What causes Cystitis?
Most infections are due to one type of bacteria - E.Coli - which lives normally in the bowel but which can also cling to the opening of the urinary system called the urethra. An infection limited to here is called urethritis, and one which affects the bladder is called cystitis. Any infection which then spreads to the kidneys is called a pyelonephritis, but this is much rarer than cystitis.
Certain People Are More At Risk Of Cystitis;
¤ people with diabetes
¤ men with enlarged prostate glands
¤ people with catheters
¤ people with disorders of their immune (defence) system
¤ women using the diaphragm as contraception
Some women are also prone to cystitis after intercourse, although the reasons for this remain poorly understood.
What Are The Signs And Symptoms Of Cystitis?
Most people with cystitis experience some symptoms (although not invariably). The commonest of these are;
¤ A frequent urge to pass water. Despite this, it is usual for little urine to actually be passed.
¤ A painful 'stinging' or 'burning' discomfort when urinating.
¤ A general feeling of tiredness, malaise and of being generally unwell.
¤ Going hot and cold.
¤ The urine may look cloudy or discoloured.
¤ Feeling sick.
¤ With a pyelonephritis, there may be fever, pain in the back or sides, and vomiting.
Will I Have Any Tests Or Investigations?
The standard investigation is to test a sample of urine for infection. Some doctors will use a dipstick test at their surgery for this, as well as sending a sample to the local hospital laboratory for analysis. The urine is examined for blood cells and bacteria, and any bacteria found are grown in a special culture, and tested against different antibiotics to see which one best destroys the bacteria (a sensitivity test). Most results are available within 48 hours, but many doctors will begin treatment once the sample has been obtained and before obtaining the results.
To obtain a clean sample of urine, your GP will ask you to give a 'clean catch' specimen. This is done by washing the genital area thoroughly, and collecting some urine after 2 or 3 seconds of urination in a sterile container, obtained from your doctor. This method helps to prevent other bacteria from contaminating the sample.
If the same infection appears to repeatedly recur, or there is a severe attack of pyelonephritis, an ultrasound scan of the kidneys may be performed, which is a simple and painless procedure. Another possible test is an IVP - an intravenous pyelogram - where a dye is injected into a vein, and this dye then shows up on simple X-rays taken shortly afterwards. The kidneys and urinary system are outlined by the dye, allowing any blockages or changes to show up. A cystoscopy is a test where a fibreoptic tube is inserted through the urethra and into the bladder, either under local or general anaesthetic, allowing for a direct view of the inside of the bladder. This is sometimes performed if the urine test shows a lot of red blood cells, or if there is a concern there may be any bleeding in the bladder.
What Treatment Might I Need?
The treatment is with antibiotics, the choice of which depends on the test results and any patient allergies they may have to medication. The usual ones used in the UK are trimethoprim, amoxycillin and nitrofurantoin although there are a number of other possible types available. It is usual for only a very few days treatment to be needed, and your doctor may ask you to provide another sample at the end of the course to make sure the infection has cleared. It is always important to finish any course of antibiotics prescribed as symptoms often disappear before the infection fully clears.
What Course Will The Illness Follow?
Most cases of uncomplicated cystitis either resolve without treatment, or respond very quickly to antibiotic therapy. If there are repeated attacks of cystitis - at least 4 each year - your GP may consider the following treatment options;
¤ a single night-time low dose antibiotic for many weeks or months. This appears to be effective and without any serious side effects.
¤ taking a single dose of antibiotic after sexual intercourse.
¤ a 1 or 2 day course of antibiotics when symptoms first appear.
Can I Do Anything To Help Myself?
For the symptoms, a warm pad or hot water bottle can help to relieve the abdominal or loin pain, as well as drinking plenty of water at this time. Avoid coffee, tea and alcohol, and it is also sensible not to eat spicy foods during an attack. Other helpful measures include;
¤ Drink cranberry juice daily. This appears to reduce the ability of E. Coli to 'stick' to the bladder as well as acidifying the urine, and so reduces the risk of infection occurring.
¤ Urinate when you need to - do not be tempted to 'hold on'.
¤ Wipe from the front to the back to prevent bacteria around the anus from entering the vagina or urethra.
¤ Shower instead of bathe.
¤ Try to urinate after intercourse or before sleeping.
¤ Avoid douches and feminine hygiene products - these can irritate the urethra.
Tell Your Doctor
1. When did your symptoms start?
2. Has your urine been cloudy or discoloured?
3. Do you feel the need to urinate more frequently?
4. Do you feel unwell in yourself?
5. Do you have any burning or stinging when you urinate?
Ask Your Doctor
1. Can my partner catch cystitis from me?
2. If I am pregnant, do I need to be treated differently for cystitis?
3. Are infections in men more serious?
4. What are the side effects of any treatment?
5. I have been told that smoking is bad for the bladder. Is this true?
By Dr Roger Henderson, MB BS Lond., LMSSA Lond.
Interstitial Cystitis Support GroupAddress: 76 High Street, Stony Stratford, MK11 1AH
Telephone: 01908 569 169
Fax: 01908 569 169
Email: info [at] intersitialcystitis.co.uk
Women's Nutritional Advisory Service
Address: PO Box 268, Lewes, East Sussex, BN7 2QN
Telephone: 01273 487 366
Fax: 01273 487 576
Email: wnas [at] wnas.org.uk
Published by Health & Medical Information website.