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cystitis-treatment

Cystitis Treatment

Cystitis is an inflammation of the urinary tract, caused by an infection. It is most common in women. According to statistics, almost all women will experience cystitis at least once in life. There is also a recurring cystitis - it means the infection can happen more than once. This problem is more common in women because they have shorter urethra and that's how bacteria reaches the bladder easily. 

Medication

Urinary Tract Infections: Cystitis Treatment

A urinary tract infection can affect kidneys, bladder, urethra and ureters. Urinary Tract Infections can be divided into 2 categories, lower tract infections which affect bladder and urethra and upper tract infections which affect kidneys and ureters. Lower tract infections are more common and can either affect the bladder and/or urethra.

What is Cystitis?

Cystitis is the most common type of lower tract infection and it is the inflammation of the bladder. Urinary tract infections can be divided into 2 categories, lower tract infections which affect bladder (cystitis) and urethra and upper tract infections which affect kidneys (nefritis) and ureters (uretritis). It affects more commonly women and according to recent studies by the National Institute of Diabetes and Digestive and Kidney Diseases, 8.1 million women seek professional care to treat urinary tract infections. 

How common is it?

1 in 5 adult women will experience cystitis at some point in their lives, because of women’s anatomy; shorter urethra and its closeness to the anus, women have 8 times the risk to get cystitis than men.

What are the main causes of Cystitis?

Its main causes are bacteria, fungi and viruses but as well can be caused by sexual activity, commonly known as Honeymoon cystitis. The most common bacteria that causes cystitis is E. coli, a type of bacteria found in your gastrointestinal tract. E. coli is responsible for up to 70-95% of all urinary tract infections. The short distance between the urethra and the anus may allow bacteria to be transferred to the bladder. It has been observed that the rates of infection tend to increase with age and affects more postmenopausal women, mostly due to changes in estrogen levels and vaginal flora.

What are the risk factors?

Certain risk factors include:

  • female anatomy
  • sexual activity (Honeymoon cystitis)
  • menopause
  • using diaphragms for birth control
  • poorly controlled diabetes
  • kidney stones
  • previous urinary tract infections
  • aging
  • pregnancy
  • weak immune system.

What are the Symptoms in adults?

Symptoms may include:

  • pelvic pain
  • burning sensation when peeing
  • bloody urine
  • cloudy urine
  • increased urgency to urinate and increased frequency
  • Urine might change color to a color similar to tea or cola in extreme cases
  • strong odor.

Children usually present a high fever 38°C, and irritability. It may accompany vomits and diarrhea. If you suspect your child is suffering from an infection, it is best to visit your doctor immediately.

Urinary tract infections may imitate or even cause a vaginal infection. It can affect 25-35% of women in reproductive ages. If you have vaginal discharge as well as the other symptoms, be sure to consult with your doctor so that a better treatment can be provided.

What are the complications of untreated cystitis?

Complications are rare, but if a urinary tract infection is left untreated it can cause various consequences:

  • Permanent kidney damage: due to upper tract urinary infections
  • recurrent infections: known as 2 or more urinary tract infections within a six month period or the presence of 4 urinary tract infections in a year
  • premature and low birth weight infant risk in pregnant women
  • urethral structural damage in men
  • Sepsis: Upper tract UTI’s affect kidneys and can be life threatening if it is not treated since the infection can travel to your bloodstream and cause sepsis. Symptoms include high fever, nausea, vomiting, chills, shivers, and pain in the upper back and the sides
  • Pyelonephritis: A type of upper urinary tract infection caused by bacteria that goes up to your kidneys or ureter by lower UTI’s. It can cause scarring in your kidneys and usually needs intravenous treatment.

When should you visit a doctor?

If you are presenting a temperature higher than 38°C (hyperthermia) or lower than 34°C (hypothermia), lumbar back pain, shivers, vomit, diarrhea, fatigue, blood in urine, or suspect you are pregnant, have had recurrent UTI’s or suffer from chronic diseases such as renal or hepatic failure, and or diabetes or use a catheter.

How should you prepare for a doctor’s appointment?

Before going to a doctor’s appointment ask what type of exams will be needed, such as urine test, complete blood count, and urine/blood cultures. Be sure to take note of all the symptoms you present even if you don’t think they are related to a urinary tract infection. Make a list of all the medicines including vitamins and other supplements you take and do not hesitate to make your doctor questions about any doubt you have or if you need a referral to a specialist.

What are some common questions your doctor might ask?

In order for your doctor to make an accurate diagnosis, he/she will ask when did the symptoms first start. If you have been treated before for a UTI, if you have had fever or lower back pain, if the pain goes away after urinating or if you have a burning sensation when urinating. Sexual activity will be asked and type of contraceptives you and your partner use. Presence of vaginal discharge or presence of blood in urine. If you suffer from other medical conditions such as chronic diseases and if you are pregnant, breast feeding or planning on having a baby.

