KLEB-see-ell-uh),Enterobacter (pronounced EN-terr-o-BACK-tur), and Proteus (pronounced PRO-tee-us) families of bacteria.

A number of other factors increase a woman's risk for cystitis. These factors include:

• Sexual intercourse. The more sexual partners a woman has, the greater her risk for cystitis.
• Use of a diaphragm for birth control
• An unusually short urethra
• Diabetes (see diabetes entry)
• Poor personal hygiene. Bacteria from vaginal discharges or feces can easily enter the female urethra. The opening to the urethra in women is very close to the vagina and the anus.
• History of previous UTIs. About 80 percent of women who have one case of cystitis will develop another case within two years.

This illustration depicts the cycle of recurring urinary tract infection. The lower tract (urethra and bladder) is relatively resistant to infection. The kidneys are more vulnerable. (Reproduced by permission of

Custom Medical Stock Photo

)

Males

Cystitis in men usually occurs as a complication of kidney or prostate gland infection. The most common cause of cystitis in men, as in women, is the bacterium Escherichia coli. Factors that increase men's risk for cystitis include:

• Lack of circumcision. Circumcision is the procedure in which the foreskin is removed from a man's penis. If the foreskin has not been removed, bacteria can grow beneath it. The bacteria can then travel up the urethra to the bladder.
• Urinary catheterization. Urinary catheterization is a medical procedure in which a long, thin tube (a catheter) is inserted into the urethra. It is pushed up into the bladder. Some men require this procedure if they are unable to urinate normally. The presence of the catheter provides a pathway by which bacteria can travel up into the bladder and cause infection.

SYMPTOMS

The symptoms of cystitis are similar in women and men. The most common symptoms involve changes in urination patterns. Patients may feel pain during urination, may feel a sudden and strong desire to urinate, or may have to urinate more frequently. About half of all patients experience fever, pain in the lower back, nausea and vomiting, or chills.

DIAGNOSIS

The first step in diagnosing cystitis is often a physical examination. A doctor examines the patient's abdomen and lower back. Swelling of the kidneys or bladder can often be felt.

The next step in diagnosis is collection of a urine sample. Normal human urine is sterile. It does not contain bacteria, blood, pus, or other abnormal substances. The presence of any of these substances in urine suggests the presence of an infection.

The patient is asked to urinate into a collecting bottle. The urine can then be tested immediately with a dip stick. A dip stick is a strip of paper that contains one or more testing chemicals. The chemicals change colors if certain abnormal substances are present in the urine. The urine may also be examined using a microscope.

If questions remain about a diagnosis, more advanced tests can also be used. For example, a dye may be injected into the urinary tract and X-ray photographs taken. The dye helps the shape of the urinary tract stand out more clearly. Any abnormal structures present can be seen on the X-ray photograph.

TREATMENT

Since cystitis is a bacterial infection, it can be treated with antibiotics. Some drugs that are commonly used include penicillin, ampicillin (pronounced AMP-ih-SIL-in), amoxicillin (pronounced uh-MOK-sih-SIL-in), sulfisoxazole (pronounced SUL-fuh-SOK-suh-zole), trimethoprim (pronounced tri-METH-o-prim), cephalosporin (pronounced seff-a-lo-SPORE-in), or fluoroquinolone (pronounced FLOOR-o-KWIN-o-lone). Women usually respond to antibiotic treatment in less than three days. Men usually require a longer period of treatment, ranging from seven to ten days.

Alternative Treatment

Some forms of alternative treatment involve changes in one's diet. Practitioners often recommend eliminating all sugar from the diet and drinking lots of water. Some herbal remedies that are suggested include garlic, goldenseal, and bearberry. These herbs are thought to kill bacteria. Acupuncture (the Chinese therapy of inserting fine needles into the skin) and homeopathic medicine may also be effective in treating cystitis.

PROGNOSIS

The prognosis for recovery from uncomplicated cystitis is very good. With proper treatment, the infection usually clears up quickly. In many cases, the condition may reoccur. However, it can be treated in essentially the same way each time it appears. More complicated infections in men may be difficult to treat if antibiotics are not able to clear up the problem.

PREVENTION

Women can reduce their risk for cystitis by becoming aware of risk factors and adjusting their lifestyles accordingly. For example, improving one's personal hygiene is an easy step to help prevent a lower urinary tract infection. In some cases, patients are advised to take an antibiotic tablet following sexual intercourse. Other preventative measures include drinking large amounts of fluid and urinating frequently, especially after intercourse.

The primary method of preventing cystitis in men is to obtain prompt treatment for prostate infections.

FOR MORE INFORMATION

Books

Chalker, Rebecca. Overcoming Bladder Disorders: Compassionate, Authoritative Medical and Self-Help Solutions for Incontinence, Cystitis, Interstitial Cystitis, Prostatitis. New York: HarperCollins, 1991.

Gillespie, Larrian, and Sandra Blakeslee. You Don't Have to Live With Cystitis, revised and updated edition. New York: Avon Books, 1996.

Simone, Catherine M. To Wake In Tears: Understanding Interstitial Cystitis. Cleveland, OH: IC Hope, 1998.