Cystitis (UTI)

What is cystitis, and what causes it? 

Cystitis is inflammation and pain of the bladder wall caused most commonly by urinary tract infections. Urinary tract infections occur when bacteria enter the urethra (urinary tract) or bladder and start to multiply (infection spreads). Naturally occurring bacteria that typically occur in the body may also cause an infection. 

Bacteria can enter the urethra in instances such as during sexual intercourse, using a contraceptive diaphragm, or tampons. Naturally occurring bacteria in the bladder are more likely to result in an infection if there is damage, irritation, or a blockage to the urinary system. 

Cystitis is not always caused by an infection, with certain hygiene products or medications also causing inflammation.  

Cystitis is most commonly seen among females; however, it can affect anyone. Women are more susceptible to UTIs, as they have a shorter urethra, meaning that bacteria can enter the bladder more easily. 

Types of cystitis

Cystitis can either be interstitial or acute. Interstitial cystitis (IC) is a chronic (long-term) condition that affects multiple layers of bladder tissue, causing bladder pain, bladder pressure, and sometimes pelvic pain. Acute cystitis is characterized as a sudden inflammation of the bladder. Acute cystitis generally occurs as a result of the bacteria E.coli, but other bacteria, such as enterococci, Lactobacillus, S. saprophyticus, and Proteus mirabilis, can also cause cystitis. 

Both interstitial and acute cystitis have multiple possible causes. Types of cystitis are characterized by their cause. 

The types of cystitis include: 

• Bacterial cystitis. This type of cystitis occurs when naturally occurring bacteria or bacteria enter the bladder through the urethra. This causes an infection in the bladder walls. 
• Drug-induced cystitis. Some medications can irritate and cause inflammation to the bladder as they are excreted from the body. 
• Chemical cystitis. The inflammation of the bladder is caused by forms of treatments such as chemotherapeutic agents or from spermicides, dyes, or gels. 
• Radiation cystitis. Radiation can also damage healthy cells when killing cancer cells. Radiation cystitis most commonly occurs in patients who receive radiation in their pelvic area. 
• Foreign body cystitis. This infection occurs from treatments using a stent, other endoscopic instruments, or a catheter. Bacteria can enter the urethra when catheters or stents are inserted or removed. 

Who is at risk for cystitis?

Cystitis is common in women who: 

• Have kidney problems 
• Are diabetic
• Have experienced menopause
• Are sexually active 
• Use diaphragms with spermicides 
• You are using irritating personal hygiene products

Men who have an enlarged prostate may be at a higher risk for cystitis due to increased retention of urine in the bladder. 

Risk factors of cystitis in women and men: 

• Use of a catheter
• HIV
• Kidney stones 
• Recent or current UTI 
• Diabetes 
• Radiation therapy 
• Chemotherapy 
• Interference in the flow of urine 
• Spinal injuries

Diagnosis

Talk to your doctor as soon as possible if you have symptoms of cystitis. Your doctor can diagnose cystitis based on your medical history and symptoms. 

If your doctor needs more information to form a diagnosis or to establish a treatment plan, the following may be recommended: 

• Imaging. Diagnostic imaging is usually not used for cystitis; however, in some cases, imaging may be required to help your doctor find other causes of bladder inflammation, such as an anatomy problem or a tumour. 

• Urine analysis. A small sample of urine is collected in a container. The urine sample is analyzed for signs of infection, such as pus, bacteria, or blood. If bacteria are found in the sample, a urine culture may be required to check what type of bacteria is causing the infection. 

Treatment 

Treatment plans will be dependent on the type of cystitis and its cause. The treatment options include: 

• Antibiotics. Nitrofurantoin (Macrobid) is the first-line antibiotic used to treat mild cases of cystitis in women. It is prescribed as a short course over three days to be taken twice daily. The antibiotic Trimethoprim is also used to treat cystitis. Antibiotics will usually improve symptoms within 24 hours and clear cystitis within 72 hours. Contact your doctor if your symptoms worsen or do not clear after a three-day course. 
• Urine alkalizing sachets. These sachets work to reduce the stinging sensation experienced when urinating by making the urine less acidic. Examples of cystitis sachets include Cystopurin and Cymalon.  

• Over-the-counter painkillers. Painkillers such as ibuprofen and paracetamol are recommended to help reduce discomfort and symptoms caused by the inflammation of the bladder. 

Lifestyle and home remedies 

To help ease symptoms at home:

• Applying heating paid can be used to help soothe bladder pain or pressure. 
• Drinking lots of fluids, including cranberry juice
• Avoid alcohol 
• Avoid food or beverages that make your symptoms worse