Cystitis (UTI, Bladder Infection)
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.
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).
The infection can occur in any part of the path the urine takes as it exits the body. 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.
Cystitis accounts for about 6 million medical visits per year or more. Although they occur in men and children, 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. 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).
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.
Why do some women seem to develop UTIs 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 of recurrent infections in women is an ill-fitting diaphragm. If it's too big, it can push against the neck of the bladder and interfere with the normal body flow of urine and contribute to incomplete bladder emptying. This can serve as a breeding ground for bacteria.
In men, an enlarged prostate can increase the risk for UTIs. Poor hygiene is linked to UTIs in children, and 50 percent of infants and 30 percent of older children with UTIs will have an anatomic abnormality. Individuals who are catheterized are also at risk for UTis.
Although there is no scientific evidence linking diet to UTIs, some people have found that alcohol, tomatoes, spices, chocolate, caffeinated and citrus beverages, and high-acid foods might contribute to bladder irritation and inflammation.
The classic symptoms of cystitis include a frequent, urgent need to urinate and a painful burning sensation (called dysuria) upon urination.
Lower back pain, lower abdominal pain, pelvic pressure, and urine that is cloudy or blood-tinged are other telltale symptoms. Sometimes there is a mild fever (101° or less) and chills.
Upper urinary tract infections may or may not include the same symptoms as cystitis, and are sometimes accompanied by a higher fever, nausea, vomiting and more severe chills. In infants, vomiting, diarrhea, fever and poor appetite can indicate a UTI. Elderly people may have a change in mental state accompanied by fever, poor appetite and lethargy.
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.
Most organisms that cause cystitis are susceptible to commonly used antibiotics. Susceptibility of organisms varies by geographic region and is also based upon having a history of taking antibiotics in the pastBecause antibiotic sensitivities change so frequently, it is important to consult with a physician to determine the best one for any particular infection. Also, experts differ about how long individuals with cystitis need to take antibiotics.
In otherwise healthy women with uncomplicated infections, a single-dose or 3-day course of antibiotics is sufficient and associated with far fewer side effects and lower costs than longer courses of treatment. Men may require 7 to 10 days of antibiotics because of involvement with the prostate. Children with uncomplicated cystitis usually receive a 10-day course of antibiotics.
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.
Three-day regimens of trimethoprim-sulfamethoxazole, norfloxacin (Noroxin) and other fluoroquinolones also work 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.
Phenazopyridine (Pyridium) can be prescribed for 1-2 days if urination is very painful.