Discomfort on passing urine, often the result of infection.
Causes of Cystitis
This very common condition is often caused by infection around the outlet from the bladder or within the bladder itself. Women suffer far more than men, because it is a shorter journey for germs to spread from the anus across the perineum (the area between the legs) up the short urethra and into the bladder. In women, this journey is only 3-4 cm/ 1¼-1¾ in. while in men it is 15-20 cm/6-8 in.
Often, in women, infection may not be found despite repeated urine tests. Such cystitis is thought to be a chronic inflammation of the bladder neck, making it irritable and giving rise to a burning sensation and a need to pass urine frequently. This inflammation could be caused by a mild infection not detectable on samples. It could be provoked by vaginal douches or wipes, or even bubble baths. Cystitis often follows sexual intercourse through sheer mechanical irritation. If a man has cystitis it points to a urethritis (see Urethritis and NSU).
People who suffer recurrent infections may have an abnormality either within the bladder, such as a bladder stone or a tumour, or further up the system in the ureters. Some people find that certain fruits or acidic foods provoke cystitis.
Symptoms of Cystitis
In women there is an urgent need to pass urine and the urine feels hot and stings. Within minutes the urgent desire returns; this cycle goes on for hours, passing just small amounts each time. There is often a trace of blood in the urine, which may smell fishy and look cloudy because of infection.
Men have similar symptoms, often with an additional aching in the perineum. If a man has a discharge with cystitis, NSU is a possibility, both men and women may have a dull ache in the lower abdomen over the bladder.
Testing urine reveals protein from pus in the urine, and blood from the inflammation of the bladder and urethra. An NSU is a test to grow the causative organism, which is frequently a bowel organism called E. coli.
Treatment of Cystitis
The body deals with minor episodes of cystitis naturally over a few days. It is helpful to drink extra fluids to keep washing out the bladder. The MSU result will dictate the appropriate antibiotic to be used. Commonly used drugs are trimethoprim and cephalexin. Any blood in the urine has to be treated seriously.
People with recurrent infections will need a cystoscopy, a procedure to look inside the bladder with a light source, or X-rays to outline the ureters.
Post-menopausal women are particularly prone to cystitis, and are helped by hormone replacement therapy (HRT). It is sensible to avoid vaginal deodorants and douches, which remove natural lubricants, to pass urine before and after intercourse and to wash carefully after opening the bowels.
Commonly Asked Questions
How do over-the-counter remedies help?
These contain salts that make the urine more alkaline. This relieves the stinging and also hampers the growth of the infection responsible. A teaspoon of ordinary sodium bicarbonate dissolved in water may be just as effective.
What if no infection is found?
Even so a regular low daily dose of an antibiotic can help. The doctor will consider irritability in the bladder, which requires cystoscopy to prove. Treatment is often a matter of trial of agents including drugs used for urinary incontinence such as oxybutynin.
Chinese and Western herbalism – many antiseptic herbs act on the urinary system to reduce irritation and increase urine output. Nutritional therapy – drink plenty of water. Cranberry juice and extracts prevent bacteria from adhering to the bladder walls. Aromatherapy -tea tree oil improves even chronic cystitis, take sitz baths daily (six drops). Shiatsu-do boosts immunity. Healing rebalances internal ecology. Other treatments to try: acupuncture; homoeopathy; Ayurveda.