What type of exams will a doctor ask to confirm the diagnosis?

Depending on the symptoms health professionals will ask for different exams.

  • First, a urine sample will be asked. To get a good urine sample, wash your hands and genitals before, and collect the sample at the middle of your stream. This will ensure that what you are collecting is what is inside and not external bacteria so treatment can be appropriate. Urine lab samples will look for white blood cells, red blood cells or presence of bacteria. 

A positive exam will present more than 100 organisms/ml of urine plus the presence of more than 7 white blood cells/ml (pyuria) in symptomatic patients or 100,000 organisms/ml of urine in asymptomatic patients.

  • Complete blood count: to check elevation in white blood cells
  • Blood and urine cultures are asked when an upper tract urinary tract infection is suspected. Urine and blood cultures tell the doctor which bacteria or other microorganism is causing your infection so that the most effective medication will be given to treat it.

If you suffer from recurrent urinary tract infections, it is normal to ask for an ultrasound, a cystoscopy a CT scan and an IVP (intravenous pyelogram) to identify the underlying cause of recurrent episodes.

Prevention

There are certain things you can do to avoid getting an urinary tract infection.

Drink water

Not only does it prevent you from getting one, it helps you while you are suffering from an urinary tract infection. It helps your urine become more diluted so that the frequency of urination increases avoiding bacteria to accumulate in your bladder.

Well balanced diet

Certain foods like yogurt that contain probiotics called lactobacillus, help you maintain good bacteria avoiding an infection. Inconclusive studies also suggest that drinking cranberry juice allows your urine pH stay acidic (5.5 or less) which helps combat infections. A diet that includes fruits and proteins also protect your body against bacterial growth so be sure to eat a well balanced diet.

Life style changes

  • Don’t hold urine for too long and always try to pee before and after sexual intercourse. This will help you flush away bacteria that might have traveled through intercourse.
  • Try not to use non-lubricated latex condoms because they increase friction and may irritate your skin, so try to include water-based lubricants during intercourse.
  • Always wipe yourself from front to back. This will prevent bacteria located in your anal region to travel to your vagina and urethra.
  • Avoid using irritating or perfumed feminine products such as douches, powders and deodorant sprays.

Cystitis in Pregnant Women

The presence of cystitis is more common in pregnant women due to changes that happen during pregnancy that provoke urine to stay longer in your bladder, also referred as stasis. These infections are known to produce complications such as low birth weight, preterm birth and perinatal mortality in fetus and complications in mother such as renal failure, sepsis and high blood pressure. In common lower urinary tract infections, oral antibiotics are recommended. For upper urinary tract infections, hospital admission and use of intravenous antibiotics are recommended. If you are pregnant and present symptoms of a cystitis, be sure to consult a doctor before taking any medication. 

Cystitis in Men

It is less common to occur in men, although homosexual active men have a higher risk of developing an urinary tract infection. If you are presenting symptoms and suspect you have a urinary tract infection be sure to visit your doctor as soon as possible, since it may present itself with more serious complications such as prostatitis (inflammation of the prostate gland), or a urinary tract obstruction. 

Interstitial Cystitis

Commonly known as Painful bladder Syndrome, presents itself with usually the same symptoms as a lower UTI although some episodes may last days, weeks or even months. It is not responsive to antibiotics and an infection is not present in exams or cultures.

It’s cause is still being studied but several theories include:

  • Problems in the pelvic floor muscles
  • Damage to the bladder, muscles and nerves because of urine
  • Immunological diseases: your immune system attacks your own bladder provoking an inflammation
  • Allergic reactions
  • Associated with other chronic diseases such as irritable bowel syndrome, lupus or fibromyalgia.

It has no cure but there are certain therapies that will help your way of living. Lifestyle changes such as stress reduction, change in diet, and avoiding alcohol or smoking are suggested. Medications or even surgery are next in line if the problem doesn’t go away.

Treatment

Some cystitis cases tend to resolve spontaneously, but treating it with antibiotics will reduce the risk of suffering recurrent urinary tract infections or a progression to an upper urinary tract infection. Depending on the cause, bacteria, fungi or viruses, so will the treatment vary. Since most cystitis cases are caused by bacteria, antibiotics are usually recommended since they will help you lessen the duration of symptoms. 

What type of medicines are there in the market?

The to-go- to counter medicines mostly used are nitrofurantoin monohydrate/macrocrystals, fosfomycin and trimethoprim-sulfamethoxazole (TMP-SMX). Beta-lactam antibiotics are used when the other antibiotics are contraindicated in patients.

Sources:

  • https://www.zavamed.com/uk/cystitis-treatment.html
  • https://emedicine.medscape.com/article/233101-treatment?src=refgatesrc1#d1
  • https://www.healthline.com/health/urinary-tract-infection-adults#symptoms-in-women
  • https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/diagnosis-treatment/drc-20353453
  • https://www.nhs.uk/conditions/interstitial-cystitis/