Cystitis Definition Cystitis is an inflammation of the bladder due to infection with a microorganism (such as a bacteria or virus). Cystitis is second only to respiratory infections in frequency.   Description The National Kidney Foundation estimates that 10 to 20 percent of women have had at least one episode of cystitis, and 80 percent of this group has had it recurrently. Although some cases of cystitis are due to fungus or a virus, most are caused by one of several types of bacteria. The most common, Escherichia coli, accounts for about 90 percent of all urinary tract infections (UTI's). If left unchecked, cystitis can spread upward to the kidneys (called ascending UTI), where it can be associated with fever and chills, and can be even more serious. Although they occur in men, UTI's are often viewed as a woman's problem. UTI's are more common in women because their urethras (the passage from which urine exits the bladder) are short, making it easier for organisms to get from outside into the bladder. Escherichia coli normally live in the intestine and bowel without causing disruption, but once they make their way to the bladder, trouble begins. Bacteria tend to live better in warm, moist places, so the area around the urethra is a common breeding site. Most typically, a woman develops a UTI if she has been sexually active (hence the moniker "honeymoon cystitis"), or has been careless with her hygiene habits (for example, wiping from back to front after a bowel movement). (Return to Top) Causes and Risk Factors Why do some women seem to develop UTI's more easily than others? Some experts say genetics may be the key, since research has shown that women with certain blood antigens (called the Lewis groups) are more susceptible to cystitis. The cells that line their urinary tracts seem to have far more receptors to which bacteria can adhere. Others may lack glycosaminoglycan, a substance found on the surface of the bladder that is inhospitable to bacteria. Another possible cause for recurrent infections is an ill-fitting diaphragm. If it's too big, it can push against the neck of the bladder (interfering with normal body function) and can result in a backup of urine. This can serve as a breeding ground for bacteria. (Return to Top) Symptoms The classic symptoms include a frequent, urgent need to urinate and a painful burning sensation (called dysuria) upon urination. Lower back pain, pelvic pressure, and urine that is cloudy or blood-tinged are other telltale symptoms. (Return to Top) Diagnosis Usually, the symptoms of frequent urination associated with burning or pressure sensation is enough to conclude that cystitis is present. Other problems can mimic cystitis, such as vaginal infections with yeast (or other organisms) or some sexually transmitted diseases. Because of this, anything other than the simplest cases of cystitis warrant evaluation by a health professional. Examination of the urine, urine cultures that grow out the responsible microorganisms, and clinical assessment of other possible causes are all valuable in determining the problem. (Return to Top) Treatment Most organisms that cause cystitis are susceptible to commonly used antibiotics. Susceptibility of organisms varies by geographic region and is based upon having a history of taking antibiotics in the past. Variation also exists, in terms of how long individuals with cystitis need to take antibiotics. In otherwise healthy women with uncomplicated infections, single-dose antibiotic therapy is sufficient and is associated with far fewer side effects and lower costs than longer courses of treatment. Some individuals are not good candidates for single-dose therapy. Patients should not be given single-dose therapy if they are pregnant, diabetic or elderly. Unsuspected upper urinary tract infection may be present in a significant number of these patients, and a 10- to 14-day course of antibiotics should be given. Ampicillin (Amcill, Omnipen, Polycillin, etc.) amoxicillin (Amoxil, Polymox, Trimox, etc.) and trimethoprim-sulfamethoxazole (Bactrim) have been the most extensively evaluated drugs for single-dose regimens. Many clinicians treat uncomplicated cystitis with a three-day course of antibiotics. Three-day regimens of trimethoprim-sulfamethoxazole or norfloxacin (Noroxin) have given excellent results and the incidence of side effects is as low as with single-dose treatment. Data on this duration of treatment is not sufficient to permit definite recommendations, but three-day regimens appear promising. As with single-dose therapy, candidates for three-day therapy must be carefully chosen to exclude those with a high probability of an upper tract infection. (Return to Top) Prevention To help prevent cystitis, a woman should: Keep the vaginal area clean, including wiping from the front to back after a bowel movement to prevent contamination of the urinary tract. Use tampons and change every three to four hours, instead of sanitary pads. (The pads can act as a culture medium for fecal bacteria, which may then be rubbed against the urinary outlet and invade the bladder.) Wear cotton undergarments, which allow air circulation and discourage the warm, moist environment needed for bacteria growth. Nylon pantyhose should have a cotton crotch. Avoid wearing tight clothes in the genital area, such as control-top pantyhose and skin-tight jeans, as well as extended wearing of a wet bathing suit. Urinate before and after intercourse and make sure that the partner's hands and penis are clean. Drink plenty of fluids and urinate "when you see a bathroom" rather than when the urge to urinate becomes strong. (Return to Top) Questions to Ask Your Doctor What tests need to be done to diagnose the condition and cause? What type of treatment do you recommend? What medication will you be prescribing? What are the side effects? What measures can be taken to help relieve discomfort? What are the chances of the infection traveling upward to the kidneys? Do some juices help more than just water? (Return to Top)