Cystitis

Written by Mr John Macfarlane, consultant urological surgeon and Dr Paul Klenerman, specialist

Venereal diseases
Gonorrhoea and chlamydia infections may cause symptoms similar to cystitis. In addition, there is usually a vaginal discharge, bleeding after sexual intercourse and an inflamed cervix. Cystitis-like symptoms among young sexually active men may be caused by venereal diseases and they should seek immediate medical advice.

Parasites
Particularly among people who have been in North Africa or the Middle East. The bladder may be infested by parasites - schistosomiasis or bilharzia (river blindness). The symptoms are similar to cystitis, but there are no bacteria in the urine.

Postmenopausal women
Due to lack of female sex hormones in postmenopausal women, a range of changes take place in the whole body. A consequence of this is that the urinary system is more easily irritated by cystitis.

Contact dermatitis
Women using a deodorant or other potentially irritating material on their genitals may develop cystitis-like symptoms.

What are the symptoms of cystitis?

Burning sensations or pain during urination.

Frequent urination.

Cloudy and foul-smelling urine.

Pain directly above the pubic bone.

Children under five years of age often have less concrete symptoms, such as weakness, irritability, reduced appetite and vomiting.

Older women may also have no symptoms other than weakness, falls, confusion or fever.

Occasional blood in the urine.

Who is at special risk?

Women or girls who do not practice proper toilet hygiene.

Pregnant women.

People with a congenital deformity in the urinary system.

Men with an enlarged prostate.

People using a catheter.

Young people having unprotected sexual intercourse.

Good advice
It is important to drink sufficiently, so the bladder is flushed thoroughly.

During urination the bladder should be emptied completely. It is a bad habit to sit on the toilet bent forward and reading while urinating.

A trick is to place yourself backwards on the toilet, so you lean against the wall. This posture is more suitable in securing a complete emptying of the bladder than the usual sitting posture.

Warm clothes on the lower part of the body will also help prevent cystitis.

As a prevention, it may be helpful to drink cranberry juice every day or take capsules. There is no doubt that this simple and natural treatment may help to reduce the frequency of recurrent infections. It is thought that the cranberry juice works by preventing common bacteria from 'sticking' to the walls of the bladder and so preventing infection taking hold.

Urination immediately after sexual intercourse will flush out most bacteria from the urethra.

Try to urinate at least once every three hours. Women who avoid urination for long periods suffer from more infections of the urinary system.

What treatments are available?
There are a number of products available from your pharmacist to treat cystitis. These can be used unless a woman is vomiting or if there is blood in the urine or if a woman is pregnant in which case she should consult her doctor. Usually, a single course of treatment clears up the problem, but if symptoms persist after trying an over-the-counter remedy then you should consult your doctor.

How does a doctor diagnose cystitis?
The diagnosis of cystitis is primarily based on symptoms and signs. Visual appearance of the urine is not helpful. The most important examination of urine is done by chemical testing (dipstick test), which is very quick, and by urine culture where the specimen is sent to a hospital laboratory to grow and examine the bacteria. The specimen must be fresh. It is also important that the woman has separated her labia (lips) during urination, to avoid bacteria from the skin and vagina contaminating the specimen. If there is inflammation, the doctor will identify bacteria and red and white blood cells in the urine using the dipstick test. If this is positive, your doctor can prescribe antibiotics immediately while waiting for further confirmation from the urine culture. This will also indicate whether the antibiotic is sensitive to the bacteria or whether there is any resistant bacteria which is not going to respond to the antibiotic.

In the case of repeated, inexplicable, infections of the urinary system, a referral should be made to a hospital for tests such as ultrasound scanning or X-rays of the urinary system and cystoscopy (telescopic examination of the bladder).

Future prospects
Some people, particularly women, may have repeated infections. To avoid this, follow the good advice above. Women who have more than two episodes of cystitis yearly may benefit from medium term use of an antibiotic as protection against infection. The effectiveness of long-term antibiotics (over 12 months) has not been clearly established.

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