|AGE Rare in children; more common in teenage girls and women of all ages||GENDER Much more common in females|
|LIFESTYLE For some women, sexual intercourse may bring on an episode||GENETICS Not a significant factor|
Cystitis is an inflammation of the bladder lining, causing painful, frequent passing of urine.
In cystitis, the lining of the bladder becomes inflamed, resulting in a frequent need to pass urine and pain when passing urine. In most cases, the condition is due to a bacterial infection.
Cystitis affects women much more commonly than men. About half of all women have at least one attack of bacterial cystitis in their lifetime, and some women have recurrent attacks. In men, cystitis is rare and is usually associated with a disorder of the urinary tract. In children, cystitis can be the result of an anatomical or structural problem and can damage the kidneys (see Urinary tract infections in children).
What are the types of cystitis?
There are several types of cystitis. The most common form is bacterial cystitis, which is often caused by Escherichia coli, a bacterium that normally lives in the intestines. Cystitis usually occurs when bacteria from the anal or vaginal areas enter the bladder through the urethra (the tube from the bladder to the outside of the body), often during sex or when the anus is wiped after a bowel movement. Women are at much greater risk of infection than men because the female urethra is shorter than that of the male and the opening is nearer the anus. The risk of bacterial cystitis is increased if the bladder cannot be emptied fully. Incomplete emptying causes urine to be retained in the bladder, and bacteria can multiply in the trapped urine. Postmenopausal women are especially prone to bacterial cystitis because they have reduced levels of the hormone oestrogen, which leaves their urethral lining vulnerable. Women who use a diaphragm and spermicide for contraception are at increased risk because a diaphragm, which has to stay in place for several hours, can prevent complete bladder emptying, and spermicide may encourage the growth of bacteria in the vagina. People with diabetes mellitus are also susceptible for several reasons: there may be glucose in their urine, which encourages the growth of bacteria; they may have reduced immunity to infection; or they may have nerve damage that prevents the bladder from emptying completely. Other disorders that prevent complete bladder emptying include an enlarged prostate gland and urethral stricture, in which the urethra is narrowed.
Interstitial cystitis is a rare, chronic, nonbacterial inflammation of the lining and tissues of the bladder that may lead to ulceration. The cause is unknown, although some women find that certain foods or drinks trigger or worsen the symptoms. This type of cystitis may be responsible for chronic symptoms of pelvic pain and urinary frequency that do not improve with antibiotics, particularly in women.
In radiation cystitis, the lining of the bladder is damaged as a result of radiotherapy to treat prostate cancer, bladder tumours, or cancer of the cervix.
What are the symptoms of cystitis?
The main symptoms of all types of cystitis are the same and include:
- Burning pain when passing urine.
- Frequent and urgent need to urinate, with little urine passed each time.
- A feeling of incomplete emptying of the bladder.
If the cause of the cystitis is a bacterial infection, you may also notice:
- Pain in the lower abdominal region and sometimes in the lower back.
- Fever and chills.
A bladder infection can spread upwards to a kidney, causing severe pain in the back (see Pyelonephritis). In some severe cases of cystitis, complete or partial loss of control over bladder function can occur as a result of irritation of the muscle in the bladder wall (see Urge incontinence).
What might be done?
If you develop the symptoms of cystitis, arrange to see your doctor. You may be able to relieve symptoms by drinking ½ litre (about 1 pint) of fluid every hour for 4 hours. Drinking cranberry juice can relieve the burning sensation when passing urine, and painkillers may ease discomfort. Self-help measures (see Preventing bacterial cystitis) may prevent a recurrence.
Your doctor will arrange for urine tests to detect any evidence of infection. While awaiting the results, he or she may prescribe antibiotics. Almost all attacks of bacterial cystitis are cured by a single course of antibiotics. Recurrent attacks in women or a single episode in men need further investigations, such as specialized X-rays of the urinary tract (see Intravenous urography), ultrasound scanning of the urinary tract and sometimes cystoscopy. If there is no evidence of a disorder but the cystitis still recurs, your doctor may prescribe a long course of low-dose antibiotics. Women may be given a single high dose of antibiotics to be taken after intercourse or at the first sign of symptoms.
If urine tests show no infection but you have recurrent attacks of pain and frequent urination, your doctor may suspect interstitial cystitis. However, bacteria may be difficult to detect, and your doctor may prescribe antibiotics even though no infection has been found. He or she may suggest self-help measures, including avoiding foods or drinks that you find trigger symptoms. Some postmenopausal women find oestrogen-containing creams helpful.
Your doctor may arrange for cystoscopy to view inside the bladder, and a sample of bladder tissue may be taken. If these investigations reveal interstitial cystitis, your doctor may suggest one of several treatments, including a course of oral corticosteroids or a procedure in which the bladder is stretched by filling it with water. This procedure, which is carried out under general anaesthesia, often relieves symptoms.
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