Mediclinic Al Sufouh

Knowledge Village - Dubai

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Cystitis

Cystitis (UTI)

Table of Contents

Overview

Acute cystitis is a UTI (urinary tract infection) localised in the bladder. It can be:

  • Non-complicated: exclusively in adult non-pregnant, premenopausal women, without co-morbidities and or abnormalities of the urinary tract;
  • Complicated: cystitis before or during puberty, after menopause, during pregnancy and in comorbid patients; we consider complicated all cystitis in men.

Cystitis occurs almost exclusively in women and is mostly uncomplicated.

In men, cystitis is never alone it comes along with other infections like prostatitis.

Symptoms are lower abdominal pain and frequent and painful urination. A less frequent sign is blood in the urine.

Most cystitis in females requires just empiric antibiotic treatment without any test.

Additional symptoms (fever, lumbar pain) are signs of complication and it needs prompt diagnosis and aggressive treatment. Immediate urine culture test and focused antibiotic treatment are mandatory in these cases.

Causes of cystitis

E. coli is a bacterium that causes most of these UTI. After bowel movements, the bacterial count increases in the genital area. If the bowel movements are irregular with constipation and or diarrhoea, this count will be even higher. Moreover, if hygiene is lacking, the bacteria will replicate further infecting the vagina. After that, they enter the bladder easily through the urethra.

Specific risk factors for cystitis in women are:

  • Sexual activity: sexually active women have more UTIs than do women who aren’t sexually active. The risk increases with a new sexual partner.
  • Mother with a history of UTI;
  • history of UTI during childhood;
  • spermicidal agents and diaphragms use for birth control;
  • Menopause: after menopause, a decline in circulating oestrogen causes changes in the urinary tract that make you more vulnerable to infection.

Symptoms

Sudden onset of pain while urinating and frequent urination (dysuria and frequency) with lower abdominal pain are the typical symptoms of UTI. Additional signs like bloody urine and vaginal discharge mean that we need to differentiate uncomplicated cystitis from other diagnoses, commonly vaginitis or stone disease. Fever and lumbar pain are signs of complicated UTI.

Diagnosis

Symptoms are enough to diagnose non-complicated cystitis. Urine dipstick or urine analysis is optional. Additional symptoms like bloody urine or vaginal discharge should prompt differential diagnosis with vaginitis and stone disease. However, taking a urine culture is recommended in patients with atypical symptoms, pregnancy, suspect of kidney infection or who fail to respond to appropriate antimicrobial therapy.

Treatment

The treatment with Fosfomycin, single-dose, pivmecillinam 400 mg three times a day for three to five days, and nitrofurantoin, should be considered for first-line treatment.

Cystitis in pregnancy

Urine analysis and culture are strong recommendations. Not all antimicrobials are suitable during pregnancy.

Cystitis in men

Cystitis in men is a complicated infection because of almost constant involvement of the prostate (prostatitis). Therefore, we need treatment with antimicrobials penetrating the prostate tissue. A treatment duration of at least fourteen days is recommended, preferably with trimethoprim-sulfamethoxazole or fluoroquinolone.

Prevention

To prevent cystitis, you must avoid bacterial growth in the vagina and in the bladder:

Reduce the bacterial count in the area around the anus after bowel movements:

  • Use a bidet for washing the perianal area, use mild soap and clean the area around the anus gently, wiping from front to back. Any wiping motion that starts nearer to the rectum and then approaches the bladder-opening area moves potentially pathogenic bacteria closer to the bladder; finally dry the area between the urethral meatus and anus with a clean towel with the same movements front to back.
  • If you can’t use a bidet, you can use an antiseptic wet wipe used with the same wiping motions.

Avoid creating a suitable environment for bacterial growth in the genital area:

  • Use tampons for periods. Tampons are advised during the menstrual period rather than sanitary napkins or pads because they keep the bladder opening area drier than a clean pad, thereby limiting bacterial overgrowth.
  • Do not wear tight-fitting undergarments made of nonbreathing materials. With such fabrics, accumulating moisture builds up. It leads to maceration of the skin and bacterial overgrowth adjacent to the opening of the bladder. Cotton underwear for general use is suggested.
  • Avoid the use of spermicidal jelly. It kills sperm as well as normal vaginal florae, which are extremely important in suppressing colonisation with pathogenic bacteria.
  • Avoid vaginal douches.

Avoid that bacteria enter the bladder:

  • Take special precautions after sexual activity; such activity may also increase risk because it can introduce bacteria into the bladder area. We recommend cleaning the genital area just before sexual intercourse. Moreover, the bladder should be emptied just after intercourse; drink two extra glasses of water after having sex.
  • When engaging in physical activity and exercise, make sure to empty the bladder frequently and drink plenty of water and other fluids.
  • Take showers and avoid long baths. Bathwater may quickly become contaminated by the bather’s skin florae. Sitting in a tub allows bacteria to reach the bladder opening area.

Avoid that the bacteria grow into your bladder:

  • Extremely useful is avoiding long intervals between urinating. Try to empty the bladder at least every 4 hours during the day while awake, even if the need or urge to void is absent; when feeling the need to empty the bladder, do not try to “hold it”.
  • Drink more water. If the urine appears darker than a very pale yellow, this means not enough liquid is being ingested; increase the fluid intake.

Final recommendations

The typical symptoms of cystitis in females can be treated empirically without diagnostics.

In selected cases of recurrent cystitis, women can use the self-treatment by taking Fosfomycin 3000 mg one shot at the early symptoms’ onset.

Pregnancy and additional symptoms can lead to complications and are always good reasons to see a doctor.

Prevention is the central part of the strategy in recurrent cases.