Cystitis literally means inflammation of the bladder (cyst = bladder, itis = inflammation). People who have had cystitis understands exactly what the word means because the tell-tale symptoms are unmistakable – the sudden painful urge to urinate and rush to the bathroom. When there, only a few painful drops come out; then, when you think you’re finished urinating and you leave the bathroom, the urge returns making you rush back, only to urinate another few painful drops.
The classic symptoms of cystitis are pain, urinary frequency and urgency. Sometimes there is discoloration of the urine. Dysuria (painful urination) usually starts as a burning sensation at the opening of the urethra into the vagina and is worst just at the end of urination. As the infection worsens, the entire pelvis and lower abdomen begins to ache and burn, sometimes constantly. Once antibiotic treatment is begun, the symptoms usually begin to subside within a matter of hours, but sometimes it takes a day or more before you are starting to feel better.
Frequency and urgency of urination – at first you might realize that your are urinating more often (sometimes this is the only symptom). As the infection worsens, you develop urgency and feel the need to rush to the bathroom, but when you get there, only a few drops of urine come out – you get up and leave and a few minutes later, it starts all over again.
Discoloration of the urine – UTI is often accompanied by discoloration of your urine. Sometimes, it is darker than usual; sometimes, it is cloudy. The discoloration that can be most alarming is when there is blood in the urine. Bloody urine is called gross hematuria (heme = blood; uria = urine). Gross means an obvious, large quantity (of blood) , but it is also gross! Gross hematuria can be very frightening, especially the first time it occurs. You might think you’ll bleed to death; you might think it’s cancer. Actually, it takes only a tiny amount of blood to discolor the urine; just a teaspoon full of blood will color the toilet bowl bright red. In fact, the most common cause of gross hematuria, at all ages, is urinary tract infection. Nevertheless, especially in older people, hematuria can be a warning sign of cancer or kidney stones, and, therefore it should always be properly evaluated by a physician to be sure that the cause is infection and not something more serious.
Most of the time, cystitis is caused by a bacterial infection, otherwise known as bacterial cystitis. It is much more common in women and girls than in men and boys. It is so common in women, and so rarely associated with any serious underlying condition, that it is often considered more of a nuisance than a threat to a woman’s health. In men and boys, however, bacterial cystitis is rarely a spontaneous event and is usually caused by a more serious underlying condition. In boys the cause is usually a congenital abnormality; in men, it’s usually a prostate problem.
The most common bacteria that cause UTIs are coliform organisms. Coliform bacteria are bacteria that live harmlessly in the intestinal tract where they help to break down the solid waste products of body metabolism. These bacteria can leave the intestinal tract through the anus and get into the urethra, and when they ascend, they cause cystitis. The most common coli form bacteria which causes cystitis is Escherichia coli (E. Coli) which accounts for over 90% of first infections. Other, less common bacteria that cause cystitis are Klebsiella pneumonia, Proteus mirabilis, Proteus vulgaris and Pseudomonas aeruginosa. These organisms are almost never seen in first infections and are usually either acquired during hospitalizations for other problems or the result of chronic or recurrent UTIs. The Proteus species is of particular concern because it can cause bladder and kidney stones. For this reason, it is important to completely eradicate Proteus from the urinary tract whenever it is present. This means that, not only must you complete the full course of antibiotics prescribed by your doctor, but you’ll also need to check another urinalysis and culture after you complete treatment to be sure that the bacteria has been eliminated.
There are two goals in the treatment of cystitis – eradicating the bacteria and eliminating the symptoms. Of course if there are no bacteria, the only goal is eliminating the symptoms. Getting rid of the bacteria is accomplished by taking antibiotics. As we discussed above, in most instances, appropriate antibiotic therapy eradicates the bacteria and the symptoms in a matter of 6 – 24 hours. While you are waiting for the antibiotic to work, you can do a number of other things to lessen symptoms. Firstly, you can drink a lot of fluid. This helps to wash the bacteria out of the bladder and eliminate them from your body. Some people find cranberry juice or yogurt to be particularly helpful. Secondly, a hot bath or heating pad on the lower abdomen to may be soothing and offer relief. Finally, there is a specific pain relieving medication for the bladder called phenazopyridine hydrochloride (Pyridium) that can help to ease the discomfort.
If your symptoms have not subsided within a few days, it’s possible that you were either taking the wrong antibiotic or there was not a bacterial infection in the first place. By the time you realize that the symptoms have not gotten better, the results of the urine culture should be available and your doctor can check the results and start you on an appropriate antibiotic if you were not taking the right one.
If the culture was negative there are a number of possibilities. You might have an infection with an organism that did not grow on the culture plate for one reason or another. The most common reason is that you took an antibiotic before you gave the urine specimen. When you do this, the antibiotic gets into the urine and prevents the bacteria from growing on the culture plate. Even if the original culture was negative, it’s OK for your doctor to try another antibiotic and see if that helps. If a second antibiotic doesn’t help, though, it’s time for a thorough evaluation to determine the cause of your symptoms. This evaluation should include a voiding diary, urodynamics, voiding cystourethrography or ultrasound of the bladder and urethra and cystoscopy.
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