Cystitis; acute bacterial

Causes and Risks:
Cystitis is caused when the normally sterile lower urinary tract (urethra and bladder) is infected by bacteria, with resultant inflammation. It is very common, occurring in 2 out of 100 people. The disorder is most common in sexually active women ages 20 to 50, but may occur in those not sexually active or in young girls. Cystitis is rare in males with anatomically normal urinary tracts. Females are more prone to the development of cystitis because of their relatively shorter urethra--bacteria do not have to travel as far to enter the bladder--and because of the relatively short distance between the urethral opening and the anus. Older adults are at high risk for developing cystitis, with the incidence in the elderly being as high as 33 out of 100 people.

Over 90% of cases of cystitis are caused by E. coli, a bacterium found in the lower gastrointestinal tract. Sexual intercourse can increase the risk of cystitis because bacteria can be introduced into the bladder through the urethra during sexual activity. Once bacteria enter the bladder, they normally are removed through urination. When bacteria multiply faster than they are removed by urination, infection results.

Risks for cystitis include obstruction of the bladder or urethra with resultant stasis of urine, insertion of instruments into the urinary tract (such as catheterization or cystoscopy ), pregnancy , diabetes , and a history of analgesic nephropathy or reflux nephropathy .

The elderly population are at increased risk for developing cystitis due to incomplete emptying of the bladder associated with such conditions as benign prostatic hyperplasia ( BPH ), prostatitis, and urethral strictures . Also, lack of adequate fluids, bowel incontinence , immobility or decreased mobility, and placement in a nursing home, all place the person at increased risk for developing cystitis.

Prevention:
Cleanliness of the genital area may help reduce the chances of introducing bacteria through the urethra. The genitals should be cleaned and wiped from front to back to reduce the chance of dragging E. coli bacteria from the rectal area to the urethra.

Increasing the intake of fluids may allow frequent urination to flush the bacteria from the bladder. Urinating immediately after sexual intercourse may help eliminate any bacteria that may have been introduced during intercourse. Refraining from urinating for long period of time may allow bacteria time to multiply, so frequent urinating may reduce risk of cystitis in those who are prone to urinary tract infections .

Symptoms:

Additional symptoms that may be associated with this disease:

* Often in the elderly person, mental changes or confusion are the only signs of a possible urinary tract infection .

Signs and Tests:



Treatment:
Mild cases of acute cystitis may disappear spontaneously without treatment. However, because of the risk of the infection spreading to the kidneys ( complicated UTI ), treatment is usually recommended. Also, due to the high mortality rate in the elderly population, prompt treatment is recommended.

MEDICATIONS:
Antibiotics may be used to control the bacterial infection. It is imperative that you finish the entire course of prescribed antibiotics. Commonly used antibiotics include:

  • nitrofurantoin
  • sulfa drugs (sulfonamides)
  • amoxicillin
  • cephalosporins
  • trimethoprim-sulfamethoxazole
  • doxycycline

Chronic or recurrent UTI should be treated thoroughly because of the chance of kidney infection ( pyelonephritis ). Antibiotics control the bacterial infection. They may need to be given for long periods of time (as long as 6 months to 2 years), or stronger antibiotics may be needed than for single, acute episodes of cystitis. Prophylactic low-dose antibiotics may be recommended after acute symptoms have subsided.

Phenazopyridine hydrochloride (pyridium) may be used to reduce the burning and urgency associated with cystitis. In addition, acidifying medications, such a ascorbic acid may be recommended to decrease the concentration of bacteria in the urine.

SURGERY:
Surgery is generally not indicated in the presence of a urinary tract infection .

OTHER THERAPY:
Preventive measures may reduce symptoms and prevent recurrence of infection. Keeping the genital area clean and remembering to wipe from front to back may reduce the chance of dragging E. coli bacteria from the rectal area to the urethra.

Urinating immediately after sexual intercourse may help eliminate any bacteria that may have been introduced during intercourse. Refraining from urinating for long period of time may allow bacteria time to multiply, so frequent urination may reduce the risk of cystitis in those who are prone to urinary tract infections .

DIET:
Increasing the intake of fluids (2000 to 4000 cc per day) encourages frequent urination that flushes the bacteria from the bladder. Avoid fluids that irritate the bladder, such as alcohol, citrus juices, and caffeine .

MONITORING:
Follow-up may include urine cultures to ensure that bacteria are no longer present in the bladder.

Prognosis:
Most cases of cystitis are uncomfortable but disappear without complication after treatment.

Complications:



Call Your Healthcare Provider:
Call for an appointment with your health care provider if symptoms indicate cystitis may be present, symptoms worsen, or new symptoms develop, especially fever , back or flank pain , and vomiting .


This is an illustration of the female urinary tract. The female and male urinary tracts are relatively the same except for the length of the urethra. The positioning in the body and relative size of the organs are also demonstrated.



This is an illustration of the male urinary tract. The female and male urinary tract are relatively the same except for the length of the urethra. The positioning and relative size of the organs are also shown.